# RMP-EVA-003 Hand and skin check after a spacewalk: symptom questions first, then a standard photo log for the flight surgeon # Version 0.2 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE. # Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/ # Every threshold marked must be set by the named owner (see the schema) before any use. schema_version: '0.3' version: '0.2' 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 10 review: 10 required corrections, R1 to R10, of which R10 applies to RMP-CARD-004, RMP-EGR-002, RMP-EGR-003 and RMP-NEURO-005; 20 optional suggestions); all required corrections that apply to this protocol 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-EVA-003 slug: rmp-eva-003 title: >- Hand and skin check after a spacewalk: symptom questions first, then a standard photo log for the flight surgeon category: eva tier: 2 rung_note: >- 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. result_language: use: - photo recorded - photo not obtained - flagged for human review - sent to flight surgeon - as stated by the crewmember never: - normal - no problem found - all clear - negative - any diagnosis or cause - healing well - healing - better - worse - no change - infected - not infected - nail is fine - just a glove injury - no DCS - not DCS - bends - safe - mild - minor scope: summary: >- 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: >- 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. covers: - Hands, fingers, nails and any skin area the CMO names, after an EVA or a suited test - 'Any new symptom after an EVA: RMP-EVA-001 (URGENT)' - 'Wound care: RMP-SKIN-001; serial wound photos: RMP-SKIN-003' 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) - Removing gloves or touching the hands or skin - Judging a finding, a nail, a rash or whether symptoms are DCS - Photographing anything outside the area the CMO set, or any photo without consent - >- Showing a photo on a shared display, or using photos for robot or AI training, research or outreach without separate written consent - Using the robot camera for the genital, breast or buttock area unless the crewmember chooses it related: - RMP-EVA-001 - RMP-EVA-002 - RMP-SKIN-003 - RMP-SKIN-001 - RMP-INF-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: - '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' robot_may: - Ask symptom questions on screen first - Move the camera to the standard view the CMO set, at the set distance, without contact - Take, label and store photos - Show earlier photos side by side on request - Send photos to the flight surgeon robot_may_not: - Touch the crewmember or the gloves - Say what a finding is or whether symptoms are DCS - Photograph without consent - 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 CMO or the crewmember started the check by command after an EVA or a suited test. 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: >- 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: >- 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. inputs: - id: IN-1 name: >- Symptoms in the crewmember's words since the EVA (joint pain, itching, rash or mottled skin, numbness, tingling, weakness, headache, breathlessness, nail or finger pain) source: Crewmember required: true if_missing: Log "no response"; D2 applies. - id: IN-2 name: >- The standard view and the area to frame (hands with a margin of surrounding skin, and any area the CMO names), set by the CMO source: CMO required: true if_missing: No photo is taken until the CMO sets the view. - id: IN-3 name: Each photo, with the area, view, date and clock time source: Robot camera required: false if_missing: Log "photo not obtained" and tell the CMO. - id: IN-4 name: EVA end time, as stated by the CMO or EVA lead source: CMO / EVA 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; photos are queued. steps: - id: S1 actor: robot rung: 2 action: >- 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 seconds is repeated and sent to the next named crewmember. success: Notice acknowledged. refs: - V1 6006 - V1 3006 - id: S2 actor: robot rung: 2 action: >- 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). success: Answers logged, or "no response". refs: - V1 6003 - id: S3 actor: crew action: >- 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. success: Hands and area in position with the scale. refs: - V1 3004 - id: S4 actor: robot rung: 2 action: >- 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. success: Photos taken and labelled, or "photo not obtained". limit: refs: - V1 7001 - id: S5 actor: robot rung: 2 action: >- 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. success: Photos shown on request. refs: - V1 7001 - id: S6 actor: crew action: >- The CMO cares for any broken skin under RMP-SKIN-001; the crew clean the camera and any shared surface under RMP-INF-002. success: Care and cleaning recorded as stated. refs: - V1 3004 - 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) reviews the answers and photos and decides on care, glove changes for the next EVA and any follow-up photos. success: Decision logged. refs: - V1 3004 - V1 6006 - id: S9 actor: robot rung: 2 action: >- 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: >- Send the flight surgeon one package: answers, labelled photos, alerts and decisions; photos go only to the people the flight surgeon names. success: Package delivered or queued. refs: - V1 6003 - V1 7003 decisions: - id: D1 after: S2 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: D2 after: S2 decided_by: robot question: Did the crewmember answer the symptom prompt, or say they want to skip it? 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: D3 after: S3 decided_by: robot question: >- Before the camera moves: did the crewmember agree to this session's photos (each view is named on screen before it is taken)? branches: - if: 'Yes' then: Continue to S4; the crewmember can say stop before or during any view. - if: No, or no answer then: The camera does not move and no photo is taken; log "photo not taken – no consent" and tell the CMO. - id: D4 after: S8 decided_by: ground question: What is the plan (care, glove changes, follow-up photos)? 