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Home › Robotic Medicine › Protocol library › RMP-ENV-001

CONCEPTUAL · DRAFT v0.3 · NOT FOR CLINICAL USE. An educational thought experiment about how a care robot could follow an auditable protocol. It is not a medical procedure, has not been validated, and must not be used to care for anyone. Thresholds marked <set by …> are deliberately left for clinical leads and validation to set. Disclaimer
Robotic Medicine · Protocol library

RMP-ENV-001 Smoke or fire: bring masks, account for crew, video

AI-assisted Reviewed (AI-assisted) AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 5 review, 25 required corrections and 18 optional suggestions); all required corrections, and the low-risk editorial suggestions, are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use.

Fixed rules (same in every protocol)

1 · Identity and scope

When smoke or fire is detected or reported, the robot sends an URGENT alert at once to the CMO, the vehicle commander and the flight surgeon, brings portable breathing masks or portable breathing apparatus on command, helps account for every crewmember by check-in, clears paths, and streams video from a crew-directed viewpoint when the link allows. The crew and vehicle fire-protection system lead under NASA-STD-3001 fire requirements and the vehicle emergency procedure. The robot does not extinguish the fire, does not declare the air safe, and does not enter a smoke-filled volume unless a human explicitly sends it.

Why this protocol was chosen. NASA-STD-3001 Volume 2 requires a fire protection system with detection, warning and extinguishing [V2 9059], health and status to the crew [V2 9060], failure alerting [V2 9061], manual activation and deactivation [V2 9062] and portable fire extinguishers [V2 9063]. NASA records list 3 smoke-inhalation events among US astronauts through 2006. Protective equipment such as respirators is required for expected hazards [V2 9053]. NASA-STD-3001 also requires real-time monitoring of combustion products including carbon monoxide (CO), hydrogen cyanide (HCN) and acid gases (HCl/HF) [V2 6024, Table 6.2-3], and emergency equipment that is clearly identified, accessible and usable [V2 9064]; the robot never reads monitor values as "air is clear". A robot that fetches masks, accounts for crew and relays video can support the human-led response without becoming a firefighter. The robot hands over sealed mask bags only; size choice and fit are the crew's and CMO's, and the robot never says "verified fit". Default: the robot does not enter a smoke-filled or closed module; a camera scout is allowed only on the commander's explicit authorization after the crew who remain have donned masks, within hard limits. Oxygen in use raises the fire risk, so "oxygen in use" is recorded and told to the commander (RMP-RESP-001). After smoke, carbon monoxide (CO) can make a pulse oximeter read falsely high (Hampson 1998), so the robot never calls a reading reassuring.

Autonomy: Max rung raised from 1 to 2 for supervised fetching of breathing masks / portable breathing apparatus, crew accounting support and video. The robot never fights the fire, never operates extinguishers as the primary responder, and never enters a declared no-go volume unless the crew explicitly send it under the vehicle procedure.

Covers

  • Smoke detector alarm, visible smoke, or reported fire or smell of burning in a habitable volume
  • Crew accounting and mask hand-over until the commander and CMO close the event

Locked out (never done by the robot under this protocol)

  • Operating a fire extinguisher as the primary firefighter
  • Declaring the fire out or the air safe
  • Entering a no-go or smoke-filled volume unless a human explicitly sends it under the vehicle procedure
  • Starting life-support or ventilation changes (crew and ground engineers decide)
  • Any medicine advice for smoke inhalation

Related: RMP-ENV-002 · RMP-ENV-003 · RMP-ENV-004 · RMP-ENV-005 · RMP-EYE-001 · RMP-RESP-001 · RMP-CARD-001 · RMP-SKIN-002 · RMP-EGR-001

2 · 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
  • Vehicle commander (or equivalent): leads the vehicle emergency procedure
  • Second trained CMO: receives medical alerts if the CMO is unavailable
  • All crew: don masks and report location when able
Commercial flights
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.) [11]

Robot may

  • Send an URGENT alert at once
  • Bring sealed mask bags or portable breathing apparatus on command and restrain them at a crew-chosen point
  • Run a crew-accounting check-in by voice or screen
  • Hold clear of hatches and extinguisher access
  • Stream video from a crew-directed position
  • Fetch medical kits on CMO command using the emergency-fetch pattern

Robot may not

  • Fight the fire or declare it out
  • Say the air is safe
  • Change ventilation or life-support settings
  • Enter a no-go volume without an explicit human send
  • Start without a human command

3 · Preconditions and consent

Consent
Emergency accounting check-ins; declining a non-urgent question is allowed once everyone is accounted for.
Emergency consent
During the event the robot prioritises accounting and mask fetch; medical recording follows the CMO.
Withdrawal
Crew can stop video; the alert and accounting log stand.

