{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.4", "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": "2026-10-20", "reviewed": "2026-10-20", "human_clinician_review": false, "text": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 2 review, 51 corrections); all corrections are applied in this version. No named human clinician has reviewed it." }, "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-INF-001", "slug": "rmp-inf-001", "title": "Fever or feeling feverish: temperature and vital-sign recording support, early escalation to the flight surgeon", "category": "infection", "tier": 1, "result_language": { "use": [ "recorded, not interpreted", "sent to flight surgeon", "above / below the set alert level" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "no infection", "not sepsis", "just a virus", "fever gone", "safe" ] }, "scope": { "summary": "When a crewmember feels feverish, has chills or shaking, or feels very unwell, the robot alerts the CMO and the flight surgeon at the start, brings the thermometer, vital-signs monitor and infection-control kit, and records temperature, heart rate, breathing rate, blood pressure, oxygen saturation and alertness as the crew measure them. It asks structured questions (chills or shaking, urine in the past 18 hours, rash, wounds, local symptoms), sends everything to the flight surgeon, and repeats the recordings on the flight surgeon's schedule. It never names a cause and gives no drug, fluid or oxygen advice.", "why": "Infection can become serious quickly, and NICE advises not to rely on fever alone, since people with sepsis may not have a high temperature. Among 46 long-duration station crew, upper respiratory symptoms (0.97 per flight year) and other infections were among the most reported immune-related events. Body temperature also behaves differently in space: resting core temperature rose by about 1 °C over 2.5 months of flight and rose higher and faster during exercise, so alert levels are set against each crewmember's in-flight baseline and the time since exercise is recorded. The red flags are modeled on the NICE sepsis guideline's risk table for community settings (NG253 Table 1), not the hospital NEWS2 score; the robot does not calculate any score. In someone with a fever, not answering can be new confusion, and an oximeter that cannot get a reading can be a sign of poor circulation, so both are escalated. A robot that fetches and records lets the CMO stay with the patient.", "covers": [ "A measured or felt fever, chills, shaking (rigors), or feeling very unwell, in a crewmember who is responsive and breathing normally", "Repeat recordings on the flight surgeon's schedule" ], "locked_out": [ "Any drug advice, including fever reducers and antibiotics", "Starting, stopping or adjusting oxygen or fluids", "Saying there is or is not an infection or sepsis, or naming a source", "Taking blood or any sample with a needle (RMP-PREV-004 covers labeling only)", "Placing a thermometer in the mouth, ear or rectum (the crewmember or CMO does it)", "Deciding isolation or evacuation (the flight surgeon decides; see RMP-INF-003 and RMP-EGR-001)" ], "related": [ "RMP-INF-002", "RMP-INF-003", "RMP-RENAL-001", "RMP-SKIN-001", "RMP-ENT-004", "RMP-EGR-001", "RMP-PHARM-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": [ "Patient: answers questions and can stop the robot at any time", "Second crewmember: helps if the CMO is busy" ], "robot_may": [ "Alert the CMO and flight surgeon at the start, when the link is up", "Fetch the thermometer, vital-signs monitor, pulse oximeter and infection-control kit (masks, gloves, wipes) and restrain them by the patient", "Record readings with the time, the method and the time since the patient last exercised", "Ask structured questions and log the answers word for word", "Send recordings to the flight surgeon and remind the CMO when a repeat is due", "Clean and disinfect what it used (RMP-INF-002)" ], "robot_may_not": [ "Touch the patient, place a thermometer, or attach sensors", "Interpret any reading, or say it is normal", "Suggest, choose or dose any medicine, fluid or oxygen", "Decide isolation or evacuation", "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": "Patient is responsive and breathing normally. If not, the CMO starts emergency care (cardiac arrest: RMP-CARD-001) and this protocol stops.", "check": "patient_responsive == true and breathing_normal == true" }, { "id": "PRE-2", "text": "A crewmember started the run by command; the CMO is present and able to take over.", "check": "human_start == true and cmo_present == true", "refs": [ "V2 10174", "V2 10168" ] }, { "id": "PRE-3", "text": "Patient, caregiver and kits restrained.", "refs": [ "V2 7046" ] }, { "id": "PRE-4", "text": "Thermometer and monitor self-tests passed; robot self-test passed.", "refs": [ "V2 10161" ] }, { "id": "PRE-5", "text": "Robot and kits cleaned before use (RMP-INF-002). The CMO decides masks, gloves and distancing at the start (S1), before others approach." }, { "id": "PRE-6", "text": "Link status and current delay known." } ], "consent": { "standard": "The patient