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: D5 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 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: symptom care and all crew 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: The crewmember or CMO asks to stop photos, or anything outside the area the CMO set is in frame action: >- Robot stops the camera at once and logs it; any photo with something outside the set area in frame is held unsent and flagged to the flight surgeon, who decides whether to keep it. level: stop - id: X10 trigger: Someone needs the space or route the robot is in action: Robot moves clear at once without contact and holds; it never pauses in a hatch route. level: safe-state refs: - V2 10172 red_flags: - id: RF1 sign: >- Any new symptom since the EVA (joint pain, itching, rash, numbness, tingling, weakness, headache, breathlessness, confusion), as stated, other than an isolated nail or fingertip finding, or a hand abrasion, with no other symptom (RF4, RF5) threshold: any action: URGENT alert; start RMP-EVA-001 (possible DCS) source: tb037 - id: RF2 sign: Mottled, patterned or marbled skin, as stated by the crewmember or the CMO threshold: any action: URGENT alert; start RMP-EVA-001 (possible DCS) source: tb037 - id: RF3 sign: Numbness, tingling or weakness in the hands or fingers, as stated threshold: any action: URGENT alert; start RMP-EVA-001 source: tb037 - id: RF4 sign: >- A nail lifting from the nail bed, blood under a nail, or nail or fingertip pain, as stated by the crewmember or the CMO threshold: any action: Flag to the flight surgeon; the CMO examines source: opperman2010 - id: RF5 sign: Broken skin, a blister or an abrasion on the hands, as stated by the crewmember or the CMO threshold: any action: Flag to the flight surgeon; care under RMP-SKIN-001 source: strauss2005 - id: RF6 sign: Fever, spreading redness or pus, as stated threshold: any action: URGENT alert; see RMP-INF-001 source: ng253 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: Camera distance from the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L3 name: >- Photo shown on a shared display, or used for robot or AI training, research or outreach without separate written consent value: not allowed enforced: >- Photos are stored only in the crewmember's medical record, encrypted in storage and in transit as the program requires; access is limited to the CMO, the flight surgeon and people the flight surgeon names. refs: - V1 7003 - id: L4 name: Automatic measurement, grading or comparison of photos value: not allowed enforced: No such function is loaded - id: L5 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 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: >- 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. - 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-8 text: >- 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. refs: - V2 7059 requirements: - id: V1 3004 use: In-mission care includes skin and wound care; the flight surgeon reviews every photo. - 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 6003 use: Logs and alerts sent to the ground are private medical communications. - id: V1 6006 use: >- EVA medical clearance by ground medical support; findings inform the flight surgeon's decisions for the next EVA. - 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 7059 use: Kit inventory and seal status are tracked. - 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. validation: - stage: simulation what: >- 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. - stage: training model what: Photo drill on hand models with nail and abrasion findings. pass: Photos comparable (same view, light and scale); every photo labelled. - stage: parabolic or station demonstration what: Camera positioning in weightlessness. pass: Camera distance limit held. - stage: flight use under flight surgeon supervision what: First use after an EVA. pass: No safety or privacy 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 CMO or the crewmember after an EVA. Symptom questions come first; the flight surgeon judges every finding. 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: '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_delay: - 'Mars: photos arrive with delay; the CMO decides under the onboard checklist.' sources: - key: tb037 text: >- NASA OCHMO. Decompression Sickness (DCS) Risk Mitigation. Technical Brief OCHMO-TB-037 Rev D (Oct 5, 2026). url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-037-decompression-sickness.pdf 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. - key: strauss2005 text: >- Strauss S, Krog RL, Feiveson AH. Extravehicular mobility unit training and astronaut injuries. Aviat Space Environ Med. 2005;76(5):469-474. url: https://pubmed.ncbi.nlm.nih.gov/15892545/ pmid: '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). - key: opperman2010 text: >- 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. url: https://doi.org/10.3357/asem.2810.2010 doi: 10.3357/asem.2810.2010 pmid: '20922881' 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). - key: imi2019 text: 'Institute of Medical Illustrators. IMI National Guidelines: Wound Management Photography (2019).' url: https://www.imi.org.uk/wp-content/uploads/2019/04/2019_Apr_IMINatGuidelines_Wound-Management.pdf 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). - 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: 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 3004, V1 3006, V1 6003, V1 6006, V1 7001, 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: Requirement IDs beginning V2. - 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: Batch 10 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026 items: - >- Link-loss wording (X5 and comms) fixed: the stray word "crew" before the list of what continues is removed, so the sentence reads, for example, "the exam already under way and all crew care continue under the onboard checklist" (R6). - >- S2 and RF1 now read "any new symptom other than an isolated nail or fingertip finding, or a hand abrasion, with no other symptom (RF4, RF5)", which stay Flags; numbness, tingling or weakness of the fingers stays URGENT under RMP-EVA-001 (RF3; OCHMO-TB-037 Type II neurological symptoms) (R9). - >- S2 adds an on-screen reminder to report any new symptom at once and a repeat symptom prompt the crewmember can accept at the time the flight surgeon sets (TB-037: most cases present at 60 to 240 minutes) (S14). - >- Baseline: a pre-EVA hand set before the first EVA of an increment, at the flight surgeon's choice; post-EVA photo frequency is set by the flight surgeon (S13). - >- Batch 10 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.