# RMP-INF-004 Air, water and surface sample collection: sampling-plan prompts, sample labelling, sealed carries and incubation log (the crew collect every sample)
# Version 0.2 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE.
# Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/
# Every threshold marked <set by ...> must be set by the named owner (see the schema) before any use.
schema_version: '0.3'
version: '0.2'
status: draft
conceptual: true
not_for_clinical_use: true
max_autonomy: 2
missions:
- leo
- commercial
- moon
- mars
updated: '2026-10-21'
review:
  state: reviewed-ai-assisted
  requested: '2026-10-21'
  human_clinician_review: false
  text: >-
    AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 12 review:
    15 required corrections, R1 to R15; 11 optional suggestions not applied in this version); all required
    corrections that apply to this protocol are applied in this version (see Corrections). No named human
    clinician has reviewed it. Not for clinical use.
  reviewed: '2026-10-21'
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-004
slug: rmp-inf-004
title: >-
  Air, water and surface sample collection: sampling-plan prompts, sample labelling, sealed carries and
  incubation log (the crew collect every sample)
category: infection
tier: 3
rung_note: >-
  Max rung 2 for the scheduled prompt, bringing the sealed sampling kit, labelling samples against the
  sampling plan, carrying sealed samples to incubation or return stowage, and logging read-outs as the
  crew state them. The crew collect every sample and read every result; the robot never opens a sample
  or judges a result.
result_language:
  use:
  - labels match the sampling plan
  - label mismatch – sample held
  - count as stated by the crew
  - sent to the environmental lead and flight surgeon
  - not read
  never:
  - normal
  - no problem found
  - all clear
  - negative
  - any diagnosis or cause
  - clean
  - contaminated
  - within limits
  - over the limit
  - no growth
  - safe to drink
  - drinkable
  - sterile
  - pathogen
  - mould-free
  - safe
  - mild
  - minor
scope:
  summary: >-
    At the times the environmental sampling plan sets (or on a crewmember's command), the robot prompts
    the crew; sampling starts only when a crewmember accepts. The robot brings the sealed sampling kit,
    checks each sample label against the plan (sample type, location, date and clock time, collector),
    carries only sealed samples to the incubation or return stowage the plan names, and logs incubation
    times and the read-outs the crew state. The crew collect every air, water and surface sample and read
    every result. The environmental lead and the flight surgeon compare results with the limits; the robot
    never does.
  why: >-
    ISS microbiology is routinely monitored by different collection methods and growth media, with testing
    on Earth; the in-flight acceptability limits are 1,000 bacterial and 100 fungal CFU (colony-forming
    units) per cubic metre of air, 10,000 bacterial and 100 fungal CFU per 100 cm2 of surface, and 50
    CFU per mL of water with no coliforms (OCHMO-TB-046). Cultivable organisms on ISS surfaces ranged
    from 10^4 to 10^9 CFU per square metre (Checinska Sielaff 2019). NASA-STD-3001 requires microbiologically
    safe air and surfaces and water-quality monitoring (V2 6059, V2 7081, V2 6046). Labelling, sealed
    carries and logging are design judgment, following RMP-PREV-004. Water use while a result is pending
    is the commander's decision with the CMO's advice, under the onboard checklist (design judgment).
  covers:
  - Scheduled and on-command air, water and surface sampling on the environmental sampling plan
  - Labels, sealed carries to incubation or return stowage, incubation times and read-outs as stated
  - 'Crew illness: RMP-INF-001 and RMP-INF-003; cleaning and spills: RMP-INF-002'
  locked_out:
  - Diagnosis or naming a cause
  - Any medicine, fluid or oxygen advice; starting, stopping or adjusting oxygen
  - Touching the crewmember
  - >-
    Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays
    quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override)
  - Collecting a sample, or opening a sample, a plate or a sealed bag
  - Reading, counting or judging a result, or comparing it with a limit
  - Saying that air, water or a surface is clean, contaminated, or fit to use or drink
  - Changing the sampling plan or the sample locations
  related:
  - RMP-INF-001
  - RMP-INF-002
  - RMP-INF-003
  - RMP-PREV-004
roles:
  medical_authority: Flight surgeon (ground). Holds medical authority for every run.
  onboard_lead: >-
    Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when
    there is no link.