agrees by voice or touch; logged.", "emergency": "If the patient cannot agree, the robot fetches and records only on a CMO decision (and the flight surgeon's, when the link allows), logged as an emergency decision.", "withdrawal": "The patient can stop the robot at any time; it backs away." }, "inputs": [ { "id": "IN-1", "name": "Temperature, with the method (for example oral or ear) and the time since the patient last exercised", "source": "Thermometer, read by the crew or sent by the device", "required": true, "if_missing": "CMO reads it and enters it." }, { "id": "IN-2", "name": "Patient's in-flight baseline temperature, heart rate and blood pressure", "source": "Medical record", "required": false, "if_missing": "Note \"no in-flight baseline\" for the flight surgeon." }, { "id": "IN-3", "name": "Heart rate (and any irregular-rhythm flag from the monitor), blood pressure and oxygen saturation, with the oximeter probe site and device", "source": "Monitor and pulse oximeter", "required": true, "if_missing": "CMO measures by hand and enters; log \"not measured\". If the oximeter cannot get a reading, send an URGENT alert as well (D2). A missing value is never treated as reassuring." }, { "id": "IN-4", "name": "Breathing rate and alertness (including any new confusion)", "source": "Entered by the CMO", "required": true, "if_missing": "Log \"not measured\"; ask the CMO." }, { "id": "IN-5", "name": "Skin check by the CMO: mottled or ashen, blue lips or tongue, a rash that does not fade when pressed, any wound or skin break", "source": "Entered by the CMO", "required": true, "if_missing": "Log \"not checked\"; remind the CMO." }, { "id": "IN-6", "name": "Questions: chills or shaking; how often urine was passed in the past 18 hours; cough, sore throat, pain passing urine, flank or belly pain, headache with stiff neck; any injury, procedure or catheter in the past 6 weeks (including RMP-RENAL-002 catheterization); whether they reported feeling unwell before this episode; similar symptoms recently", "source": "Patient, by voice or touch", "required": true, "if_missing": "If the patient declines a question, log \"declined\". If the patient does not answer (rather than declining), log \"no answer\" and ask the CMO to check alertness now (RF3, D2). Never treated as reassuring." }, { "id": "IN-7", "name": "Link status and delay", "source": "Communications system", "required": true, "if_missing": "Treat as link down." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "On a crew command such as \"fever\", alert the CMO and, if the link is up, send an immediate \"fever event started\" alert to the flight surgeon; start the event clock; prompt the CMO: \"Decide masks, gloves and distancing now, before others approach.\" Recordings follow as they are made.", "success": "CMO acknowledges; flight surgeon alert delivered, or queued if there is no link.", "refs": [ "V2 10174", "V1 6003" ] }, { "id": "S2", "actor": "robot", "rung": 2, "action": "Bring the infection-control kit (masks first), then the thermometer, vital-signs monitor and pulse oximeter; restrain them by the patient.", "success": "Kits restrained at the patient.", "limit": "", "refs": [ "V2 7046" ] }, { "id": "S3", "actor": "crew", "action": "The patient or CMO takes the temperature; the CMO attaches the blood pressure cuff and oximeter, counts the breathing rate, checks alertness and checks the skin.", "success": "Readings taken, or marked \"not measured\"." }, { "id": "S4", "actor": "robot", "rung": 2, "action": "Record each reading with the time, method, patient ID and time since the patient last exercised, and the oximeter probe site and device (pulse oximeters can overestimate oxygen saturation; overestimation has been reported in people with dark skin).", "success": "Readings recorded." }, { "id": "S5", "actor": "robot", "rung": 2, "action": "Ask the structured questions and log the answers word for word. If the patient stops answering, ask the CMO to check alertness now (RF3); do not carry on with the questions.", "success": "Answers logged, or \"no answer\" escalated to the CMO." }, { "id": "S6", "actor": "robot", "rung": 2, "action": "Send the readings and answers to the flight surgeon at once, or queue them and show the CMO the onboard checklist page. Compare each value with the red-flag list and apply the action listed for each match.", "success": "Delivered or queued; alerts sent.", "refs": [ "V1 6003", "V1 7003" ] }, { "id": "S7", "actor": "robot", "rung": 2, "action": "Prompt the CMO on screen when a repeat recording is due (every minutes, and at once if the patient feels worse); the robot approaches only when the CMO accepts, then records and sends each repeat. A prompt never starts the robot.", "success": "Each repeat recorded and sent.", "refs": [ "V2 10174" ] }, { "id": "S8", "actor": "ground", "action": "The flight surgeon (or the CMO under the onboard checklist when there is no link) decides tests, treatment, isolation and any evacuation planning; the robot logs the decisions.", "success": "Decision logged.", "refs": [ "V1 3007" ] }, { "id": "S9", "actor": "robot", "rung": 2, "action": "Clean