4 · Required sensor inputs

IDInputSourceRequiredIf missing
IN-1Detector alarm state and crew report of smoke, fire or burning smellVehicle systems; crew voiceYesLog "no response"; keep URGENT alert.
IN-2Each crewmember's location and "accounted / not answered", as statedCrew check-inYesAny no-answer is URGENT for a search under the vehicle procedure.
IN-3Mask bag IDs and seal status when readable without delayKit labelsOptionalLog "not read" if reading would delay hand-over.
IN-4Link status and delayCommunications systemYesTreat as link down.
IN-5Oxygen in use: yes, no or unknown, as stated by the CMO or the commanderCMO or commander, by voice; RMP-RESP-001 X10OptionalLog "oxygen use unknown" and tell the commander; never treated as "no".

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

  1. S1RobotRung 2

    On a detector alarm the crew accept, or on a crewmember's word, send an URGENT "smoke or fire" alert to the commander, the CMO and the flight surgeon at once. 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 <set by validation> seconds is repeated and sent to the next named crewmember.

    Done when: Alert acknowledged, or escalated.

    V2 10174V1 6003V2 9059

  2. S2RobotRung 2

    On the commander's or CMO's command, bring sealed portable breathing masks or portable breathing apparatus to the crew-chosen hand-over point and restrain them. This is an emergency fetch on a human command (commander or 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 (commander or 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". Announce "EMERGENCY FETCH – NOT VERIFIED". Never say the contents, fit or seal were checked before use.

    Done when: Masks within reach, or skipped; override logged.

    Limit: <set by validation>

    V2 7046V2 9053

  3. S3Crew

    The commander leads the vehicle fire procedure (detect, warn, extinguish, isolate as the vehicle provides). The CMO treats smoke inhalation under the medical checklist. Portable extinguishers are crew-operated [V2 9063].

    Done when: Human-led response; robot logs what is stated.

    V2 9059V2 9063

  4. S4RobotRung 2

    Run a crew-accounting check-in: call each name once, log "accounted" or "no response". Any no-response is URGENT for the commander's search plan. Keep paths to hatches and extinguishers clear.

    Done when: Accounting complete or gaps flagged URGENT.

    V1 3006

    D1DecisionRobot decides

    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?

    • Yes → 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 <set by validation> seconds is repeated and sent to the next named crewmember.
    • No → Continue. The URGENT alert from S1 stands.
    D2DecisionRobot decides

    Did each crewmember answer the accounting check-in?

    • Yes → Continue.
    • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
    • No response, or the answer does not make sense → 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.
  5. S5RobotRung 2

    Default: do not enter a smoke-filled or closed module, and prefer a hatch-side camera view when that is enough. Enter only if the commander explicitly authorizes it, masks are already on the crew who remain, the commander names the path and keep-out, and the visibility and thermal hard limits in the robot controller allow it; return at once when any limit is reached or the commander says return. The robot never declares the volume clear or the fire out. If not authorized, hold clear.

    Done when: Hatch-side view or authorized path followed within limits, or hold logged.

    V2 10172

  6. S6RobotRung 2

    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.

    Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

    V2 10173V1 3006

  7. S7Ground

    The flight surgeon and ground team support the commander and CMO; medical evacuation is a flight-surgeon decision [V1 3007]. The robot logs decisions it is told.

    Done when: Decision logged.

    V1 3007

    D3DecisionGround decides

    What is the plan (fire response, medical care, module isolation, evacuation)?

    • Link live → Flight surgeon decides; robot logs.
    • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
  8. S8RobotRung 2

    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. Apply to medical kits fetched during the event.

    Done when: Reconciliation recorded; opened – not restocked until resealed.

    V2 7059

  9. S9RobotRung 2

    Send one package: alert times, accounting log, mask fetch overrides, video pointer, kit inventory record and decisions.

