# RMP-MSK-001 Major trauma: bring trauma kit, video, assist crew (the robot does not lead) # 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 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' reviewed: '2026-10-21' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 6 review, 26 required corrections and 17 optional suggestions); all required corrections, and the low-risk suggestions, are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use. 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-MSK-001 slug: rmp-msk-001 title: 'Major trauma: bring trauma kit, video, assist crew (the robot does not lead)' category: msk tier: 1 rung_note: >- 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. result_language: use: - logged, not interpreted - sent to flight surgeon - EMERGENCY FETCH – NOT VERIFIED (CMO or commander command) - as stated by the CMO never: - normal - no problem found - all clear - negative - any diagnosis or cause - bleeding controlled - stable - no spinal injury - fracture - internal bleeding - verified - safe - mild - minor - contained - bleeding stopped - not serious scope: summary: >- 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 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: >- 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 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). covers: - Serious injury in flight or on a planetary surface, including heavy bleeding, crush or impact - Support while the CMO runs the onboard trauma checklist - >- Routing to RMP-NEURO-001 (head injury), RMP-MSK-002 (limb injury), RMP-SKIN-001 (wounds; not used for an open fracture unless the flight surgeon directs), RMP-SKIN-002 (burns), RMP-CARD-001 (no signs of life) 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) - Applying pressure, a dressing, a tourniquet, a pelvic binder, a collar or a splint - Moving, turning or restraining the injured crewmember - Saying bleeding is controlled or that the spine is uninjured - Holding an ultrasound probe (see RMP-RENAL-001 for the imaging pattern; trauma imaging is crew-led) - Touching, moving or commenting on an object stuck in a wound; the CMO follows the onboard checklist 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 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' robot_may: - Send an URGENT alert at once - Bring the sealed trauma kit and emergency kits on command - Clear and restrain loose items and floating debris away from the scene - Record the CMO's stated ABCDE findings and actions with clock times - Stream video when the link allows - Reconcile kits afterwards through RMP-PHARM-001 as an inventory record only robot_may_not: - Touch, move or restrain the injured crewmember - Apply any dressing, pressure, tourniquet, binder, collar or splint - Judge bleeding, breathing or spinal injury - 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: A crewmember, the CMO or the commander started the protocol by command after a serious injury. 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] - id: PRE-5 text: >- 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: standard: Emergency care; recording by the CMO's agreement when the crewmember cannot speak. emergency: 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. inputs: - id: IN-1 name: Injury as stated (what happened, where it hurts, heavy bleeding) source: Voice required: true if_missing: Log "no response"; keep the URGENT alert. - id: IN-2 name: >- CMO's stated findings in ABCDE order and each action with its clock time (including any tourniquet time the crew state) source: CMO required: false if_missing: Log "not stated". - id: IN-3 name: Responsiveness as stated by the CMO source: CMO required: false if_missing: Log "not stated"; treat as URGENT. - id: IN-4 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 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 seconds is repeated and sent to the next named crewmember. success: Alert acknowledged, or escalated. refs: - V2 10174 - V1 6003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- 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". success: Kits within reach, or skipped; override logged. limit: refs: - V2 7046 - id: S3 actor: crew action: >- The CMO leads trauma care under the onboard checklist (Earth context: NICE NG39 ABCDE). Crew restrain patient and rescuer as the checklist directs. The robot stays clear. success: Human-led care; robot logs what is stated. refs: - V1 3004 - id: S4 actor: robot rung: 2 action: >- 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. success: Scene clear; timeline logged. refs: - V1 6003 - id: S5 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: S6 actor: ground action: >- The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on ongoing care, imaging and evacuation [V1 3007]. success: Decision logged. refs: - V1 3007 - id: S7 actor: robot rung: 2 action: >- 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. success: RMP-PHARM-001 run logged with its result, or none ordered. refs: - V2 7059 - id: S8 actor: robot rung: 2 action: >- 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. success: Reconciliation recorded; kits shown as opened – not restocked until resealed. refs: - V2 7059 - id: S9 actor: robot rung: 2 action: >- Send the flight surgeon one package: alert times, the ABCDE timeline as stated, video pointer and decisions. success: Package delivered or queued. refs: - V1 6003 - V1 7001 - V1 7003 decisions: - id: D1 after: S3 decided_by: crew question: Does the crewmember show no signs of life (unresponsive, not breathing normally)? branches: - if: 'Yes' then: Start RMP-CARD-001 at once; this record continues as context. - if: 'No' then: Continue trauma care. - id: D2 after: S4 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 seconds is repeated and sent to the next named crewmember. - if: 'No' then: Continue. - id: D3 after: S4 decided_by: robot question: Did the CMO answer when asked for a stated finding or time? 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: D4 after: S6 decided_by: ground question: What is the plan (care, imaging, evacuation)? 