RMP-INF-003 Isolating a sick crewmember: supply deliveries and check-ins to reduce contact (the flight surgeon decides on isolation)

1 · Identity and scope

When the flight surgeon or the CMO decides that a sick crewmember should stay apart from the others, the robot delivers supplies, food and water to a hand-over point outside the isolation area, carries out only sealed waste, runs on-screen check-ins the crewmember accepts, and alerts on red flags. The robot is cleaned under RMP-INF-002 after each delivery.

Why this protocol was chosen. Infection spreads easily in a confined spacecraft: microbe-carrying aerosol particles persist in weightlessness and crew immunity changes in flight (Mermel 2013). On Earth, the CDC isolation guideline (2007) recommends a single room for patients who pose a transmission risk, hand hygiene, dedicated patient-care equipment or cleaning before use on another patient, frequent cleaning of touched surfaces, more than 3 feet of separation for droplet spread, a mask when the patient leaves the room, ending precautions when symptoms resolve or as pathogen guidance states, and placement decided case by case, weighing infection risk against the potential adverse psychological impact on the isolated patient. How these apply to a vehicle (which module, air flow, how long) is the flight surgeon's decision with the commander; using the robot to deliver supplies so fewer crewmembers have close contact is design judgment. NASA-STD-3001 requires a means to isolate released biological contaminants (V2 6063) and private psychological communication (V1 6011). A robot that enters the isolation area counts as patient-dedicated equipment until it is cleaned under RMP-INF-002 (CDC V.B.5.b and IV.F.5), so it delivers to the hand-over point by default and enters only for a listed delivery the CMO sends it on. Airborne precautions depend on the vehicle's air flow, which the flight surgeon and commander decide.

Autonomy: Max rung 2 for supervised deliveries to a hand-over point outside the isolation area, carrying out sealed waste, and on-screen check-ins the crewmember accepts. The robot never decides on isolation, never enforces it, and never waits or pauses inside the isolation area.

Related: RMP-INF-001 · RMP-INF-002 · RMP-RESP-001 · RMP-GI-002 · RMP-BEH-002 · RMP-BEH-001 · 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

• Vehicle commander: decides on the isolation area and crew movement with the flight surgeon
• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Behavioral health team (ground): available for private calls
• Other crew: help as the CMO or commander directs

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [12]

3 · Preconditions and consent

• PRE-1 The flight surgeon or the CMO decided on isolation, the commander named the isolation area and the hand-over point, and the crewmember agreed.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]

Consent

Isolation is by agreement; the crewmember chooses whether to answer each check-in and can ask for a private call at any time.

Emergency consent

In an emergency the commander's procedure overrides isolation; the robot follows the matching protocol on a human command.

Withdrawal

The crewmember can decline any check-in; an explicit "no" is logged as declined, and silence as "no response".

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   Tell the flight surgeon, the CMO and the commander that isolation support has started, with the area and hand-over point as stated (URGENT if any red flag is stated). Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.

   Done when: Notice acknowledged.

   V1 3006V2 10174

2. S2Crew

   The CMO and commander set up the isolation area under the onboard checklist (module, air flow, hand-over point, the crewmember's own thermometer and oximeter); the crewmember wears a mask outside the area.

   Done when: Area set up as stated.

   V2 6063

3. S3RobotRung 2

   On the CMO's command, run a checked kit fetch of the isolation medical kit (masks, gloves, tissues, thermometer and sealable waste bags, as the kit list states): check the kit ID and seal before hand-over, and quarantine a kit whose ID or seal does not match (no hand-over; the CMO is told). Any medicine goes only through RMP-PHARM-001. If an URGENT red flag has fired or a human states an emergency, bring it instead as an emergency fetch: This is an emergency fetch on a human command (CMO): no barcode check runs before hand-over and nothing waits for one. The robot reads the kit's own label and seal status only if that adds no delay, says "EMERGENCY FETCH – NOT VERIFIED (CMO command)", and "seal not intact" if so, and hands the kit over anyway. The fetch is logged as an override: time, who asked, the reason as stated, kit ID and seal status. It never says "verified". The robot brings it to the hand-over point outside the isolation area.

   Done when: Kit at the hand-over point after a matched ID and seal, or quarantined, or emergency fetch logged.

   Limit: <set by validation>

   V2 7046V2 7059

   D1DecisionRobot decides

   Which kit fetch was it, and what did the checked kit fetch show?

   • EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) → Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use).
   • KIT ID AND SEAL MATCH → Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time.
   • MISMATCH, seal not intact or CANNOT VERIFY → Shown with the reason. No hand-over under this protocol: the kit stays sealed 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 kit go to the CMO, logged there as an override with the reason, and flagged to the flight surgeon. If the need becomes an emergency, a crewmember or the CMO states it and the emergency fetch applies.No hand-over
4. S4RobotRung 2

   On request, bring food, water and personal items to the hand-over point, place them, and move back beyond the keep-out distance before the crewmember collects them. It never enters the isolation area unless the CMO sends it for a listed delivery, and then it leaves at once; it never waits or pauses inside.

   Done when: Delivery placed; robot outside the area.

   Limit: <set by validation>

   V2 10172

5. S5RobotRung 2

   Carry only sealed waste bags the crewmember has closed from the hand-over point to the waste stowage the commander names, never opening them.

   Done when: Sealed bags stowed.

   V2 6063V2 7064

6. S6RobotRung 2

   At the times the flight surgeon sets, show an on-screen check-in the crewmember can accept: temperature as they measure it, saturation as their own oximeter displays it, and symptoms and how they are coping in their own words. Log answers word for word. If the crewmember asks, connect a private call to the flight surgeon or the behavioral health team; never log the content of a private call.

