RMP-GI-003 Constipation and bloating: private bowel and symptom log, relay to the flight surgeon (no drug, fluid or diet advice)

1 · Identity and scope

When a crewmember reports hard or infrequent stools, straining, a feeling of not emptying, or bloating, the robot keeps a private log (red flags first; clock times of bowel movements, bloating, fluids taken and urine passed, as reported, and medicines logged by humans), shows it to the crewmember, and sends summaries to the flight surgeon. Red flags go to the CMO and flight surgeon at once. The robot handles no stool or waste, gives no drug, fluid, food or exercise advice, and fetches a medicine only after a human order, through RMP-PHARM-001.

Why this protocol was chosen. Constipation is common in flight: NASA records list 113 episodes of constipation (space adaptation) among US astronauts through 2006, and 9 on the ISS through Expedition 40; NASA groups constipation and urinary retention with space adaptation sickness, and treats it with fluid management and fiber, with stool softeners and laxatives available. On Earth, functional constipation is generally defined as difficult or seemingly incomplete bowel movements, or bowel movements once every 3-4 days or less, without alarm symptoms; dehydration, inactivity, low food intake and some medicines (for example some motion-sickness, pain and allergy medicines) are linked with it, and alarm symptoms such as rectal bleeding, obstructive symptoms or recent onset call for a doctor's assessment (WGO 2010). A US guideline is given entirely to constipation caused by opioid medicines (AGA 2019), so the medicine class is passed to the flight surgeon (RF9); the robot names none. A private, exact log lets the flight surgeon see the trend and spot the warning signs early. The plain-language red flags for "obstructive symptoms" (belly swelling with vomiting, or not passing wind or stool) translate the WGO term (design judgment, kept URGENT by the review). Belly pain (RF1) and dizziness or fainting (RF7) are not WGO alarm features; they are design judgment, matching the rest of the library.

Autonomy: Tier 3 as in the library contents: a logging aid only. The robot handles no stool or waste and names no medicine.

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

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 privately and can stop or pause them at any time
• Second trained CMO: receives alerts if the CMO is the patient

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 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 The check-in is private: the crewmember chooses where it happens and who is present; bowel questions can be answered on the crewmember's own screen instead of by voice.V1 3004
• PRE-4 Robot self-test passed.V2 10161
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to private check-ins and chooses voice or screen. Any question can be declined; an explicit "no" is logged as declined for that question only. Reading the waste-system log needs the crewmember's agreement.

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; an alert already sent is not withdrawn.

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 private log, tell the CMO, and send a "constipation or bloating 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

   Run a private check-in by voice or on the crewmember's screen: red-flag questions first, then bowel movements (clock times and how they were), bloating, fluids taken and urine passed, as reported. Log answers word for word. D1 is checked after every answer.

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

   V1 3004

   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.
3. S3RobotRung 2

   Show the crewmember their own log as a clock-time timeline, with no words about whether it is good or bad. Medicines are shown only as entries on a clock-time timeline (what the CMO or crewmember states was taken, and when). No running counter or elapsed time per dose, and no tone, colour or spoken cue tied to a dose interval.

   Done when: Timeline shown; the crewmember can add notes.

4. S4Crew

   The CMO sees the crewmember in person when asked or on any red flag, and examines as the CMO chooses. Any medicine, food, fluid or exercise plan is decided by the CMO or flight surgeon.

   Done when: CMO entries logged.

   V1 3004

5. S5RobotRung 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.

   V2 7059

   D3DecisionRobot 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
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: the timeline of bowel movements, bloating, fluids and urine as reported, CMO entries, medicines logged by humans, RMP-PHARM-001 results 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 any treatment, fluid, food or exercise plan, further checks (for example RMP-GI-001) and work limits. The robot logs the decisions.

   Done when: Decision logged.

   V1 3004

   D4DecisionGround decides

   What is the plan (treatment, fluids, food, exercise, further checks, 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 private 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.

   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, answer and alert, 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
• 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 [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 CMO who is the patient, lost link, and an RMP-PHARM-001 MISMATCH. Pass: Every red flag acts as listed; no response escalates; zero advice or cause statements; zero hand-overs after a MISMATCH; zero self-starts.
2. Earth analog. Bed-rest or isolation analog volunteers using private check-ins (no illness needed). Pass: Data completeness at or above <set by validation>; volunteers rate the check-ins as private and not intrusive.
3. 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 [10].

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

• Only the robot pauses; crew care never waits for the link or the robot.
• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps running private check-ins and logging offline.
• 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 log, 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.

[9]

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: 113 constipation (space adaptation) events and 2 hemorrhoid events among US astronauts (Shuttle, Mir and ISS through 2006); Table 1: 9 constipation events on the ISS through Expedition 40.
2. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Space adaptation sickness includes constipation and urinary retention; constipation is treated with fluid management and fiber, and stool softeners and laxatives are available; medicines used for space adaptation sickness include promethazine and meclizine (antihistamines).
3. World Gastroenterology Organisation. WGO Global Guidelines. Constipation: a global perspective (November 2010). www.worldgastroenterology.org/UserFiles/file/guidelines/cons… Supports: Functional constipation is generally defined as persistent difficult or seemingly incomplete defecation and/or infrequent bowel movements (once every 3-4 days or less) in the absence of alarm symptoms or secondary causes; risk factors include inactivity, low calorie intake and the number of medications taken; associated conditions include dehydration and fluid depletion; medications associated with constipation include antihistamines, antispasmodics, opiates and others (Table 3); alarm symptoms (Table 5) include change in stool caliber, heme-positive stool, iron-deficiency anemia, obstructive symptoms, recent onset of constipation, rectal bleeding, rectal prolapse and weight loss.
4. Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, Hanson BJ, Sultan S; American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019;156(1):218-226. PMID 30340754. doi:10.1053/j.gastro.2018.07.016 Supports: A US gastroenterology guideline given entirely to constipation caused by opioid medicines. Cited only for that fact (RF9: the medicine class goes to the flight surgeon); only the PubMed record was read, and the robot names and advises no medicine.
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: In the NICE sepsis guideline's risk table for community settings (Table 1), not passing urine in the previous 18 hours and objective evidence of a new altered mental state are high-risk criteria; the guideline asks about fever or shaking chills but says not to rely on fever alone. Used as context for the no-urine, fever and confusion red flags; the hours and the temperature stay placeholders.
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 3003 item a (periodic monitoring of general health status); V1 3004 items c (privacy), d (history) and m (administering and managing all medications).
7. 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.
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: Requirement IDs beginning V2.
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.