RMP-EVA-003 Hand and skin check after a spacewalk: symptom questions first, then a standard photo log for the flight surgeon

1 · Identity and scope

After a spacewalk (EVA) or a suited test, on the CMO's or the crewmember's command, the robot first asks on screen about any new symptom (any new symptom raises an URGENT possible-DCS alert under RMP-EVA-001). Then, with the crewmember's consent before the camera moves, it takes standard photos of the hands and any skin area the CMO names, as in RMP-SKIN-003: an establishing view with a margin of surrounding skin, and close-ups with and without a scale. Photos are labelled, stored in the medical record and sent to the flight surgeon, who judges every finding. A baseline hand set before the first EVA of an increment can be taken at the flight surgeon's choice; how often post-EVA photos are taken is the flight surgeon's choice.

Why this protocol was chosen. Hand injuries are common in EVA work: in suit training, 47% of 352 symptom comments were in the hands, where moisture and hard glove contact caused fingernail injuries (Strauss 2005), and fingernail lifting from the nail bed (onycholysis) is linked to larger hand circumference, at 19.6% against 5.6% in male crewmembers (Opperman 2010). Any new symptom after an EVA may be decompression sickness: NASA describes skin signs such as itching, mild rash and a mottled, patterned rash (cutis marmorata), and most cases present between 60 and 240 minutes (OCHMO-TB-037), so symptom questions come before any photo and any new symptom is URGENT, as in RMP-EVA-001. The photo rules follow RMP-SKIN-003 (IMI 2019: standard views, an establishing view with "a wide area of healthy tissue", and the same view without the scale); the scale choice and image storage rules are design judgment.

Autonomy: Max rung 2 for asking symptom questions on screen, moving the camera to the standard view the CMO sets at the set distance and without contact, and labelling, storing and sending photos, as in RMP-SKIN-003. The crewmember removes their own gloves; the robot never judges a finding.

Related: RMP-EVA-001 · RMP-EVA-002 · RMP-SKIN-003 · RMP-SKIN-001 · RMP-INF-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

• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Vehicle commander: leads any cabin emergency procedure
• Other crew: help as the CMO or commander directs

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]

3 · Preconditions and consent

• PRE-1 The CMO or the crewmember started the check by command after an EVA or a suited test.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]

Consent

The crewmember agrees to the photos before the camera moves; photos frame only the area the CMO set, with a margin of surrounding skin. For the genital, breast or buttock area, the robot camera is used only if the crewmember chooses it; otherwise the CMO takes the photos with a handheld camera and adds them to the log. Photos go only to the CMO, the flight surgeon and people the flight surgeon names.

Emergency consent

If the crewmember cannot agree, no photo is taken; any symptom or concern raises an URGENT alert under RMP-EVA-001.

Withdrawal

The crewmember can stop a photo or the whole check at any time; withdrawal stops future photos, and the flight surgeon decides on photos already taken.

4 · Required sensor inputs

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

   Tell the flight surgeon and the CMO that a post-EVA hand and skin check has started, with the EVA end time as stated (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 <set by validation> seconds is repeated and sent to the next named crewmember.

   Done when: Notice acknowledged.

   V1 6006V1 3006

2. S2RobotRung 2

   Before any photo, show the symptom prompt on screen (any new symptom since the EVA, listed first), and log answers word for word. Any new symptom other than an isolated nail or fingertip finding, or a hand abrasion, with no other symptom (RF4, RF5) raises an URGENT possible-DCS alert under RMP-EVA-001 at once, and photos wait; numbness, tingling or weakness of the fingers stays URGENT (RF3). The robot reminds the crewmember on screen to report any new symptom at once, and shows a repeat symptom prompt the crewmember can accept at the time the flight surgeon sets (most DCS cases present between 60 and 240 minutes, OCHMO-TB-037).

   Done when: Answers logged, or "no response".

   V1 6003

   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.
   D2DecisionRobot decides

   Did the crewmember answer the symptom prompt, or say they want to skip it?

   • 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.
3. S3Crew

   The crewmember removes their own gloves and places their hands on the plain background in the standard position; the CMO places the scale the flight surgeon chose (a disposable paper scale, or a reusable ABFO No. 2 scale cleaned under RMP-INF-002) beside any area to close up. For the genital, breast or buttock area, the robot camera is used only if the crewmember chooses it; otherwise the CMO takes the photos with a handheld camera and adds them to the log.

   Done when: Hands and area in position with the scale.

   V1 3004

   D3DecisionRobot decides

   Before the camera moves: did the crewmember agree to this session's photos (each view is named on screen before it is taken)?

   • Yes → Continue to S4; the crewmember can say stop before or during any view.
   • No, or no answer → The camera does not move and no photo is taken; log "photo not taken – no consent" and tell the CMO.
4. S4RobotRung 2

   Only after the crewmember agrees (D3), move the camera to the standard view the CMO set (about 90 degrees, the same distance, light and plain background each time), no closer than the set camera distance, and take the standard set: an establishing view of both hands, including the fingertips and nails, with a margin of surrounding skin; close-ups of any area the CMO names with the scale; and the same close-ups without the scale. Label each with the area, view, date and clock time, and mark it "for human review". A photo with anything outside the area the CMO set in frame is held unsent and flagged to the flight surgeon, who decides whether to keep it.

   Done when: Photos taken and labelled, or "photo not obtained".

   Limit: <set by validation>

   V1 7001

5. S5RobotRung 2

   On request, show earlier photos of the same area (for example from before the EVA, if the flight surgeon's schedule took them) side by side for the CMO; the robot never says what has changed.

   Done when: Photos shown on request.

