RMP-GI-002 Vomiting or diarrhea: intake and output log, sealed containment and clean-up supplies, relay to the flight surgeon (no drug or fluid advice)

1 · Identity and scope

When a crewmember reports diarrhea at any time, vomiting that is not space motion sickness in the first flight days (RMP-NEURO-004 covers that), or vomiting together with diarrhea at any time, the robot tells the flight surgeon, brings containment, hygiene and protective supplies, hands over fresh bags and collects only sealed waste, runs short voice check-ins (red flags first; episodes, fluids taken and urine passed, as reported), and sends summaries. Red flags go to the CMO and flight surgeon at once. Space motion sickness in the first flight days stays with RMP-NEURO-004; if unsure, the CMO chooses, and the robot never decides which applies. Vomiting after a blow to the head goes to RMP-NEURO-001, and gastrointestinal symptoms with allergy signs to RMP-RESP-003, as URGENT.

Why this protocol was chosen. NASA records list 33 episodes of diarrhea and 4 of gastroenteritis among US astronauts through 2006, and diarrhea is recorded on the ISS. In a closed cabin, body waste must be contained so that feces or vomitus do not escape into the habitable volume [V2 7102], and an infection can spread to the rest of the crew. Acute diarrhea is often defined as 3 or more loose stools above baseline in 24 hours; fever, bloody stools and abdominal pain can come with it (ACG 2016). A helper that keeps supplies coming, collects sealed waste and keeps an exact log lets the sick crewmember rest and limits contact with others.

Related: RMP-NEURO-004 · RMP-NEURO-001 · RMP-RESP-003 · RMP-INF-001 · RMP-INF-002 · RMP-INF-003 · RMP-GI-001 · RMP-RENAL-004 · RMP-PREV-004 · RMP-PHARM-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

• Crewmember with symptoms: answers check-ins and can stop or pause them at any time
• Second trained CMO: receives alerts if the CMO is the patient
• Other crew: told by the CMO which hygiene measures to follow

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.) [13]

3 · Preconditions and consent

• PRE-1 A crewmember (the one with symptoms, or the CMO) started the log by command.human_start == trueV2 10174
• PRE-2 The crewmember is awake and answering. If not, stop and alert at once (X7).crew_responsive == true
• PRE-3 Robot self-test passed; containment, hygiene and protective supplies stocked; the robot's cleaning supplies are available.V2 10161
• PRE-4 Robot and supplies restrained when not moving.V2 7046
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to check-ins by voice. Bowel questions are asked privately, and the crewmember chooses who is present. Any question can be declined; an explicit "no" is logged as declined for that question only.

Emergency consent

If the crewmember cannot answer, the robot does not continue the log; it sends an URGENT alert and a crewmember checks in person (X7).

Withdrawal

The crewmember can stop or pause check-ins at any time.

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

   On a crewmember's command, open the log, tell the CMO, and send a "vomiting or diarrhea log started" note to the flight surgeon (queued if the link is down).

   Done when: CMO acknowledges; note delivered or queued.

   V2 10174V1 6003

2. S2RobotRung 2

   Bring emesis and waste bags, wipes, a clean-up kit, gloves, masks and eye protection for helpers, and any drink pouch the crewmember asks for (unless "nothing by mouth" is logged; then route the request to the CMO). Restrain them within reach.

   Done when: Supplies restrained within reach.

   Limit: <set by validation>

   V2 7046V2 9053

3. S3RobotRung 2

   Run a voice check-in: red-flag questions first, then episodes, fluids taken and urine passed. Log answers word for word. D1 is checked after every answer.

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

   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 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.
4. S4RobotRung 2

   On request, hand over a fresh bag; the crewmember closes it; the robot takes only sealed bags, labels and stows them as biohazard waste, and cleans its surfaces (RMP-INF-002). It never holds an open bag near the crewmember's face.

   Done when: Sealed waste stowed; cleaning logged.

   V2 7102V2 10172

5. S5Crew

   The CMO sees the crewmember in person when asked or on any red flag, and decides hygiene measures for the crew (RMP-INF-003). Any medicine is ordered by the CMO or flight surgeon and fetched through RMP-PHARM-001.

   Done when: CMO decision logged.

   V1 3004

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. S7RobotRung 2

   Every <set by flight surgeon> hours, or before each private medical conference, send the flight surgeon a summary: episodes over time, fluids and urine as reported, CMO entries, medicines logged by humans, other crew affected, and alerts.

   Done when: Summary delivered or queued.

   V1 6003V1 7001V1 7003

8. S8Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides treatment, fluids, testing, hygiene measures and work limits. The robot logs the decisions.

   Done when: Decision logged.

   V1 3004

   D3DecisionGround decides

   What is the plan (treatment, fluids, testing, hygiene, work limits)?

   • 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

   Offer a check-in every <set by flight surgeon> hours until the crewmember and flight surgeon close the log. At each scheduled time the robot prompts the crewmember on their own screen; it approaches only when the crewmember (or the CMO) accepts, and a prompt never starts the robot. A routine check-in never wakes a sleeping crewmember unless the CMO or flight surgeon has set wake checks.

   Done when: Each prompt accepted, postponed or answered; log closed by a human.