  others:
  - 'Second trained CMO: receives every alert and takes over if the CMO is the patient'
  - 'Vehicle commander: leads any cabin emergency procedure'
  - 'Other crew: help as the CMO or commander directs'
  - >-
    Environmental lead (ground, with the flight surgeon): sets the sampling plan and reads every result
    against the limits
  robot_may:
  - Prompt the crew at the times the sampling plan sets
  - Bring the sealed sampling kit
  - Check sample labels against the sampling plan
  - Carry sealed samples to incubation or return stowage
  - Log incubation times and read-outs as stated
  robot_may_not:
  - Collect or open a sample
  - Read or judge a result
  - Say whether air, water or a surface is fit to use
  - Start a scheduled run without a crewmember accepting the prompt
  commercial: >-
    On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority
    and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001
    requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for
    spaceflight participants.)
preconditions:
- id: PRE-1
  text: >-
    The sampling run starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded
    schedule alone never starts it. An unaccepted prompt is logged "not accepted" and the CMO is told.
    A crewmember or the CMO can also start it by command.
  check: human_start == true
  refs:
  - V2 10174
- id: PRE-2
  text: Robot self-test passed; kit stowage locations known.
  refs:
  - V2 10161
  - V2 7059
- id: PRE-3
  text: Robot and supplies restrained when not moving.
  refs:
  - V2 7046
- id: PRE-4
  text: Link status known. The crew never wait for the robot before acting.
  check: link_state in [live, delayed, down]
consent:
  standard: Sampling involves no crewmember's body; the crew agree to their names being logged as collectors.
  emergency: A sampling run stops at once for any emergency.
  withdrawal: The crew can stop a run at any time; samples not taken are listed as "not taken".
inputs:
- id: IN-1
  name: >-
    Environmental sampling plan (sample types, locations, times, incubation and return stowage), set by
    the environmental lead
  source: Environmental lead
  required: true
  if_missing: The robot shows "sampling plan not loaded" and runs only on a crewmember's command.
- id: IN-2
  name: Sample labels (sample ID, type, location, date and clock time, collector)
  source: Robot scanner
  required: true
  if_missing: >-
    Label mismatch – sample held; the robot never relabels. Only the collector corrects a label, and only
    if they can confirm the location and time from the plan; the robot logs the original and the corrected
    label. Otherwise the crew discard or repeat the sample as the plan states.
- id: IN-3
  name: Read-outs as the crew state them (colony counts, test results)
  source: Crew
  required: false
  if_missing: Log "not read".
- id: IN-4
  name: Link status and delay
  source: Communications system
  required: true
  if_missing: Treat as link down; results are queued.
steps:
- id: S1
  actor: robot
  rung: 2
  action: >-
    Tell the flight surgeon and the environmental lead that a sampling run is due or has started (logged
    and sent with the next package; URGENT only if a red flag is stated). The sampling run starts only
    when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts
    it. An unaccepted prompt is logged "not accepted" and the CMO is told. A crewmember or the CMO can
    also start it by command. 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.
  success: Notice logged; prompt accepted or "not accepted" logged.
  refs:
  - V2 10174
  - V1 3006
- id: S2
  actor: robot
  rung: 2
  action: >-
    Bring the sealed environmental sampling kit from its stowage, check its kit ID and seal against the
    plan before hand-over, and hand it over closed; a kit whose ID or seal does not match is held and
    the crew are told.
  success: Kit handed over closed, or held.
  limit: <set by validation>
  refs:
  - V2 7059
- id: S3
  actor: crew
  action: >-
    The crew collect each air, water and surface sample at the locations and times the plan states, wearing
    gloves, and close each sample in its sealed bag.
  success: Samples collected and sealed, or "not taken".
  refs:
  - V2 6059
  - V2 7081
  - V2 6046
- id: S4
  actor: robot
  rung: 2
  action: >-
    Scan each sample label and compare it with the plan (sample type, location, date and clock time, collector).