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 the log at the next contact. - id: D5 after: S7 decided_by: robot question: What did RMP-PHARM-001 show for the ordered item? branches: - if: MATCH TO ORDER then: >- 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. - if: MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check then: >- 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. handoff: none 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: >- Robot pauses its own movement in its stopped position and tells the CMO and the commander. This pauses robot movement only: crew bleeding control, CPR, defibrillation, oxygen, masks and the commander's vehicle procedure 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; 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: 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: The CMO needs the robot's space action: Robot moves to its rest position at once and holds; it does not leave the module on its own. level: safe-state refs: - V2 10172 - id: X10 trigger: Blood or fluid droplets float near the robot action: >- Robot holds still and announces it; the CMO decides when it may move again; the crew contain droplets; the robot is cleaned before its next task. level: pause refs: - V2 10172 red_flags: - id: RF1 sign: Heavy bleeding, as stated threshold: any action: URGENT alert; the CMO controls bleeding under the checklist; the robot never applies pressure source: ng39 - id: RF2 sign: No signs of life, or not breathing normally threshold: any action: URGENT alert; start RMP-CARD-001 now source: aha2025bls - id: RF3 sign: Reduced responsiveness, confusion, or a head or neck injury threshold: any action: >- URGENT alert; see RMP-NEURO-001; the CMO follows the onboard spinal-precautions checklist (Earth context: NICE NG41 1.1.1, airway with in-line spinal immobilisation); the robot never coaches neck or spine handling source: ng41 - id: RF4 sign: Breathing difficulty or chest injury threshold: any action: URGENT alert; see RMP-RESP-001 source: ng39 - id: RF5 sign: Pain after a high-energy impact or crush to the chest, abdomen or pelvis threshold: any action: URGENT alert; the CMO assesses; the flight surgeon decides on imaging source: ng39 - id: RF6 sign: A limb that is pale, cold, numb or without a pulse, as stated threshold: any action: URGENT alert; see RMP-MSK-002 source: ng37 - id: RF7 sign: Burn with the injury (design judgment) threshold: any action: URGENT alert; see RMP-SKIN-002 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: Trauma interventions by the robot value: not allowed enforced: No pressure, tourniquet, binder, collar or splint task is loaded - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Closest approach to the patient and CMO value: enforced: Distance sensing 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: >- Alert time, each stated ABCDE finding and action with clock time (including any stated tourniquet time), video start/stop. - 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 - id: LOG-7 text: >- 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". refs: - V2 7059 - id: LOG-8 text: >- 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. refs: - V2 7059 requirements: - id: V1 3004 use: In-mission care includes medical kits, procedures and restraints; the crew deliver trauma care. - 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 3007 use: Medical evacuation when needed; 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 supplies restrained. - id: V2 7059 use: >- Kit inventory and seal status are tracked; after an emergency fetch the robot reconciles the kit through RMP-PHARM-001 as an inventory record (never a check before use) and shows it as "opened – not restocked" until resealed. - 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 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. - stage: training model what: CMO drills on a trauma manikin with the robot fetching kits. pass: Kits within seconds; CMO never obstructed. - stage: parabolic or station demonstration what: Kit fetch and debris clearing in weightlessness without a patient. pass: Kits closed and restrained. - stage: flight use under flight surgeon supervision what: First use in drills. pass: No safety events. 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 a crewmember, the CMO or the commander. The CMO leads; the robot does not. 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 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_delay: - Trauma care cannot wait for the ground; the onboard checklist and two trained CMOs lead. sources: - key: ng39 text: >- National Institute for Health and Care Excellence. Major trauma: assessment and initial management. NICE guideline NG39 (2016). url: https://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 (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. - key: ng37 text: >- National Institute for Health and Care Excellence. Fractures (complex): assessment and management. NICE guideline NG37 (2016, last updated 2022). url: https://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. - key: ng41 text: >- National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. NICE guideline NG41 (2016). url: https://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 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. - key: ermed text: >- 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). url: https://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. - key: aha2025bls text: >- 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. url: https://doi.org/10.1161/CIR.0000000000001369 doi: 10.1161/CIR.0000000000001369 pmid: '41122888' supports: Hand-off to cardiac arrest support when there are no signs of life. - 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 3004 (kits, procedures, restraints), V1 3006, V1 3007.' - 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: 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: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 6 review) items: - >- RF3 (head or neck injury): the CMO follows the onboard spinal-precautions checklist; the robot never coaches neck or spine handling; source NICE NG41 1.1.1 (item 6). - >- S2 also brings eye protection and absorbent containment supplies; new precondition on eye protection when bleeding is present; new never-word "contained" (item 7). - RF7 (burn with the injury) labelled design judgment, routing to RMP-SKIN-002 (item 8). - >- NG37 cited by its correct title, "Fractures (complex): assessment and management" (2016, last updated 2022) (item 9). - >- Covers: RMP-SKIN-001 wound steps are not used for an open fracture unless the flight surgeon directs (item 10). - >- X5 and the comms loss-of-signal branch: only the robot pauses; crew bleeding control, CPR, oxygen and masks never wait for the link or the robot (item 24). - >- New lockout: the robot never touches, moves or comments on an object stuck in a wound (suggestion 31); never-words "bleeding stopped" and "not serious". - >- Batch 6 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician. - >- 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: v2). Editorial; no change to steps, thresholds or limits.