   V2 10174

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 Each check-in time, count, answer and alert, and each sealed waste bag stowed, so the flight surgeon can follow the trend.
• 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

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [10] and Volume 2 Revision F [8]. 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 check-ins covering every red flag, no response, a second sick crewmember, a CMO who is the patient, and lost link. Pass: Every red flag acts as listed, including the routes to RMP-NEURO-001 and RMP-RESP-003; no response escalates; zero advice or cause statements; zero self-starts.
2. Earth analog. Bed-rest or isolation analog volunteers using voice check-ins and supply fetching (no illness needed). Pass: Data completeness at or above <set by validation>; volunteers rate the robot as not intrusive.
3. Parabolic or station demonstration. Fresh-bag hand-over, sealed-bag collection and surface cleaning in weightlessness, without a patient. Pass: Zero open-bag handling; zero escapes of test material.
4. Flight use under flight surgeon supervision. First use as a logging aid alongside the usual medical conferences. Pass: No safety events; the flight surgeon finds the log useful.

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. The flight surgeon reviews the log; red flags go to the CMO and flight surgeon at once.

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 v0.4.

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 [12].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon sees summaries at the private medical conference and can be alerted at any time.

Loss of signal

• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps running check-ins and logging offline.
• Crew bleeding control and CPR continue under the onboard checklist and never wait for the link or the robot.
• Red flags go to the CMO (or the second trained CMO) at once; the CMO decides under the pre-approved onboard checklist.
• At the next contact the robot sends one package: the trend, counts, alerts and decisions.

Mars-class delay

• Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; red-flag thresholds and the check-in schedule are set before flight and the CMO acts on them.

[11]

Sources

1. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 2: 33 diarrhea and 4 gastroenteritis events among US astronauts (Shuttle, Mir and ISS through 2006); Table 1: diarrhea recorded on the ISS through Expedition 40.
2. Riddle MS, DuPont HL, Connor BA. ACG clinical guideline: diagnosis, treatment, and prevention of acute diarrheal infections in adults. Am J Gastroenterol. 2016;111(5):602-622. PMID 27068718. doi:10.1038/ajg.2016.126 Supports: Acute diarrhea is often defined as an abrupt onset of 3 or more loose or liquid stools above baseline in 24 hours; infectious diarrhea often comes with nausea, vomiting, abdominal pain and cramps, bloating, fever, bloody stools, tenesmus and urgency; stool testing is used for dysentery, moderate-to-severe disease and symptoms lasting more than 7 days.
3. 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.
4. National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. Clinical guideline CG141 (2012). www.nice.org.uk/guidance/cg141 Supports: Management of acute upper gastrointestinal bleeding. Cited only as context for vomiting blood as a red flag: it is a management guideline, not a symptom list.
5. National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232 (May 18, 2023). www.nice.org.uk/guidance/ng232/chapter/Recommendations Supports: Recommendation 1.2.4: community services should refer to an emergency department anyone with a head injury and any of: a Glasgow Coma Scale score below 15 on initial assessment; any loss of consciousness; any focal neurological deficit; suspected complex skull fracture or penetrating head injury; amnesia for events before or after the injury; persistent headache; any vomiting since the injury; any seizure; previous brain surgery; a high-energy head injury; a bleeding or clotting disorder; current anticoagulant or antiplatelet treatment (except aspirin alone); intoxication; or continuing concern about the diagnosis. Signs of basal skull fracture include blood behind the eardrum, "panda" eyes, cerebrospinal fluid leaking from the ear or nose and Battle's sign (1.5.8). With a suspected neck injury, paraesthesia in the arms or legs or a focal peripheral deficit is a high-risk factor (1.6.2). CT is the primary investigation, and people who need CT where none is available are transferred (1.5.1, 1.5.5). CT within 1 hour for a GCS score of 12 or less on initial assessment, below 15 at 2 hours after the injury, a suspected open or depressed skull fracture, any sign of basal skull fracture, a post-traumatic seizure, a focal neurological deficit, or more than 1 episode of vomiting (1.5.8); CT within 8 hours after loss of consciousness or amnesia with a bleeding or clotting disorder or a dangerous mechanism (1.5.9); consider CT for anticoagulant or antiplatelet treatment other than aspirin alone (1.5.13). Only assume a depressed conscious level is due to intoxication after an important brain injury has been excluded (1.4.2). Consider referral for irritability or altered behaviour (1.2.5). Signs of deterioration include agitation or abnormal behaviour, a drop in GCS, severe or increasing headache, persistent vomiting, and new neurological signs (1.9.13); a second competent person confirms deterioration if possible, otherwise the supervising doctor is contacted without waiting (1.9.14). With a suspected neck injury, an axial load to the head is a high-risk factor (1.6.2).
6. Cardona V, Ansotegui IJ, Ebisawa M, et al. World Allergy Organization anaphylaxis guidance 2020. World Allergy Organ J. 2020;13(10):100472. PMID 33204386. doi:10.1016/j.waojou.2020.100472 Supports: Anaphylaxis is highly likely with acute skin or mucosal involvement plus respiratory or cardiovascular involvement, or severe gastrointestinal symptoms (severe crampy abdominal pain, repetitive vomiting), especially after exposure to non-food allergens; intramuscular epinephrine (adrenaline) continues to be the first-line treatment; remove exposure to the trigger if possible (for example, discontinue administration of drugs or therapeutic agents).
7. McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. PMID 29462280. doi:10.1093/cid/cix1085 Supports: Guideline on C. difficile infection, which the ACG acute diarrhea guideline does not cover. Only the abstract was read; its testing criteria are not used here, and the flag on diarrhea during or after antibiotics is a referral to the flight surgeon only.
8. 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 7102 requires body waste, including vomitus, to be collected and contained; its rationale notes that vomiting may trigger bystander nausea and vomiting in adjacent crewmembers, so a cluster is not necessarily an infection. Section 10.6 covers automated and robotic systems.
9. 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.
10. 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: Requirement IDs beginning V1.
11. 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.
12. 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.
13. 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.