    Show "labels match the sampling plan" only when every field matches; otherwise show "label mismatch
    – sample held" with the fields named; the robot never relabels. Only the collector corrects a label,
    and only if they can confirm the location and time from the plan; the robot logs the original and
    the corrected label. Otherwise the crew discard or repeat the sample as the plan states, as in RMP-PREV-004.
  success: Each sample shown with its result.
  refs:
  - V2 7059
- id: S5
  actor: robot
  rung: 2
  action: >-
    Carry only sealed sample bags the crew have closed to the incubation or return stowage the plan names,
    never opening them, and log the incubation start time. Then hold at the cleaning point until the crew
    have cleaned the gripper under RMP-INF-002.
  success: Sealed samples stowed; times logged.
  refs:
  - V2 6063
- id: S6
  actor: robot
  rung: 2
  action: >-
    At the read-out time the plan sets, show an on-screen prompt; the crew read each result and state
    it, and the robot logs it word for word as "count as stated by the crew". It never reads, counts or
    judges a result.
  success: Read-outs logged or "not read".
  refs:
  - V1 6003
- id: S7
  actor: robot
  rung: 2
  action: >-
    Ask the crewmember who collected the samples, on screen or by voice, whether they saw mould, a spill,
    or water that looked or smelled unusual, and whether anyone feels unwell; log the answers word for
    word.
  success: Answers logged or "no response".
  refs:
  - V1 6003
- id: S8
  actor: robot
  rung: 2
  action: >-
    After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its
    rest position in the module, with its screen and voice link available, until a human has taken over
    or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans
    say they did, and repeats the alert if it is not acknowledged.
  success: Robot at rest in the module until a human releases it; alert acknowledged or escalated.
  refs:
  - V2 10173
  - V1 3006
- id: S9
  actor: ground
  action: >-
    The environmental lead and the flight surgeon (or the commander and CMO under the onboard checklist
    when there is no link) compare the results with the limits and decide on cleaning and repeat samples;
    water use while a result is pending, or after RF3, is the commander's decision with the CMO's advice,
    under the onboard checklist (with a link, the environmental lead and flight surgeon advise).
  success: Decision logged.
  refs:
  - V2 6046
- id: S10
  actor: robot
  rung: 2
  action: >-
    Send one package to the environmental lead and the flight surgeon: samples taken and not taken, labels,
    times, read-outs as stated, answers and alerts.
  success: Package delivered or queued.
  refs:
  - V1 6003
decisions:
- id: D1
  after: S7
  decided_by: robot
  question: >-
    Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer,
    reading or observation meet a red flag?
  branches:
  - if: 'Yes'
    then: >-
      Stop the current question or step at once and apply the action listed for each matching red flag
      (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert
      goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link
      is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the
      second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not
      acknowledged within <set by validation> seconds is repeated and sent to the next named crewmember.
  - if: 'No'
    then: Continue.
- id: D2
  after: S7
  decided_by: robot
  question: Did the crewmember answer the questions, or say they want to skip them?
  branches:
  - if: 'Yes'
    then: Continue.
  - if: Declined explicitly (the crewmember says no to a question)
    then: Log "declined" for that question only; the alert already sent stands.
  - if: No response, or the answer does not make sense
    then: >-
      URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the
      patient, checks the crewmember in person at once.
- id: D3
  after: S9
  decided_by: ground
  question: What cleaning, water use or repeat sampling applies?
  branches:
  - if: Link live
    then: >-
      Flight surgeon decides on cleaning and repeat samples; water use while a result is pending, or after
      RF3, is the commander's decision with the CMO's advice, under the onboard checklist, and the environmental
      lead and flight surgeon advise; robot logs.
  - if: Link down or delay too long
    then: >-
      The CMO decides on cleaning and repeat samples under the pre-approved onboard checklist; water use
      while a result is pending, or after RF3, is the commander's decision with the CMO's advice, under
      the onboard checklist; the flight surgeon reviews the log 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: before it holds, it moves to a position clear of a hatch route or a crewmember's
    route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew sampling,
    care already under way and all other care continue under the onboard checklist and never wait for
    the link or the robot. The CMO decides whether the robot continues offline under the pre-approved
    onboard checklist; it resumes only on the CMO's confirmation.
  level: pause
  refs:
  - V2 10172
  - V2 10173
- id: X6
  trigger: An URGENT alert is not acknowledged within the set time
  action: >-
    Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if
    the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not
    leave on its own.
  level: urgent
  refs:
  - V1 3006
  - V2 10173
- id: X7
  trigger: The crewmember stops responding, or seems confused or drowsy, at any point
  action: >-
    URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its
    rest position and does not continue the run; a crewmember checks in person.
  level: urgent
- id: X8
  trigger: A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice
  action: >-
    Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.
  level: stop
- id: X9
  trigger: A sample bag or plate leaks or opens
  action: >-
    Robot stops at once, holds the bag where it is without opening or moving it further, tells the crew,
    and holds at the cleaning point until the crew have cleaned it under RMP-INF-002.
