{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.4", "status": "draft", "conceptual": true, "not_for_clinical_use": true, "max_autonomy": 2, "missions": [ "leo", "commercial", "moon", "mars" ], "updated": "2026-10-21", "review": { "state": "reviewed-ai-assisted", "requested": "2026-10-21", "reviewed": "2026-10-21", "human_clinician_review": false, "text": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 8 review, 17 required corrections and 16 optional suggestions); all required corrections are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use." }, "fixed_rules": { "flight_surgeon_is_medical_authority": true, "cmo_acts_under_delegated_care": true, "human_starts_and_restarts_robot": true, "robot_never_diagnoses": true, "no_drug_or_fluid_advice_by_robot": true, "safe_state_on_fault_or_no_response": true, "lost_link_pause_then_cmo_decides": true }, "robot_lockouts": { "diagnosis": true, "drug_or_fluid_advice": true, "starting_stopping_or_adjusting_oxygen_or_any_medicine": true, "self_start_or_self_restart": true, "changing_own_protocol_thresholds_or_limits": true, "handing_over_a_mismatched_item_as_verified": true }, "id": "RMP-EGR-002", "slug": "rmp-egr-002", "title": "Landing-day medical kit and stretcher support: kit fetch, clear routes and an empty stretcher in place (people move the crewmember)", "category": "egress", "tier": 2, "rung_note": "Max rung 2 for supervised fetching of the landing medical kit, clearing routes, and placing an empty stretcher with its brakes or restraints set as the checklist states. The robot never lifts, carries or transfers a crewmember and never moves an occupied stretcher.", "result_language": { "use": [ "as stated", "time as stated", "stretcher in place, brakes set as stated", "sent to flight surgeon" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "fit to walk", "can walk", "expected after landing", "normal for landing", "stable", "ready to move", "safe", "mild", "minor" ] }, "scope": { "summary": "On landing day, on the landing medical lead's command, the robot brings the landing medical kit, clears the route from the hatch to the medical area, places an empty stretcher where the lead names, and logs times as stated. The crew help each crewmember out and decide who walks, sits or lies down. At an Earth landing the robot is support-only: it does not clear routes or place a stretcher; it only fetches kit and hands over records (RMP-EGR-001) when the landing medical lead asks.", "why": "After weightlessness, crew often need help to move because of muscle weakness and balance problems, and orthostatic intolerance, nausea, deconditioning and balance impairment are expected re-adaptation issues; NASA places flight surgeons at the landing site with a landing medical kit (OCHMO-TB-051). Gravity transitions impair posture and walking, which affects egress (OCHMO-TB-010), and after long flights light-headedness on standing is common (Lee 2015). NASA-STD-3001 requires landing-site medical capability (V1 3012), mobility aids for assisted egress (V2 8040) and expedited egress after landing (V2 12045). After landing on the Moon or Mars after weeks or months of weightlessness, where there is no recovery team, the CMO leads under the onboard checklist and the flight surgeon advises over the link. At an Earth landing, NASA flight surgeons and the recovery team lead with their own kit (OCHMO-TB-051); there the robot is support-only: it fetches kit and hands over records when the landing medical lead asks, never leads or directs care, and never touches or moves anyone (design judgment). This protocol never moves an occupied stretcher. Any future patient-moving protocol needs certified equipment, an attendant at the patient's side, rung 1 control and validated terrain limits (design judgment). Which stretcher or mobility aid each lander and surface habitat carries is set by the program.", "covers": [ "The landing medical kit, route clearing and an empty stretcher on landing day", "Times as stated", "Light-headedness on standing: RMP-CARD-004; vital-sign and balance checks: RMP-EGR-003; evacuation package: RMP-EGR-001" ], "locked_out": [ "Diagnosis or naming a cause", "Any medicine, fluid or oxygen advice; starting, stopping or adjusting oxygen", "Touching the crewmember", "Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override)", "Lifting, carrying or transferring a crewmember, or moving an occupied stretcher", "Pausing in the hatch route or a crewmember's route during egress", "Saying a crewmember can walk or stand", "At an Earth landing: leading or directing any care, or any task other than fetching kit and handing over records when the landing medical lead asks" ], "related": [ "RMP-EGR-001", "RMP-EGR-003", "RMP-CARD-004", "RMP-MSK-001", "RMP-GI-002", "RMP-CARD-001", "RMP-PHARM-001" ] }, "roles": { "medical_authority": "Flight surgeon (ground). Holds medical