and disinfect the thermometer, monitor, kits and its own surfaces per RMP-INF-002; update inventory.", "success": "Cleaning and inventory logged.", "refs": [ "V2 7059" ] } ], "decisions": [ { "id": "D1", "after": "S1", "decided_by": "crew", "question": "Is the patient unresponsive, not breathing normally, or newly confused?", "branches": [ { "if": "Yes", "then": "The CMO starts emergency care; URGENT call to the flight surgeon; cardiac arrest goes to RMP-CARD-001." }, { "if": "No", "then": "Continue." } ] }, { "id": "D2", "after": "S4", "decided_by": "robot", "question": "Is any reading missing, did a device fail, or did the patient not answer?", "branches": [ { "if": "The oximeter cannot get a reading", "then": "URGENT alert to the CMO and flight surgeon (this can indicate poor circulation because of shock), and ask the CMO to check the patient now; record the probe site and device. Never treated as only a device fault." }, { "if": "The patient does not answer a question (rather than declining)", "then": "URGENT: ask the CMO to check alertness now; treated as possible new confusion (RF3). Never treated as reassuring." }, { "if": "Another reading is missing, or another device failed", "then": "Ask the CMO to measure by hand and enter it; log \"not measured\". Never treated as reassuring." }, { "if": "No", "then": "Continue." } ] }, { "id": "D3", "after": "S6", "decided_by": "robot", "question": "Does any value or answer meet a red flag?", "branches": [ { "if": "Yes", "then": "Apply the action listed for each matching red flag (all are URGENT in this protocol): alert the CMO and flight surgeon; the robot names the value, not its meaning." }, { "if": "No", "then": "Continue the repeat schedule. Values below the alert level do not rule out a serious infection." } ] }, { "id": "D4", "after": "S7", "decided_by": "ground", "question": "What happens next (tests, treatment, isolation, evacuation planning)?", "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 at the next contact." } ] } ], "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: it pauses any movement in its stopped position and tells the CMO. This pauses robot movement only: the CMO's sepsis checklist and crew oxygen continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether to continue offline under the pre-approved onboard checklist; the robot resumes only on the CMO's confirmation. Everything is logged and sent to the flight surgeon at the next contact.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "Patient becomes unresponsive, stops breathing normally or becomes confused", "action": "Robot stops, tells the CMO and alerts the flight surgeon; the CMO starts emergency care (RMP-CARD-001 for cardiac arrest).", "level": "urgent" } ], "red_flags": [ { "id": "RF1", "sign": "Temperature high", "threshold": " °C or higher, or more than °C above the crewmember's in-flight baseline (recorded with the time since exercise)", "action": "URGENT alert to the CMO and flight surgeon", "source": "stahn" }, { "id": "RF2", "sign": "Temperature low", "threshold": "below °C", "action": "URGENT alert (NICE: do not rely on fever or hypothermia alone)", "source": "ng253" }, { "id": "RF3", "sign": "New confusion, drowsiness, or a change in behavior noticed by the patient or crew, or the patient stops answering", "threshold": "any", "action": "URGENT alert; the CMO checks alertness now", "source": "ng253" }, { "id": "RF4", "sign": "Breathing rate high, or oxygen saturation low", "threshold": "breathing above per minute; saturation below %", "action": "URGENT alert", "source": "ng253" }, { "id": "RF5", "sign": "Heart rate high, or systolic blood pressure low", "threshold": "above beats per minute; below mmHg, or more than mmHg below the crewmember's in-flight baseline", "action": "URGENT alert", "source": "ng253" }, { "id": "RF6", "sign": "Mottled or ashen skin, blue lips or tongue, or a rash that does not fade when pressed", "threshold": "any (CMO check)", "action": "URGENT alert", "source": "ng253" }, { "id": "RF7", "sign": "Little or no urine", "threshold": " (NICE asks how often urine was passed in the past 18 hours)", "action": "URGENT alert", "source": "ng253" }, { "id": "RF8", "sign": "Shaking chills (rigors)", "threshold": "any", "action": "URGENT alert (NICE asks about rigors as part of the assessment; they are not a risk-table criterion, but this draft escalates them)", "source": "ng253" }, { "id": "RF9", "sign": "The patient feels very unwell, or the CMO is worried", "threshold": "any", "action": "URGENT alert; values below the alert level do not override this", "source": "ng253" }, { "id": "RF10", "sign": "Fever with flank pain or urinary symptoms", "threshold": "any", "action": "URGENT alert; a suspected infected, blocked kidney needs urgent drainage plus antibiotics, which may not be available onboard (RMP-RENAL-001); the flight surgeon decides, including on evacuation [V1 3007]", "source": "eau" }, { "id": "RF11", "sign": "Fever with worsening headache, stiff neck, or new neurological signs", "threshold": "any", "action": "URGENT alert", "source": "nice150" }, { "id": "RF12", "sign": "Fever