RMP-MSK-001 Major trauma: bring trauma kit, video, assist crew (the robot does not lead)

1 · Identity and scope

After a serious injury (a crush, a high-energy impact, a fall during surface operations, heavy bleeding, or an injury with reduced responsiveness), the robot sends an URGENT alert at once, brings the sealed trauma kit and other emergency kits on command, clears space and restrains loose items, records the CMO's stated assessment in the <C>ABCDE order as a clock-time timeline, and streams video when the link allows. The CMO and crew give all trauma care. The robot never touches the injured crewmember.

Why this protocol was chosen. Trauma is a planning concern for exploration missions, where help is far away; NASA's in-flight medical conditions evidence report describes rapid ultrasound to look for internal bleeding after injury, used by minimally trained crew. On Earth, NICE guideline NG39 orders the first assessment as <C>ABCDE: catastrophic bleeding first, then airway with in-line spinal immobilisation (keeping the neck in line), breathing, circulation, disability (neurological state) and exposure, recording whether the patient is improving or getting worse. In weightlessness, blood and loose objects float and the patient and rescuer must be restrained. A helper that alerts, fetches and keeps the scene clear frees the crew's hands. Open question for review: the onboard method for restraining patient and rescuer for bleeding control in weightlessness, and whether the robot should record a timer for a tourniquet the crew apply (clock time only, never an endpoint).

Autonomy: Max rung raised from 1 to 2 for supervised fetching of the trauma kit, clearing space and video. The robot never applies pressure, a tourniquet, a binder or a collar, never moves the injured crewmember, and never leads the response.

Related: RMP-NEURO-001 · RMP-MSK-002 · RMP-MSK-004 · RMP-SKIN-001 · RMP-SKIN-002 · RMP-CARD-001 · RMP-RESP-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

• 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

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 CMO or the commander started the protocol by command after a serious injury.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]
• PRE-5 When bleeding is present, the CMO and helpers wear the eye protection the onboard checklist names; the crew, never the robot, deal with floating blood.

Consent

Emergency care; recording by the CMO's agreement when the crewmember cannot speak.

Emergency consent

If the crewmember cannot agree, the robot proceeds on the CMO's or commander's command.

Withdrawal

The crewmember or CMO can stop video; the alert and record stand.

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, the CMO's or the commander's word, send an URGENT "major trauma" alert to the flight surgeon and the CMO at once. 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: Alert acknowledged, or escalated.

   V2 10174V1 6003V1 3006

2. S2RobotRung 2

   On the CMO's or commander's command, bring the sealed trauma kit and emergency kit, with eye protection and absorbent containment supplies, to the CMO and restrain them within reach. This is an emergency fetch on a human command (CMO or commander): 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 or commander 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".

   Done when: Kits within reach, or skipped; override logged.

   Limit: <set by validation>

   V2 7046

3. S3Crew

   The CMO leads trauma care under the onboard checklist (Earth context: NICE NG39 <C>ABCDE). Crew restrain patient and rescuer as the checklist directs. The robot stays clear.

   Done when: Human-led care; robot logs what is stated.

   V1 3004

   D1DecisionCrew decides

   Does the crewmember show no signs of life (unresponsive, not breathing normally)?

   • Yes → Start RMP-CARD-001 at once; this record continues as context.
   • No → Continue trauma care.
4. S4RobotRung 2

   Clear and restrain loose items away from the scene (never near the patient's body), hold clear of the CMO, stream video when the link allows unless the CMO stops it, and log each stated finding and action on a clock-time timeline.

   Done when: Scene clear; timeline logged.

   V1 6003

   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 CMO answer when asked for a stated finding or time?

   • 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.
5. S5RobotRung 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

6. S6Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on ongoing care, imaging and evacuation [V1 3007].

   Done when: Decision logged.

   V1 3007

   D4DecisionGround decides

   What is the plan (care, imaging, evacuation)?

   • 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.
7. S7RobotRung 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
8. S8RobotRung 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: Reconciliation recorded; kits shown as opened – not restocked until resealed.

   V2 7059

9. S9RobotRung 2

   Send the flight surgeon one package: alert times, the <C>ABCDE timeline as stated, video pointer and decisions.

   Done when: Package delivered or queued.

   V1 6003V1 7001V1 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 Alert time, each stated <C>ABCDE finding and action with clock time (including any stated tourniquet time), video start/stop.
• 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
• 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 [7]. 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 heavy bleeding, head injury, no signs of life, CMO as patient, floating droplets, lost link. Pass: Zero contact; every emergency fetch logged as an override; hand-offs work.
2. Training model. CMO drills on a trauma manikin with the robot fetching kits. Pass: Kits within <set by validation> seconds; CMO never obstructed.
3. Parabolic or station demonstration. Kit fetch and debris clearing in weightlessness without a patient. Pass: Kits closed and restrained.
4. Flight use under flight surgeon supervision. First use in drills. 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 by a crewmember, the CMO or the commander. The CMO leads; the robot does not.

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 [10].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives the alert, records and video when the link allows.

Loss of signal

• Only the robot pauses its own movement and tells the CMO and the commander; recording continues offline on confirmation.
• Crew bleeding control, CPR, oxygen and masks continue under the onboard checklist and never wait for the link or the robot.

Mars-class delay

• Trauma care cannot wait for the ground; the onboard checklist and two trained CMOs lead.

[9]

Sources

1. National Institute for Health and Care Excellence. Major trauma: assessment and initial management. NICE guideline NG39 (2016). www.nice.org.uk/guidance/ng39/chapter/Recommendations Supports: 1.8.1 Assess catastrophic haemorrhage, airway with in-line spinal immobilisation, breathing, circulation, disability (neurological), exposure and environment (<C>ABCDE); 1.8.2 record whether the patient is improving or deteriorating. 1.5.1 Use simple dressings with direct pressure to control external haemorrhage; tourniquets when direct pressure fails (1.5.2). 1.5.3 Pelvic binder if active bleeding from a pelvic fracture is suspected after blunt high-energy trauma. The robot never applies pressure, a tourniquet or a binder.
2. National Institute for Health and Care Excellence. Fractures (complex): assessment and management. NICE guideline NG37 (2016, last updated 2022). www.nice.org.uk/guidance/ng37/chapter/Recommendations Supports: 1.3.7 When assessing neurovascular status in a limb injury, document for both limbs which nerves and nerve functions were tested and the findings. 1.1.11 Consider pre-hospital splinting of suspected long-bone fractures of the leg. Open fractures and life-threatening bleeding follow NG39. The robot never says fracture or sprain and never splints.
3. National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. NICE guideline NG41 (2016). www.nice.org.uk/guidance/ng41/chapter/Recommendations Supports: 1.1.1 On arrival, use a prioritising sequence to assess people with suspected trauma, for example <C>ABCDE, including airway with in-line spinal immobilisation; 1.1.2 protect the cervical spine with manual in-line spinal immobilisation. Earth context for the CMO's onboard spinal-precautions checklist; the robot never coaches neck or spine handling.
4. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to Medical Conditions that occur in Flight, as well as Private Medical Conditions, in Exploration Missions (In-Flight Medical Conditions). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Rapid ultrasound to look for internal bleeding after injury, with minimally trained crew able to obtain images; trauma is a planning concern for exploration missions.
5. Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. PMID 41122888. doi:10.1161/CIR.0000000000001369 Supports: Hand-off to cardiac arrest support when there are no signs of life.
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 3004 (kits, procedures, restraints), V1 3006, V1 3007.
7. 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.
8. 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.
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.