  level: stop
  refs:
  - V2 6063
- id: X10
  trigger: Someone needs the space or route the robot is in
  action: Robot moves clear at once without contact and holds; it never pauses in a hatch route.
  level: safe-state
  refs:
  - V2 10172
red_flags:
- id: RF1
  sign: A crewmember needs care during the run (design judgment)
  threshold: any
  action: URGENT alert; the run stops
- id: RF2
  sign: Visible mould or fungal growth on a surface, panel or water port, as stated
  threshold: any
  action: Flag to the environmental lead and flight surgeon; see RMP-INF-002
  source: tb046
- id: RF3
  sign: Water that looks cloudy or coloured, or smells unusual, as stated (design judgment)
  threshold: any
  action: >-
    Flag at once to the commander, CMO, environmental lead and flight surgeon; the commander decides on
    water use with the CMO's advice, under the onboard checklist (with a link, the environmental lead
    and flight surgeon advise)
- id: RF4
  sign: Two or more crewmembers with fever, vomiting or diarrhoea, as stated (design judgment)
  threshold: any
  action: Flag to the flight surgeon; see RMP-INF-001 and RMP-INF-003
- id: RF5
  sign: Any cabin alarm (fire, toxic atmosphere or pressure)
  threshold: any
  action: 'Stop: the run ends and the commander leads the emergency procedure'
  source: atsdrnh3
safety_limits:
- id: L1
  name: Contact with the crewmember
  value: not allowed
  enforced: Keep-out zone in the robot controller
  refs:
  - V2 10172
- id: L2
  name: Opening a sample, plate or sealed bag
  value: not allowed
  enforced: No such task is loaded; gripper limited to sealed-bag carries
- id: L3
  name: Robot speed near the crewmember
  value: <set by validation>
  enforced: Hard limit in the controller
  refs:
  - V2 10172
logs:
- id: LOG-1
  text: Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.
  refs:
  - V2 10163
  - V2 10164
- id: LOG-2
  text: Mode changes and safety-limit events are announced to the operator as they happen and logged.
  refs:
  - V2 10162
  - V2 10172
- id: LOG-3
  text: >-
    Records are stored and sent as private medical data, encrypted, with access limited to the medical
    team.
  refs:
  - V1 6003
  - V1 7003
- id: LOG-4
  text: Results are kept in a permanent, retrievable format so the flight surgeon can see trends.
  refs:
  - V1 7001
- id: LOG-5
  text: >-
    Prompt and acceptance; each sample with type, location, time, collector and label result; incubation
    start; read-outs as stated; answers as stated; sealed carries.
- id: LOG-6
  text: >-
    Each URGENT alert, who received it, the time it was acknowledged (or the escalation to the next named
    crewmember), and the time a human released the robot.
  refs:
  - V2 10163
requirements:
- id: V1 3006
  use: >-
    Two trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO
    is the patient (see the commercial-flight note).
- id: V1 6003
  use: Logs and alerts sent to the ground are private medical communications.
- id: V1 7001
  use: Records kept so the flight surgeon can see trends.
- id: V1 7003
  use: Secure handling of medical records.
- id: V2 6046
  use: Water-quality monitoring; the crew are told when results approach limits.
- id: V2 6059
  use: Microbiologically safe air; the environmental lead reads air samples against the limits.
- id: V2 6063
  use: >-
    Released chemical and biological contaminants are removed or isolated; the robot keeps contaminated
    items sealed and out of clean areas.
- id: V2 7045
  use: Usable by non-physician crew, including when the CMO is the patient.
- id: V2 7046
  use: Patient, caregiver and supplies restrained.
- id: V2 7059
  use: Kit inventory and seal status are tracked.
- id: V2 7081
  use: Microbiologically safe surfaces; the environmental lead reads surface samples.
- 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 runs with a label mismatch, a leaking bag, mould stated, an alarm mid-run, lost link.
  pass: Zero samples opened; zero results judged; every red flag raised.
- stage: training model
  what: Mock sampling run with all three sample types.
  pass: Every label checked; every carry sealed.
- stage: parabolic or station demonstration
  what: Sealed carries in weightlessness.
  pass: No loose items.
- stage: flight use under flight surgeon supervision
  what: First runs alongside the crew's manual log.
  pass: Agreement with the manual log.
signoff:
  protocol:
  - 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
  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 an accepted prompt or a crewmember's command. The crew collect and read every sample; the
    environmental lead and flight surgeon judge every result.