with a wound, burn or spreading redness", "threshold": "any", "action": "URGENT alert; see RMP-SKIN-001" }, { "id": "RF13", "sign": "A new irregular heartbeat flagged by the monitor", "threshold": "any", "action": "URGENT alert (the robot relays the flag; it does not read the rhythm)", "source": "ng253" }, { "id": "RF14", "sign": "The oximeter cannot get a reading", "threshold": "any", "action": "URGENT alert; the CMO checks the patient now (possible poor circulation)", "source": "ng253" } ], "safety_limits": [ { "id": "L1", "name": "Contact with the patient", "value": "not allowed", "enforced": "Keep-out zone; items are passed to the CMO, not placed on the patient", "refs": [ "V2 10172" ] }, { "id": "L2", "name": "Robot speed near crew", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] }, { "id": "L3", "name": "Hand-over force when passing kits", "value": "", "enforced": "Force sensing at the gripper" }, { "id": "L4", "name": "Time from command to kits at the patient", "value": "", "enforced": "Logged; if exceeded, crew fetch kits directly" } ], "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": "Event start, first flight surgeon alert, each reading with time since exercise, and each repeat, so delays can be audited." } ], "requirements": [ { "id": "V1 3004", "use": "In-mission care includes assessing and trending vital signs, personal protective equipment, and administering and managing medications (a human capability)." }, { "id": "V1 3006", "use": "Two crew medical officers per vehicle for NASA programs (see the commercial-flight note)." }, { "id": "V1 3007", "use": "Evacuation for problems beyond onboard care; the flight surgeon decides." }, { "id": "V1 6003", "use": "Logs and alerts sent to the ground are private medical communications." }, { "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 kits restrained." }, { "id": "V2 7059", "use": "Inventory updated with supplies used." }, { "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 fever scenarios, including sepsis-like cases with a temperature below the alert level, missing readings and device failures, at station, Moon and Mars delays.", "pass": "Flight surgeon alert at time zero in every case with a link; every red flag alerts; zero cases where a missing value is reported as reassuring; zero cause statements." }, { "stage": "training model", "what": "Manikin or standardized-patient drills; crew take readings while the robot fetches and records.", "pass": "Time from command to first transmitted readings at or below ." }, { "stage": "Earth analog", "what": "Analog crews with remote flight surgeons.", "pass": "Pass criteria set in advance by the clinical lead and safety board." }, { "stage": "flight use under flight surgeon supervision", "what": "First use for scheduled temperature checks on healthy crew, to build in-flight baselines.", "pass": "No safety events; readings usable." } ], "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 any crewmember. The flight surgeon is alerted at the start when the link allows; otherwise the CMO follows the onboard checklist, with flight surgeon review at the next contact." }, "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 is alerted at the start and sees readings in near real time.", "loss_of_signal": [ "The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps recording on schedule and queues everything.", "The CMO's sepsis checklist and crew oxygen continue under the onboard checklist and never wait for the link or the robot.", "The CMO decides under the pre-approved onboard checklist; the robot never waits for the ground before urgent onboard care.", "At the next contact the robot sends one package: readings, answers, alerts and decisions." ], "mars_delay": [ "With up to about 21-23 minutes one way, and blackouts of about 2-3 weeks, the CMO acts on red flags onboard.", "Alert levels (set against each crewmember's in-flight baseline), the repeat schedule and the onboard treatment plan must be set before flight." ], "max_delay_for_live_guidance": "" }, "sources": [ { "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": "Red flags are modeled on NG253 Table 1 (community settings), not the hospital NEWS2 score; the robot calculates no score. Do not rely on fever or hypothermia alone (1.4.1); a rise in temperature can be a physiological response (1.4.3); heart rate is lower in fit adults and a new arrhythmia can be a response to infection; interpret blood pressure against previous values (Table 1: systolic more than 40 mmHg below normal); changes in mental state are significant and may be subtle (1.4.6-1.4.7); if oxygen saturation is difficult to measure, this may indicate poor peripheral circulation because of shock (1.4.10), and pulse oximeters may overestimate saturation, which has been reported in people with dark skin; trauma, surgery or invasive procedures in the last 6 weeks is a risk factor; ask how often urine was passed in the past 18 hours and about rigors (1.3.5), and about previous presentations (1.3.6). Numbers from the guideline are not used as thresholds here." }, { "key": "stahn", "text": "Stahn AC, Werner