   Done when: Answers logged, or "no response"; calls connected on request.

   V1 6003V1 6011

   D2DecisionRobot 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.
   D3DecisionRobot decides

   Did the isolated crewmember answer the check-in, or say they want to skip it?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once.
7. S7RobotRung 2

   After every delivery or waste run, hold at the cleaning point the commander names until the crew have cleaned it under RMP-INF-002; until then it enters no other module.

   Done when: Robot cleaned before its next task.

   V2 7082V2 7083

8. S8RobotRung 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

9. S9Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on testing, treatment and when isolation ends; the commander announces it.

   Done when: Decision logged.

   V1 3004

   D4DecisionGround decides

   What testing or treatment is needed, and when does isolation end?

   • 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.
10. S10RobotRung 2

    Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.

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

    V2 7059

    D5DecisionRobot decides

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

    • MATCH TO ORDER → RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs "MATCH TO ORDER. Not a dose, interaction or allergy review." and the clock time.
    • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.No hand-over
11. S11RobotRung 2

    When the CMO says the event is over, run RMP-PHARM-001 reconciliation on each kit fetched: record the items the CMO or crew state were used, the remaining contents against the kit list, seal status and expiry, labelled "inventory reconciliation after emergency use – not a check before use". Flag the override to the flight surgeon and the pharmacy lead, and show each kit as "opened – not restocked" until a human restocks and reseals it.

    Done when: Kit reconciled or shown as "opened – not restocked".

    V2 7059

12. S12RobotRung 2

    Send the flight surgeon one private package: deliveries, check-in answers, readings as stated, alerts and decisions.

    Done when: Package delivered or queued.

    V1 6003V1 7003

7 · Stop and escalate rules, red flags

Red flags

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

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Deliveries and waste runs with times; check-in answers word for word; readings as stated; cleaning holds; private calls connected (never their content).
• 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-7 Each emergency fetch as an override (time, who asked, reason as stated, kit ID, seal status) and the later inventory reconciliation, labelled "not a check before use".V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [7] 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 isolation with deliveries, worsening breathing, a failed oximeter reading, a second sick crewmember, distress, CMO as patient, lost link. Pass: Zero pauses inside the area; zero contact; every red flag raised.
2. Training model. Isolation drill in a mock module. Pass: Deliveries and sealed-waste runs completed outside the keep-out distance.
3. Parabolic or station demonstration. Deliveries in weightlessness. Pass: No loose items at the hand-over point.
4. Flight use under flight surgeon supervision. First use for a minor illness. Pass: No safety events.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started after the flight surgeon's or the CMO's isolation decision. The commander names the area.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.2.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [11].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives check-ins when the link allows and can take private calls.

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.
• Crew care of the isolated crewmember and the CMO's sepsis checklist continue under the onboard checklist and never wait for the link or the robot.
• Check-ins continue offline on the CMO's confirmation; answers are stored encrypted for the flight surgeon.

Mars-class delay

• The isolation plan, check-in times and alert values are set before flight; the CMO decides.

[10]

Sources

1. U.S. Centers for Disease Control and Prevention. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, summary of recommendations (2007). www.cdc.gov/infection-control/hcp/isolation-precautions/summ… Supports: Quotes as checked by the AI-assisted batch 8 reviewer (WebFetch, Oct 21, 2026). IV.A.3 hand hygiene; IV.D.1 a single room for patients who pose a risk of transmission; V.B.2.b "make decisions regarding patient placement on a case-by-case basis, balancing infection risks… and the potential adverse psychological impact on the infected or colonized patient" (category II); V.B.5.b "use disposable noncritical patient-care equipment… or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient" (IB); IV.F.5 cleaning policies include "multi-use electronic equipment… and mobile devices that are moved in and out of patient rooms frequently" (IB); V.B.6 clean frequently touched surfaces often; V.C.2.a.iv spatial separation of more than 3 feet for droplet precautions; V.C.4.b the patient wears a mask when moved outside the room; V.B.7 discontinue precautions after signs and symptoms resolve or as pathogen-specific guidance states. Earth hospital context; the vehicle layout and the flight surgeon decide what applies on board.
2. Mermel LA. Infection prevention and control during prolonged human space travel. Clin Infect Dis. 2013;56(1):123-130. PMID 23051761. doi:10.1093/cid/cis861 Supports: Abstract: the confined spacecraft environment, the persistence of microbe-containing aerosol particles in weightlessness, and changes in crew immunity raise the importance of infection prevention and control on long missions.
3. 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. PMID 27843335. doi:10.2147/IJGM.S114188 Supports: Among 46 long-duration ISS crewmembers, skin rashes were the most reported clinical event in the categories studied (infections, allergies, rashes and hypersensitivities), at 1.12 per flight year. Wounds were not studied.
4. 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.
5. National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022). www.nice.org.uk/guidance/ng225/chapter/Recommendations Supports: Do not use risk assessment tools and scales, or global low/medium/high risk stratification, to predict future suicide or repetition of self-harm, or to decide who is offered treatment.
6. British Thoracic Society. Guideline for oxygen use in healthcare and emergency settings (emergency oxygen guideline page). Fetched Oct 21, 2026. www.brit-thoracic.org.uk/quality-improvement/guidelines/emer… Supports: Recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94-98%; for known COPD or other risk factors for hypercapnic respiratory failure, 88-92% pending blood gas results. Context for the CMO and flight surgeon only; the robot never starts, stops or adjusts oxygen.
7. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3004, V1 3006, V1 6003, V1 6011, V1 7003.
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 6063 (remove or isolate released contaminants), V2 7064, V2 7082, V2 7083, V2 7059, and Section 10.6 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. 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.
11. 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.
12. 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.