   V1 7001

6. S6Crew

   The CMO cares for any broken skin under RMP-SKIN-001; the crew clean the camera and any shared surface under RMP-INF-002.

   Done when: Care and cleaning recorded as stated.

   V1 3004

7. S7RobotRung 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

8. S8Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) reviews the answers and photos and decides on care, glove changes for the next EVA and any follow-up photos.

   Done when: Decision logged.

   V1 3004V1 6006

   D4DecisionGround decides

   What is the plan (care, glove changes, follow-up photos)?

   • 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.
9. S9RobotRung 2

   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.

   Done when: RMP-PHARM-001 run logged with its result, or none ordered.

   V2 7059

   D5DecisionRobot decides

   What did RMP-PHARM-001 show for the ordered item?

   • MATCH TO ORDER → 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.
   • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → 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.No hand-over
10. S10RobotRung 2

    Send the flight surgeon one package: answers, labelled photos, alerts and decisions; photos go only to the people the flight surgeon names.

    Done when: Package delivered or queued.

    V1 6003V1 7003

7 · Stop and escalate rules, red flags

Red flags

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

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Answers as stated with times; consent before each session; each photo with area, view, date and time; photos not obtained or held unsent and the flight surgeon's decision; photos taken by the CMO with a handheld camera; who viewed the photos.
• LOG-6 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.V2 10163
• LOG-8 Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses.V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [6] and Volume 2 Revision F [7]. 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 checks with a new symptom after the EVA, a missed consent, something outside the set area in frame, CMO as patient, lost link. Pass: Every new symptom URGENT before any photo; zero photos without consent; zero contact.
2. Training model. Photo drill on hand models with nail and abrasion findings. Pass: Photos comparable (same view, light and scale); every photo labelled.
3. Parabolic or station demonstration. Camera positioning in weightlessness. Pass: Camera distance limit held.
4. Flight use under flight surgeon supervision. First use after an EVA. Pass: No safety or privacy 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 the CMO or the crewmember after an EVA. Symptom questions come first; the flight surgeon judges every finding.

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 v0.2.

13 · Change control for learning

• 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.

Change-plan model: FDA guidance [10].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives answers and photos when the link allows.

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.
• Symptom care and all crew care continue under the onboard checklist and never wait for the link or the robot.
• Photos are queued; any symptom goes to the CMO at once under RMP-EVA-001.

Mars-class delay

• Mars: photos arrive with delay; the CMO decides under the onboard checklist.

[9]

Sources

1. NASA OCHMO. Decompression Sickness (DCS) Risk Mitigation. Technical Brief OCHMO-TB-037 Rev D (Oct 5, 2026). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-037-decompr… Supports: DCS is caused by inert gas bubbles forming during rapid reductions in ambient pressure, most significantly in the move from cabin pressure to EVA suit pressure; NASA classifies DCS as Type I (itching, musculoskeletal pain, mild rashes) and Type II (neurological symptoms, numbness, weakness, cognitive issues, inner ear problems, cardiopulmonary issues), and describes cutis marmorata (a mottled, patterned skin rash); arterial gas embolism can cause stroke-like neurological effects, loss of consciousness and seizures; U.S. Navy protocols are widely adopted on Earth; diagnosis is based on symptoms; the majority of cases present between 60 and 240 minutes and inflammatory responses can last more than 24 hours; no hyperbaric chamber is available in flight, and increasing suit and cabin pressure may be combined to treat symptoms, depending on the scenario; a break in prebreathe rapidly reintroduces nitrogen; NASA has never experienced a Type II event in spaceflight.
2. Strauss S, Krog RL, Feiveson AH. Extravehicular mobility unit training and astronaut injuries. Aviat Space Environ Med. 2005;76(5):469-474. PMID 15892545. pubmed.ncbi.nlm.nih.gov/15892545/ Supports: Abstract: in 770 suit training tests at NASA's Neutral Buoyancy Laboratory, 190 (24.6%) had suit symptoms; of 352 symptom comments, 166 (47%) were in the hands, where moisture and hard glove contact caused fingernail injuries; most symptoms were short-lived, but some could become significant injuries. Training (underwater) context. Abstract read Oct 21, 2026 (saved copy in src/b10).
3. Opperman RA, Waldie JM, Natapoff A, Newman DJ, Jones JA. Probability of spacesuit-induced fingernail trauma is associated with hand circumference. Aviat Space Environ Med. 2010;81(10):907-913. PMID 20922881. doi:10.3357/asem.2810.2010 Supports: Abstract: many astronauts sustain hand injuries in EVA training and operations, which can cause fingernail delamination (onycholysis) that needs medical care; in 232 crewmembers' records, male crewmembers with a hand circumference above 22.86 cm had a 19.6% probability of finger injury against 5.6% at or below it, with similar findings in women. Abstract read Oct 21, 2026 (saved copy in src/b10).
4. Institute of Medical Illustrators. IMI National Guidelines: Wound Management Photography (2019). www.imi.org.uk/wp-content/uploads/2019/04/2019_Apr_IMINatGui… Supports: Standardise equipment, lighting, background, viewpoint and magnification so serial photographs can be compared; use the same light source each time where possible; hold a measurement scale on the same plane as the wound and photograph from 90 degrees; acute wounds are photographed at each dressing change, and any significant change is photographed; written guidance on consent for clinical photography. Earth hospital context. Saved copy read Oct 21, 2026 (a 2025 version 2.0 exists).
5. 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). www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessme… 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.
6. 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 6003, V1 6006, V1 7001, V1 7003.
7. 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: Requirement IDs beginning V2.
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.