authority for every run.", "onboard_lead": "Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.", "others": [ "Landing medical lead: the CMO on the Moon or Mars, advised by the flight surgeon over the link; at an Earth landing, the NASA flight surgeon with the recovery team", "Other crew: help each crewmember out and move them", "Second trained CMO: receives every alert and takes over if the CMO is the patient" ], "robot_may": [ "Bring the landing medical kit by a checked kit fetch (or an emergency fetch)", "Clear routes from the hatch to the medical area (Moon or Mars only)", "Place an empty stretcher and set its brakes or restraints as the checklist states (Moon or Mars only)", "Log times as stated", "At an Earth landing: fetch kit and hand over records (RMP-EGR-001) when the landing medical lead asks" ], "robot_may_not": [ "Lift, carry or transfer anyone", "Move an occupied stretcher", "Pause in the hatch route", "Say who can walk", "Start without a human command" ], "commercial": "On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.)" }, "preconditions": [ { "id": "PRE-1", "text": "The landing medical lead or the commander started the protocol by command after landing.", "check": "human_start == true", "refs": [ "V2 10174" ] }, { "id": "PRE-2", "text": "Robot self-test passed; kit stowage locations known.", "refs": [ "V2 10161", "V2 7059" ] }, { "id": "PRE-3", "text": "Robot and supplies restrained when not moving.", "refs": [ "V2 7046" ] }, { "id": "PRE-4", "text": "Link status known. The crew never wait for the robot before acting.", "check": "link_state in [live, delayed, down]" } ], "consent": { "standard": "Times and statements are recorded as part of the crew medical record.", "emergency": "In an emergency egress the commander's procedure leads; the robot clears routes only on command or holds clear.", "withdrawal": "A crewmember can decline the stretcher; the robot logs \"declined\" and stays clear." }, "inputs": [ { "id": "IN-1", "name": "Landing medical lead's command and the medical area, as stated", "source": "Landing medical lead / commander", "required": true, "if_missing": "The robot does not start." }, { "id": "IN-2", "name": "Hatch open time and each crewmember out, as stated", "source": "Commander / crew", "required": false, "if_missing": "Log \"not stated\"." }, { "id": "IN-3", "name": "How each crewmember feels, in their words", "source": "Crewmember", "required": false, "if_missing": "Log \"no response\"; D3 applies." }, { "id": "IN-4", "name": "Who used the stretcher, as stated", "source": "Landing medical lead", "required": false, "if_missing": "Log \"not stated\"." }, { "id": "IN-5", "name": "Link status and delay", "source": "Communications system", "required": true, "if_missing": "Treat as link down; the CMO leads under the onboard checklist." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "Log the start and the landing type the person who started the protocol states (Earth landing, or Moon or Mars). At a Moon or Mars landing: tell the flight surgeon and the CMO that landing-day support has started (URGENT if any red flag is stated). Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember. At an Earth landing the robot only tells the landing medical lead that it is in the support-only role.", "success": "Notice acknowledged.", "refs": [ "V1 3006", "V2 10174" ] }, { "id": "S2", "actor": "robot", "rung": 2, "action": "On the CMO's command (at an Earth landing, on the landing medical lead's request), run a checked kit fetch of the landing medical kit (blood pressure cuff, pulse oximeter, emesis bags, towels, water and thermometer, as the kit list states): check the kit ID and seal before hand-over, and quarantine a kit whose ID or seal does not match (no hand-over; the CMO is told). Any medicine goes only through RMP-PHARM-001. If an URGENT red flag has fired or a human states an emergency, bring it instead as an emergency fetch: This is an emergency fetch on a human command (CMO): no barcode check runs before hand-over and nothing waits for one. The robot reads the kit's own label and seal status only if that adds no delay, says \"EMERGENCY FETCH – NOT VERIFIED (CMO command)\", and \"seal not intact\" if so, and hands the kit over anyway. The fetch is logged as an override: time, who asked, the reason as stated, kit ID and seal status. It never says \"verified\". The robot brings it to the point the landing medical lead names.", "success": "Kit at the named point after a matched ID and seal, or quarantined, or emergency fetch logged.", "limit": "", "refs": [ "V2 7046", "V2 7059", "V1 3012" ] }, { "id": "S3", "actor": "robot", "rung": 2, "action": "Moon or Mars only: before the hatch opens, or on the landing medical lead's command, clear the route from the hatch to the medical area of loose items, then hold at a position outside every route. Once egress has started it only