    Done when: Package delivered or queued.

    V1 6003V1 7001V1 7003

7 · Stop and escalate rules, red flags

IDTriggerWhat happensLevel
X1The patient (or the crewmember being examined) says stop, or withdraws consentRobot 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.V2 10165stop
X2Any crewmember presses stop or takes over controlProtective stop; robot holds its stopped position; only a human may restart it.V2 10165V2 10168V2 10174safe-state
X3Robot fault, sensor fault, or a force, speed or reach limit is reachedProtective stop and hand control to the CMO; log the fault.V2 10172V2 10168safe-state
X4CMO is asked to take over and does not respond (for example, the CMO is the patient)Robot stays stopped; the next named crewmember is called.V2 10173V2 7045safe-state
X5Loss of link, or delay longer than the limit for live guidanceRobot pauses its own movement in its stopped position and tells the CMO and the commander. This pauses robot movement only: crew masks, moving away from the smoke and the commander's vehicle procedure 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; the robot resumes only on the commander's confirmation. Everything is logged and sent to the flight surgeon at the next contact.V2 10172V2 10173pause
X6An URGENT alert is not acknowledged within the set timeRobot 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.V1 3006V2 10173urgent
X7The crewmember stops responding, or seems confused or drowsy, at any pointURGENT 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.urgent
X8A crewmember asks the robot what is wrong, or for medicine, fluid or treatment adviceRobot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.stop
X9The commander declares the robot's module a no-go volumeRobot leaves by the path the commander names, or powers down in place if ordered; it never declares the volume safe.V2 10172V2 9059safe-state
X10Robot sensors detect its own fault in smoke (visibility or thermal limit)Protective stop; hand control to the crew; log the fault.V2 10172safe-state

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

IDSignThresholdAction
RF1Visible flame, spreading smoke, or detector alarm, as reported or shown [1]anyURGENT alert; vehicle fire procedure leads
RF2A crewmember does not answer the accounting check-in [7]anyURGENT alert to the commander and CMO; search under the vehicle procedure
RF3Cough, voice change, chest pain or breathing difficulty after smoke exposure, as stated [2]anyURGENT alert to the CMO and flight surgeon; see RMP-RESP-001
RF4Burns from the fire event [4]anyURGENT alert; see RMP-SKIN-002
RF5Unresponsive crewmember during the event [3]anyURGENT; start RMP-CARD-001 when the scene allows under the commander's direction
RF6Fire-protection system failure alert [1]anyURGENT alert to the commander and ground; [V2 9061]
RF7Eye pain, tearing or vision change after smoke or combustion exposure, as stated [1]anyURGENT alert; see RMP-EYE-001 (eye care is crew-led)

8 · Safety limits

IDLimitValueHow enforced
L1Contact with the crewmembernot allowedKeep-out zone in the robot controllerV2 10172
L2Operating extinguishers or life-support controlsnot allowedNo extinguisher-discharge or ECLSS-control task is loaded
L3Camera-scout distance, time, visibility and thermal limits<set by program environmental lead with the flight surgeon>Controller hard limits; entry only on the commander's explicit authorization; return when any limit is reached
L4Entering a commander-declared no-go volumenot allowedPath planner blocks no-go volumes; a human send under the vehicle procedure is logged as an override and is the only exception
L5Robot speed near the crewmember<set by validation>Hard limit in the controllerV2 10172
L6Handing over a mismatched or unverified medicine under this protocolnot allowedRMP-PHARM-001 quarantine is the default; only the CMO's logged two-step override inside RMP-PHARM-001 can release it