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: results reach the environmental lead when the link allows.'
  loss_of_signal:
  - >-
    Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and
    tells the CMO; it resumes offline only on the CMO's confirmation.
  - >-
    Crew sampling, care already under way and all other care continue under the onboard checklist and
    never wait for the link or the robot.
  - >-
    Results are queued; water use while a result is pending, or after RF3, is the commander's decision
    with the CMO's advice, under the onboard checklist.
  mars_delay:
  - >-
    Mars: water use while a result is pending, or after RF3, is the commander's decision with the CMO's
    advice, under the onboard checklist; results are reviewed with delay.
sources:
- key: tb046
  text: NASA OCHMO. Microbiology. Technical Brief OCHMO-TB-046 Rev A (2025).
  url: https://www.nasa.gov/wp-content/uploads/2025/05/ochmo-tb-046-microbiology-rev-a.pdf
  supports: >-
    ISS microbiology is routinely monitored by various collection methods, growth on different media and
    testing on Earth; culture-based monitoring needs sample return for identification. In-flight acceptability
    limits: air 1,000 bacterial and 100 fungal CFU (colony-forming units) per cubic metre; surfaces 10,000
    bacterial and 100 fungal CFU per 100 cm2; water 50 CFU per mL with no detectable coliforms. Read Oct
    21, 2026 (saved copy in src/b12).
- key: checinska2019
  text: >-
    Checinska Sielaff A, Urbaniak C, Mohan GBM, et al. Characterization of the total and viable bacterial
    and fungal communities associated with the International Space Station surfaces. Microbiome. 2019;7(1):50.
  url: https://doi.org/10.1186/s40168-019-0666-x
  doi: 10.1186/s40168-019-0666-x
  pmid: '30955503'
  supports: >-
    Cultivable bacteria and fungi on ISS surfaces ranged from 10^4 to 10^9 CFU per square metre depending
    on location; the dominant organisms are associated with the human microbiome and may include opportunistic
    pathogens. Abstract read.
- key: atsdrnh3
  text: >-
    Agency for Toxic Substances and Disease Registry (CDC). Medical Management Guidelines for Ammonia
    (NH3). Fetched Oct 21, 2026.
  url: https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=7&toxid=2
  supports: >-
    NIOSH IDLH (immediately dangerous to life or health) 300 ppm. Ammonia is corrosive to eyes, skin and
    airways; upper airway swelling and pulmonary edema may lead to airway obstruction; after severe exposure,
    injury to the eyes, lungs and skin may continue to develop for 18 to 24 hours. Eye exposure: irrigate
    with plain water or saline for at least 15 minutes. Rescuers should be trained and appropriately attired
    before entering the contaminated (hot) zone. No antidote; treatment is supportive (humidified oxygen
    is given by clinicians).
- key: v1
  text: 'NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).'
  url: https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf
  supports: 'NASA-STD-3001 Vol 1 Rev C: V1 3006, V1 6003.'
- 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: >-
    NASA-STD-3001 Vol 2 Rev F: V2 6046, V2 6059, V2 6063, V2 7059, V2 7081, and Section 10.6 automated
    and robotic systems.
- key: tb044
  text: NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025).
  url: https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf
  supports: >-
    The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the
    JSC 48522 medical checklist.
- key: marsdelay
  text: >-
    NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept
    Review).
  url: https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf
  supports: >-
    One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
- key: pccp
  text: >-
    U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change
    control plan for artificial intelligence-enabled device software functions (guidance).
  url: >-
    https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence
  supports: A model for planning, validating and rolling back software updates.
- key: faa460
  text: 'U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.'
  url: https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460
  supports: >-
    Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical
    standards for spaceflight participants.
corrections:
- date: '2026-10-21'
  version: '0.2'
  source: Batch 12 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026
  items:
  - >-
    R13: water use while a result is pending, or after RF3, is the commander's decision with the CMO's
    advice under the onboard checklist; with a link, the environmental lead and flight surgeon advise.
    RF3, S9, D3 and the comms block now match, and the open question is closed. Design judgment.
  - >-
    R14: the robot never relabels a sample. Only the collector corrects a label, and only if they can
    confirm the location and time from the plan; the robot logs the original and corrected labels; otherwise
    the sample is discarded or repeated as the plan states (IN-2 and S4). Design judgment, following RMP-PREV-004.
  - >-
    Batch 12 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026);
    no named human clinician.