holds clear; it never pauses in the hatch route.", "success": "Route clear; robot out of the routes.", "refs": [ "V2 12045", "V2 7055" ] }, { "id": "S4", "actor": "robot", "rung": 2, "action": "Moon or Mars only: bring the empty stretcher (and the restraint straps the checklist lists) to the point the landing medical lead names, set its brakes or restraints as the checklist states, show \"stretcher in place, brakes set as stated\", and move back beyond the keep-out distance before anyone is moved. It never moves an occupied stretcher.", "success": "Empty stretcher in place; robot beyond the keep-out distance.", "limit": "", "refs": [ "V2 8040" ] }, { "id": "S5", "actor": "crew", "action": "The crew help each crewmember out, decide who walks, sits or lies on the stretcher, and move them; the flight surgeon or CMO does the first medical checks.", "success": "Crew out, as stated.", "refs": [ "V1 3017", "V2 12045" ] }, { "id": "S6", "actor": "robot", "rung": 2, "action": "Moon or Mars only: log the hatch open time, each crewmember out and any stretcher use, as stated. Ask each crewmember, on screen or by voice when the lead allows, how they feel, and log the answers word for word. Vital-sign and balance checks run under RMP-EGR-003.", "success": "Times and answers logged.", "refs": [ "V1 6003" ] }, { "id": "S7", "actor": "robot", "rung": 2, "action": "After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.", "success": "Robot at rest in the module until a human releases it; alert acknowledged or escalated.", "refs": [ "V2 10173", "V1 3006" ] }, { "id": "S8", "actor": "ground", "action": "The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on care and transport.", "success": "Decision logged.", "refs": [ "V1 3012", "V1 3017" ] }, { "id": "S9", "actor": "robot", "rung": 2, "action": "Moon or Mars only: only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.", "success": "RMP-PHARM-001 run logged with its result, or none ordered.", "refs": [ "V2 7059" ] }, { "id": "S10", "actor": "robot", "rung": 2, "action": "When the CMO says the event is over, run RMP-PHARM-001 reconciliation on each kit fetched: record the items the CMO or crew state were used, the remaining contents against the kit list, seal status and expiry, labelled \"inventory reconciliation after emergency use – not a check before use\". Flag the override to the flight surgeon and the pharmacy lead, and show each kit as \"opened – not restocked\" until a human restocks and reseals it.", "success": "Kit reconciled or shown as \"opened – not restocked\".", "refs": [ "V2 7059" ] }, { "id": "S11", "actor": "robot", "rung": 2, "action": "Send the flight surgeon one package: times, stretcher use, answers, alerts and decisions. At an Earth landing: hand over the records under RMP-EGR-001 when the landing medical lead asks.", "success": "Package delivered or queued.", "refs": [ "V1 6003", "V1 7003" ] } ], "decisions": [ { "id": "D1", "after": "S2", "decided_by": "robot", "question": "Which kit fetch was it, and what did the checked kit fetch show?", "branches": [ { "if": "EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency)", "then": "Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use)." }, { "if": "KIT ID AND SEAL MATCH", "then": "Hand the kit over closed; log \"KIT ID AND SEAL MATCH. Not a check of the contents.\" and the clock time." }, { "if": "MISMATCH, seal not intact or CANNOT VERIFY", "then": "Shown with the reason. No hand-over under this protocol: the kit stays sealed in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the kit go to the CMO, logged there as an override with the reason, and flagged to the flight surgeon. If the need becomes an emergency, a crewmember or the CMO states it and the emergency fetch applies.", "handoff": "none" } ] }, { "id": "D2", "after": "S6", "decided_by": "robot", "question": "Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?", "branches": [ { "if": "Yes", "then": "Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember." }, { "if": "No", "then": "Continue." } ] }, { "id": "D3", "after": "S6", "decided_by": "robot", "question": "Did each crewmember answer when asked how they feel?", "branches": [ { "if": "Yes", "then": "Continue." }, { "if": "Declined explicitly (the crewmember says no to a question)", "then": "Log \"declined\" for that question only; the alert already sent stands." }, { "if": "No response, or the answer does not make sense", "then": "URGENT: log \"no response\" (never \"declined\"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once." } ] }, { "id": "D4", "after": "S4", "decided_by": "crew", "question": "Is anyone in or near the stretcher's position or the robot's path?", "branches": [ { "if": "Yes, or not known", "then": "Robot holds where it is, out of the routes, until the landing medical lead says the path is clear." }, { "if": "No (stated by the lead)", "then": "Continue." } ] }, { "id": "D5", "after": "S8", "decided_by": "ground", "question": "What care and transport are needed?", "branches": [ { "if": "Link live", "then": "Flight surgeon decides; robot logs." }, { "if": "Link down or delay too long", "then": "The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact." } ] }, { "id": "D6", "after": "S9", "decided_by": "robot", "question": "What did RMP-PHARM-001 show for the ordered item?", "branches": [ { "if": "MATCH TO ORDER", "then": "RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs \"MATCH TO ORDER. Not a dose, interaction or allergy review.