A, Opatz O, et al. Increased core body temperature in astronauts during long-duration space missions. Sci Rep. 2017;7(1):16180.", "url": "https://doi.org/10.1038/s41598-017-15560-w", "doi": "10.1038/s41598-017-15560-w", "pmid": "29170507", "supports": "During exercise, core body temperature rose higher and faster in space than on Earth; resting core temperature rose by about 1 °C, developing gradually over 2.5 months of flight." }, { "key": "crucian", "text": "Crucian B, Babiak-Vazquez A, Johnston S, et al. Incidence of clinical symptoms during long-duration orbital spaceflight. Int J Gen Med. 2016;9:383-391.", "url": "https://doi.org/10.2147/IJGM.S114188", "doi": "10.2147/IJGM.S114188", "pmid": "27843335", "supports": "Among 46 long-duration ISS crewmembers, upper respiratory symptoms (0.97 per flight year) and various other infections were among the most reported events in the categories studied (infections, allergies, rashes and hypersensitivities)." }, { "key": "ermed", "text": "NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017).", "url": "https://humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf", "supports": "Table 2: 33 respiratory infections, 13 skin infections and 9 urinary tract infections among US astronauts (Shuttle, Mir and ISS through 2006)." }, { "key": "eau", "text": "European Association of Urology. EAU Guidelines on Urolithiasis.", "url": "https://uroweb.org/guidelines/urolithiasis", "supports": "Section 3.4.2: the obstructed kidney with all signs of urinary tract infection and/or anuria is a urological emergency; urgent decompression is often necessary, with antibiotics." }, { "key": "nice150", "text": "National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150.", "url": "https://www.nice.org.uk/guidance/cg150/chapter/Recommendations", "supports": "Headache features that need further investigation or referral include worsening headache with fever, sudden-onset headache reaching maximum intensity within 5 minutes, new-onset neurological deficit, and impaired level of consciousness." }, { "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": "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": "Requirement IDs beginning V1." }, { "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": "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": "2026-10-20", "version": "0.2", "source": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 2 review)", "items": [ "Red flags are described as modeled on NG253 Table 1 (community settings), not NEWS2; the robot calculates no score; rigors are an assessment question, escalated by this draft (item 23).", "Low blood pressure is also judged against the in-flight baseline; added in-flight baseline heart rate and blood pressure, and RF13 for a new irregular heartbeat flagged by the monitor (item 24).", "An oximeter that cannot get a reading now triggers an URGENT alert (possible poor circulation from shock), and the probe site and device are recorded (item 25).", "A question the patient does not answer (rather than declines) is now treated as possible new confusion: the CMO checks alertness at once (item 26).", "Added questions about any injury, procedure or catheter in the past 6 weeks and earlier reports of feeling unwell (item 27).", "RF2 (low temperature) now cites NG253 (item 28).", "RF10 notes that drainage and antibiotics may not be available onboard and the flight surgeon decides on evacuation [V1 3007]; cites EAU section 3.4.2 (item 29).", "The CMO is prompted at S1 to decide masks, gloves and distancing before others approach; masks are brought first (item 30; no guideline text verified for this order).", "Each red-flag decision now applies the action listed for each matching red flag (URGENT alert, stop, or private flag), not URGENT for everything (review item 47).", "Repeat check-ins inside an open log are now on-screen prompts; the robot approaches only when the crewmember or CMO accepts, and a prompt never starts it (item 49, [V2 10174]).", "Red flags that had no source now cite one where a source fits; the rest are shown as general clinical red flags with no source cited (item 50).", "The \"item that failed a check\" lockout is kept and now notes that it applies when RMP-PHARM-001 is used (item 51).", "NASA evidence reports are cited as \"approved for public release\" (item 48)." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Batch 7 editorial (AI-assisted), Oct 21, 2026", "items": [ "Citation labels changed to the site's year-only convention: \"(approved for public release )\" now reads \"(YYYY)\", and NASA-STD-3001 Volume 2 \"Revision F (approved July 14, 2026)\" now reads \"(Rev F, 2026)\" (sources: ermed, v2). Editorial; no change to steps, thresholds or limits." ] }, { "date": "2026-10-21", "version": "0.4", "source": "Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026", "items": [ "X5 and the comms loss-of-signal branch now say only the robot pauses: the CMO's sepsis checklist and crew oxygen continue under the onboard checklist and never wait for the link or the robot (batch 7 review item 13). Editorial; robot behaviour unchanged." ] } ] }