9 · Logs and audit

10 · Links to NASA-STD-3001

RequirementTopic (paraphrased)How this protocol uses it
[V1 3004]In-mission medical care capabilities (including inventory, vital signs, imaging and ECG, procedures, restraints, medications, private data transmission)Emergency medical care after smoke exposure; medicines are human decisions.
[V1 3006]Crew medical officers: two per vehicleTwo trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO is the patient (see the commercial-flight note).
[V1 3007]Medical evacuationEvacuation decisions stay with the flight surgeon.
[V1 6003]Private medical communicationsLogs and alerts sent to the ground are private medical communications.
[V1 7001]Medical records kept permanently and retrievable for trend analysisRecords kept so the flight surgeon can see trends.
[V1 7003]Security of medical recordsSecure handling of medical records.
[V2 7045]Medical equipment usable by non-physician crewUsable by non-physician crew, including when the CMO is the patient.
[V2 7046]Restraint of patient, care provider and suppliesPatient, caregiver and supplies restrained.
[V2 7059]Inventory management: track locations and quantitiesKit 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.
[V2 9053]Protective equipment for expected hazardsProtective equipment (including respirators) for expected hazards; the robot fetches sealed masks, the crew don them.
[V2 9059]Fire protection system (detecting, warning and extinguishing)Fire protection system with detecting, warning and extinguishing; the crew and vehicle lead.
[V2 9060]Fire protection system health and statusFire-protection health and status to the crew; the robot may relay displayed status, not interpret it.
[V2 9061]Fire protection system failure alertingAlert the crew to fire-protection system failures.
[V2 9062]Fire protection system manual activation and deactivationManual activation and deactivation of the fire protection system; humans only.
[V2 9063]Portable fire extinguishersPortable fire extinguishers; crew-operated.
[V2 10161]Automated system status shown to the operatorRobot shows its status and health.
[V2 10162]Mode changes announcedMode changes are announced to the operator.
[V2 10163]Data recording and sharingRobot records and shares its data.
[V2 10164]Clear allocation of responsibility (human or system)Shows whether the human or the robot is expected to act.
[V2 10165]Human override and shutdownHuman can override and shut down the robot.
[V2 10168]Failure recovery: safe human takeoverHuman can take over.
[V2 10172]Protective stop when limits are exceededProtective stop when a limit is exceeded.
[V2 10173]Safety DefaultRobot stays stopped if no one takes over.
[V2 10174]Only a human initiates or restartsOnly a human starts or restarts the robot.

IDs as published in Volume 1 Revision C [7] and Volume 2 Revision F [1]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

  1. Simulation. Scripted detector alarms, missing crewmember on accounting, mask fetch, no-go volume, CMO as patient, lost link. Pass: Zero all-clear statements; zero extinguisher use by the robot; every emergency fetch logged as an override; unaccounted crew escalates.
  2. Earth analog. Fire-drill training with the robot fetching sealed mask bags. Pass: Masks at the hand-over point within <set by validation> seconds.
  3. Parabolic or station demonstration. Mask-bag fetch and restraint in weightlessness without smoke. Pass: Bags closed and restrained; hatches kept clear.
  4. Flight use under flight surgeon supervision. First use in vehicle fire drills. Pass: No safety events.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use
  • Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
  • Flight surgeon, as medical authority
  • Robotics and medical-device safety board
  • Program approval for the mission
Each run
Started by a crewmember, commander or CMO. Alerts go to commander, CMO and flight surgeon at once; the vehicle procedure leads.
Restart after a stop
Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.3.

13 · Change control for learning

Change-plan model: FDA guidance [10].

Loss of signal and Mars delay

Live link
Low Earth orbit: ground flight directors and the flight surgeon receive the alert and video when the link allows.
Loss of signal
  • The robot pauses non-essential motion and tells the commander and CMO; accounting continues offline on confirmation.
  • Crew masks, moving away from the smoke and the commander's vehicle procedure continue under the onboard checklist and never wait for the link or the robot.
  • The vehicle procedure never waits for the link.
Mars-class delay
  • Fire response cannot wait for the ground; the vehicle procedure and trained crew lead.
[9]
Corrections and updates

Oct 21, 2026, version 0.2. AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 5 review); no named human clinician. Changes:

  • Requirement set V2 9059-9063 kept; V2 9064 (emergency equipment accessibility) cited in the "why" and sources (item 17).
  • RMP-EYE-001 and RMP-ENV-005 added to related; new RF7: eye pain, tearing or vision change after smoke or combustion exposure → URGENT; see RMP-EYE-001 (item 18).
  • The "why" adds NASA-STD-3001 combustion-product monitoring: CO, HCN and HCl/HF [V2 6024, Table 6.2-3]; the robot never reads monitor values as "air is clear" (item 19; suggestion 42).
  • Typo "have don masks" removed. S5 camera scout: default no entry; prefer a hatch-side view; entry only on the commander's explicit authorization, with masks on the crew who remain, a named path and keep-out, and controller visibility and thermal hard limits (new limit L3); never declares the volume clear or the fire out (item 20).
  • Mask fit question closed: the robot hands over sealed mask bags only; size and fit are the crew's and CMO's; never "verified fit" (suggestion 39).
  • Batch 5 drafts now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.