\" and the clock time." }, { "if": "MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check", "then": "MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.", "handoff": "none" } ] }, { "after": "S1", "decided_by": "crew", "question": "Is this an Earth landing, as the person who started the protocol states (the robot never decides it)?", "branches": [ { "if": "Yes (Earth landing)", "then": "Support-only: only the kit-fetch step (checked kit fetch, or the emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request; every step marked \"Moon or Mars only\" is skipped, and the robot holds outside every route until asked." }, { "if": "No (Moon or Mars landing)", "then": "Continue with every step." } ], "id": "D7" } ], "stop_rules": [ { "id": "X1", "trigger": "The patient (or the crewmember being examined) says stop, or withdraws consent", "action": "Robot stops all motion at once, backs away to its rest position and tells the CMO. Recording stops unless the patient agrees to keep it running.", "level": "stop", "refs": [ "V2 10165" ] }, { "id": "X2", "trigger": "Any crewmember presses stop or takes over control", "action": "Protective stop; robot holds its stopped position; only a human may restart it.", "level": "safe-state", "refs": [ "V2 10165", "V2 10168", "V2 10174" ] }, { "id": "X3", "trigger": "Robot fault, sensor fault, or a force, speed or reach limit is reached", "action": "Protective stop and hand control to the CMO; log the fault.", "level": "safe-state", "refs": [ "V2 10172", "V2 10168" ] }, { "id": "X4", "trigger": "CMO is asked to take over and does not respond (for example, the CMO is the patient)", "action": "Robot stays stopped; the next named crewmember is called.", "level": "safe-state", "refs": [ "V2 10173", "V2 7045" ] }, { "id": "X5", "trigger": "Loss of link, or delay longer than the limit for live guidance", "action": "Only the robot pauses: before it holds, it moves to a position clear of a hatch route or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew egress, help moving, CPR and the CMO's care continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether the robot continues offline under the pre-approved onboard checklist; it resumes only on the CMO's confirmation.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "An URGENT alert is not acknowledged within the set time", "action": "Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own.", "level": "urgent", "refs": [ "V1 3006", "V2 10173" ] }, { "id": "X7", "trigger": "The crewmember stops responding, or seems confused or drowsy, at any point", "action": "URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person.", "level": "urgent" }, { "id": "X8", "trigger": "A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice", "action": "Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.", "level": "stop" }, { "id": "X9", "trigger": "A crewmember enters the robot's or the stretcher's path", "action": "Robot stops at once and holds; it moves only when the landing medical lead says the path is clear.", "level": "safe-state", "refs": [ "V2 10172" ] }, { "id": "X10", "trigger": "The robot is in the hatch route when someone needs it", "action": "Robot moves clear at once without contact, by the shortest path out of the route, and holds.", "level": "safe-state", "refs": [ "V2 12045", "V2 10172" ] } ], "red_flags": [ { "id": "RF1", "sign": "Unresponsive, or not breathing normally", "threshold": "any", "action": "URGENT alert; start RMP-CARD-001 now", "source": "aha2025bls" }, { "id": "RF2", "sign": "Fainting, or light-headedness on standing", "threshold": "any", "action": "URGENT alert; the crew lay the crewmember down; see RMP-CARD-004", "source": "tb019" }, { "id": "RF3", "sign": "Injury from the landing or egress (design judgment)", "threshold": "any", "action": "URGENT alert; see RMP-MSK-001" }, { "id": "RF4", "sign": "Vomiting (in a helmet or suit: design judgment)", "threshold": "any", "action": "URGENT alert; see RMP-GI-002", "source": "mtb004" }, { "id": "RF5", "sign": "Displayed oxygen saturation (pulse oximeter) below the shared alert value", "threshold": "below percent (shared parameter SPO2_ALERT_PCT)", "action": "URGENT alert; see RMP-RESP-001; the crew act without waiting for a reading", "source": "btso2" }, { "id": "RF6", "sign": "The oximeter cannot get a reading after the validated attempts (L5), and \"saturation not obtained\" is logged", "threshold": "any", "action": "URGENT alert; the CMO checks the crewmember now (possible poor circulation); the robot never says \"probe error\" and never treats a missing reading as reassuring", "source": "ng253" }, { "id": "RF7", "sign": "Chest pain or palpitations (design judgment)", "threshold": "any", "action": "URGENT alert; see RMP-CARD-002" }, { "id": "RF8", "sign": "Overheating, heavy sweating or confusion in the suit (design judgment)", "threshold": "any", "action": "URGENT alert; a crewmember checks in person" } ], "safety_limits": [ { "id": "L1", "name": "Contact with the crewmember", "value": "not allowed", "enforced": "Keep-out zone in the robot controller", "refs": [ "V2 10172" ] }, { "id": "L2", "name": "Lifting, carrying or transferring a crewmember, or moving an occupied stretcher", "value": "not allowed", "enforced": "No such task is loaded; the stretcher moves only when its load sensor reads empty, or, if it has no load sensor, only after the landing medical lead states \"empty\" and nobody is within the keep-out distance" }, { "id": "L3", "name": "Robot in the hatch route during egress", "value": "not allowed", "enforced": "Keep-out map of routes in the robot controller" }, { "id": "L4", "name": "Robot speed near the crewmember", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] }, { "id": "L5", "name": "Failed oximeter readings before \"saturation not obtained\"", "value": "", "enforced": "Software" } ], "logs": [ { "id": "LOG-1", "text": "Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.", "refs": [ "V2 10163", "V2 10164" ] }, { "id": "LOG-2", "text": "Mode changes and safety-limit events are announced to the operator as they happen and logged.", "refs": [ "V2 10162", "V2 10172" ] }, { "id": "LOG-3", "text": "Records are stored and sent as private medical data, encrypted, with access limited to the medical team.", "refs": [ "V1 6003", "V1 7003" ] }, { "id": "LOG-4", "text": "Results are kept in a permanent, retrievable format so the flight surgeon can see trends.", "refs": [ "V1 7001" ] }, { "id": "LOG-5", "text": "Hatch open time, each crewmember out, stretcher placement and use, answers as stated." }, { "id": "LOG-6", "text": "Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named crewmember), and the time a human released the robot.", "refs": [ "V2 10163" ] }, { "id": "LOG-7", "text": "Each emergency fetch as an override (time, who asked, reason as stated, kit ID, seal status) and the later inventory reconciliation, labelled \"not a check before use\".", "refs": [ "V2 7059" ] } ], "requirements": [ { "id": "V1 3006", "use": "Two trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO is the patient (see the commercial-flight note)." }, { "id": "V1 3012", "use": "Medical capability at the landing site; the robot brings the landing medical kit." }, { "id": "V1 3017", "use": "Post-mission reconditioning starts at egress; times and answers go to the flight surgeon." }, { "id": "V1 6003", "use": "Logs and alerts sent to the ground are private medical communications." }, { "id": "V1 7001", "use": "Records kept so the flight surgeon can see trends." }, { "id": "V1 7003", "use": "Secure handling of medical records." }, { "id": "V2 7045", "use": "Usable by non-physician crew, including when the CMO is the patient." }, { "id": "V2 7046", "use": "Patient, caregiver and supplies restrained." }, { "id": "V2 7055", "use": "Medical items stay accessible during egress." }, { "id": "V2 7059", "use": "Kit inventory and seal status are tracked; after an emergency fetch the robot reconciles the kit through RMP-PHARM-001 as an inventory record (never a check before use) and shows it as \"opened – not restocked\" until resealed." }, { "id": "V2 8040", "use": "Mobility aids for assisted egress; the robot places an empty stretcher only." }, { "id": "V2 10161", "use": "Robot shows its status and health." }, { "id": "V2 10162", "use": "Mode changes are announced to the operator." }, { "id": "V2 10163", "use": "Robot records and shares its data." }, { "id": "V2 10164", "use": "Shows whether the human or the robot is expected to act." }, { "id": "V2 10165", "use": "Human can override and shut down the robot." }, { "id": "V2 10168", "use": "Human can take over." }, { "id": "V2 10172", "use": "Protective stop when a limit is exceeded." }, { "id": "V2 10173", "use": "Robot stays stopped if no one takes over." }, { "id": "V2 10174", "use": "Only a human starts or restarts the robot." }, { "id": "V2 12045", "use": "Egress is expedited; routes are cleared first and the robot never pauses in them." } ], "validation": [ { "stage": "simulation", "what": "Scripted landing with a fainting crewmember, vomiting in a suit, a crowded hatch area, CMO as patient, lost