Oct 21, 2026, version 0.3. Batch 7 editorial (AI-assisted), Oct 21, 2026; no named human clinician. Changes:

  • Citation labels changed to the site's year-only convention: "(approved for public release <date>)" now reads "(YYYY)", and NASA-STD-3001 Volume 2 "Revision F (approved July 14, 2026)" now reads "(Rev F, 2026)" (sources: v2). Editorial; no change to steps, thresholds or limits.
  • X5 and the comms loss-of-signal branch now say only the robot pauses: crew masks, moving away from the smoke and the commander's vehicle procedure never wait for the link or the robot (batch 6 review item 24 / suggestion 40). Editorial; robot behaviour unchanged.
  • New input "Oxygen in use: yes, no or unknown, as stated" (never treated as "no"); the "why" links oxygen in use to fire risk and says carbon monoxide makes a pulse oximeter read falsely high (Hampson 1998, PMID 9792574); never-words "reading is reassuring" and "oxygen level is good" (batch 6 review items 1d and 4).

Earlier version: Draft v0.2, Oct 21, 2026. Download the current YAML above.

Sources

  1. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: NASA-STD-3001 Vol 2 Rev F: V2 9053 (protective equipment); V2 9059-9063 (fire protection system, status, failure alerting, manual control, portable extinguishers); V2 9064 (emergency equipment clearly identified, accessible and usable); V2 6024 and Table 6.2-3 (combustion product monitoring: CO 5-1000 ppm, HCN 2-50 ppm, HCl/HF 2-50 ppm). Section 10.6 covers automated and robotic systems.
  2. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to Medical Conditions that occur in Flight, as well as Private Medical Conditions, in Exploration Missions (In-Flight Medical Conditions). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 2 (US astronauts, Shuttle, Mir and ISS through Expedition 13 / 2006): headache (space adaptation) 233, headache (late) 49, headache (CO2 induced) 20; choking/obstructed airway 3; smoke inhalation 3. Table 1 (ISS through Expedition 40): headache 33.
  3. 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. PMID 41122888. doi:10.1161/CIR.0000000000001369 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.
  4. American Burn Association. Guidelines for Burn Patient Referral: Advice on Transfer and Consultation (2022). www.ameriburn.org/burn-care-team/resources/guidelines-for-bu… Supports: Immediate consultation with consideration for transfer: full-thickness burns; partial-thickness burns of 10% or more of total body surface area; deep partial or full-thickness burns of the face, hands, genitalia, feet, perineum or over any joint; burns with other illnesses or injuries; poorly controlled pain; all suspected inhalation injury; all chemical injuries; high-voltage electrical injuries. Consultation: partial-thickness burns under 10%; all potentially deep burns of any size; signs of potential inhalation such as facial flash burns, singed facial hair or smoke exposure; low-voltage electrical injuries. The palm of the patient's hand is about 1% of body surface area; full-thickness burns are dry and leathery, white, brown or black, with loss of pin-prick sensation.
  5. Hampson NB. Pulse oximetry in severe carbon monoxide poisoning. Chest. 1998;114(4):1036-41. doi:10.1378/chest.114.4.1036. PMID 9792574. pubmed.ncbi.nlm.nih.gov/9792574/ Supports: Abstract: pulse oximeters overestimate arterial oxygenation in severe carbon monoxide (CO) poisoning; an elevated carboxyhaemoglobin level falsely raises the pulse oximeter saturation. Why the robot never calls a reading reassuring during a smoke or fire event.
  6. Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019). www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Gu… Supports: Override is limited to medicines needed in emergent circumstances where waiting could harm the patient (3.3b); limit what is available on override (3.4b); require documentation of the override rationale (3.4d); routinely analyze override reports (3.6). Used for the emergency-fetch pattern by analogy (a robot fetching a sealed kit is not a dispensing cabinet).
  7. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3004, V1 3006, V1 3007.
  8. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
  9. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
  10. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
  11. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.

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