link.", "pass": "Zero route pauses; zero occupied-stretcher moves; every red flag raised." }, { "stage": "training model", "what": "Landing-day drill with a mock hatch and stretcher.", "pass": "Kit, route and stretcher in place within the time the plan sets." }, { "stage": "parabolic or station demonstration", "what": "Not applicable (landing only); a surface analogue test instead.", "pass": "Keep-out held." }, { "stage": "flight use under flight surgeon supervision", "what": "First use at a surface landing.", "pass": "No safety events." } ], "signoff": { "protocol": [ "Clinical lead for the specialty (sets every clinical threshold marked )", "Flight surgeon, as medical authority", "Robotics and medical-device safety board", "Program approval for the mission" ], "restart_after_stop": "Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.", "each_run": "Started by the landing medical lead or the commander. People move every crewmember." }, "change_control": [ "Every change gets a new version number and a written reason; earlier versions are kept.", "Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.", "Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.", "If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.", "The robot never changes its own protocol, thresholds or limits." ], "comms": { "live": "Earth landing site: NASA flight surgeons and the recovery team are present and lead; the robot fetches kit and hands over records only. Moon: the flight surgeon advises over a link with a few seconds of delay; the CMO leads on the surface.", "loss_of_signal": [ "Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation.", "Crew egress, help moving, CPR and the CMO's care continue under the onboard checklist and never wait for the link or the robot.", "The CMO leads under the onboard checklist." ], "mars_delay": [ "Mars: no real-time guidance; the landing plan and kit list are set before flight." ] }, "sources": [ { "key": "tb051", "text": "NASA OCHMO. Crew Medical Support for Entry, Descent, and Landing. Technical Brief OCHMO-TB-051.", "url": "https://www.nasa.gov/wp-content/uploads/2026/05/ochmo-tb-051-crew-medical-support-entry-descent-landing.pdf", "supports": "Flight surgeons are present at the landing site with a landing medical kit (for example blood pressure cuff, pulse oximeter, emesis bags, thermometer and fluids); expected re-adaptation issues include orthostatic intolerance, nausea, deconditioning and neurovestibular impairment; \"Due to muscle weakness and balance issues, astronauts often need assistance\" with mobility. Read Oct 21, 2026." }, { "key": "tb010", "text": "NASA OCHMO. Sensorimotor Overview. Technical Brief OCHMO-TB-010 Rev A (2023).", "url": "https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-010-sensorimotor.pdf", "supports": "Gravity transitions (weightlessness to a planetary surface or Earth) cause decrements in postural control and locomotion, spatial disorientation and motion sickness during and after the transition; these affect egress and early surface activity." }, { "key": "tb019", "text": "NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B.", "url": "https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthostatic-intolerance.pdf", "supports": "Orthostatic intolerance is triggered by upright positioning and can cause presyncope and syncope; it is a major concern after landing (reduced plasma volume, altered sympathetic response); fluid loading and compression garments are countermeasures [V2 7042]." }, { "key": "lee2015", "text": "Lee SMC, Feiveson AH, Stein S, Stenger MB, Platts SH. Orthostatic intolerance after ISS and Space Shuttle missions. Aerosp Med Hum Perform. 2015;86(12 Suppl):A54-A67.", "url": "https://doi.org/10.3357/AMHP.EC08.2015", "doi": "10.3357/AMHP.EC08.2015", "pmid": "26630196", "supports": "Abstract: on landing day only 2 of 6 ISS astronauts completed a 10-minute 80-degree head-up tilt test, against 52 of 65 Space Shuttle astronauts; by 3 days after landing 13 of 15 ISS and 19 of 19 Shuttle astronauts completed it. Orthostatic intolerance is more common, and recovery slower, after long-duration flight." }, { "key": "mtb004", "text": "NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025).", "url": "https://www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-adaptation-sickness-sas.pdf", "supports": "Terrestrial readaptation motion sickness after landing: dizziness, nausea, pallor and sweating, made worse by heat, head movements and noxious stimuli." }, { "key": "aha2025bls", "text": "Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478.", "url": "https://doi.org/10.1161/CIR.0000000000001369", "doi": "10.1161/CIR.0000000000001369", "pmid": "41122888", "supports": "Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read." }, { "key": "ng253", "text": "National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025, last updated Sept 23, 2026).", "url": "https://www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessment", "supports": "People with sepsis may feel very unwell and may not have a high temperature; do not rely on fever alone; a rise in temperature can be a physiological response; assess temperature, heart rate, breathing rate, blood pressure, level of consciousness and oxygen saturation; look for mottled or ashen skin, blue skin, lips or tongue, a non-blanching rash, and breaks in the skin; ask how often the person passed urine in the past 18 hours and about fever or shaking chills (rigors); pay attention to new changes in behavior and to concerns raised by others." }, { "key": "btso2", "text": "British Thoracic Society. Guideline for oxygen use in healthcare and emergency settings (emergency oxygen guideline page). Fetched Oct 21, 2026.", "url": "https://www.brit-thoracic.org.uk/quality-improvement/guidelines/emergency-oxygen/", "supports": "Recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94-98%; for known COPD or other risk factors for hypercapnic respiratory failure, 88-92% pending blood gas results. Context for the CMO and flight surgeon only; the robot never starts, stops or adjusts oxygen." }, { "key": "v1", "text": "NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).", "url": "https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf", "supports": "NASA-STD-3001 Vol 1 Rev C: V1 3006, V1 3012 (landing-site medical capability), V1 3017, V1 6003, V1 7003." }, { "key": "v2", "text": "NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems.", "url": "https://standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2", "supports": "NASA-STD-3001 Vol 2 Rev F: V2 8040 (mobility aids for assisted egress), V2 12045 (expedited egress), V2 7055, V2 7059, and Section 10.6 automated and robotic systems." }, { "key": "tb044", "text": "NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025).", "url": "https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf", "supports": "The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist." }, { "key": "marsdelay", "text": "NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review).", "url": "https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf", "supports": "One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction." }, { "key": "pccp", "text": "U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance).", "url": "https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence", "supports": "A model for planning, validating and rolling back software updates." }, { "key": "faa460", "text": "U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.", "url": "https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460", "supports": "Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants." } ], "corrections": [ { "date": "2026-10-21", "version": "0.2", "source": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 8 review)", "items": [ "Scope: Moon and Mars only (missions [moon, mars]); the Earth-landing sentences and comms line are removed, with one line of context that NASA flight surgeons and the recovery team lead at Earth landings (OCHMO-TB-051) (fix 9).", "RF4: label now \"(in a helmet or suit: design judgment)\"; OCHMO-MTB-004 covers vomiting with gravity transitions but not helmets (fix 16).", "S3: the route is cleared before the hatch opens or on the lead's command; once egress has started the robot only holds clear. L2: without a load sensor the stretcher moves only after the lead states \"empty\" and nobody is within the keep-out distance (suggestion 27).", "Why: the open question is replaced by \"This protocol never moves an occupied stretcher\"; any future patient-moving protocol needs certified equipment, an attendant, rung 1 control and validated terrain limits (Q4, suggestion 28).", "Batch 8 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Scope decision by the foundation owner (Oct 21, 2026)", "items": [ "Scope: Earth landings are back in scope in a support-only role (missions restored to low Earth orbit, commercial, Moon and Mars). At an Earth landing, NASA flight surgeons and the recovery team lead; the robot only fetches kit and hands over records (RMP-EGR-001) when the landing medical lead asks, never leads care, and never touches or moves anyone.", "Moon and Mars wording is kept: there the CMO leads under the onboard checklist, advised by the flight surgeon." ] }, { "date": "2026-10-21", "version": "0.4", "source": "Batch 10 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026", "items": [ "Earth landing gated at step level: a new decision after S1 asks whether this is an Earth landing; if yes, only the kit-fetch step (checked or emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request, and every other robot step is marked \"Moon or Mars only\" (R10; owner scope decision of Oct 21, 2026; OCHMO-TB-051)." ] } ] }