{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.3", "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-002", "slug": "rmp-msk-002", "title": "Suspected fracture or sprain: splint supplies, video; the crew hold the limb steady", "category": "msk", "tier": 1, "rung_note": "Max rung raised from 1 to 2 for supervised fetching of splint supplies, holding a display and video. The library outline had the robot hold the limb steady; this draft keeps the no-contact rule, so the crew hold the limb. A robot limb hold stays a research item.", "result_language": { "use": [ "logged, not interpreted", "sent to flight surgeon", "as stated by the crewmember", "pain score as stated" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "fracture", "sprain", "broken", "not broken", "just a sprain", "verified", "safe", "mild", "minor", "only a small knock", "low force", "just a bruise" ] }, "scope": { "summary": "After a limb injury, the robot alerts the flight surgeon at once, brings the splint and immobilisation supplies by a checked kit fetch (or an emergency fetch when an URGENT red flag has fired or a human states an emergency), shows the onboard splinting checklist and a both-limbs neurovascular record form, logs the CMO's stated checks word for word, takes photos on the CMO's request, and streams video when the link allows. It never says fracture or sprain, never touches the limb and never applies a splint.", "why": "Bone loss in long-duration flight raises the question of fracture risk on exploration missions (NASA in-flight medical conditions evidence report, bone fracture section), and surface operations add falls. On Earth, NICE guideline NG37 asks clinicians to record nerve and circulation checks (neurovascular status) for both limbs, and to consider splinting a suspected long-bone fracture of the leg before hospital; open fractures and heavy bleeding go to the major-trauma guideline (NG39). A record of what the CMO checked and when helps the flight surgeon decide without the robot judging the injury. Open question for review: whether a robot limb hold under ground control (rung 1) should ever be allowed, given the no-contact rule.", "covers": [ "Pain, swelling or deformity of a limb after a strike, twist or fall, in flight or on a surface", "Support while the CMO runs the onboard splinting checklist", "Routing to RMP-MSK-001 (major trauma), RMP-SKIN-001 (wound, but not an open fracture unless the flight surgeon directs), RMP-MSK-004 (back)" ], "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)", "Holding, moving or splinting the limb", "Saying fracture, sprain, broken or not broken", "Pain medicine suggestions (any medicine goes through the CMO and RMP-PHARM-001)" ], "related": [ "RMP-MSK-001", "RMP-MSK-003", "RMP-MSK-004", "RMP-SKIN-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": [ "Alert the flight surgeon at once", "Bring splint and immobilisation supplies by a checked kit fetch", "Show the splinting checklist and the both-limbs neurovascular form", "Log stated checks, pain scores and times word for word", "Take photos on the CMO's request", "Stream video when the link allows" ], "robot_may_not": [ "Touch, hold, move or splint the limb", "Judge the injury or say what it is", "Suggest a medicine", "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 or the CMO started the protocol by command after a limb 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]" } ], "consent": { "standard": "The crewmember agrees to photos and recording; the CMO confirms.", "emergency": "If the crewmember cannot agree, the robot proceeds on the CMO's command.", "withdrawal": "The crewmember can stop photos or video at any time; the alert and record stand." }, "inputs": [ { "id": "IN-1", "name": "What happened and where it hurts, as stated", "source": "Voice", "required": true, "if_missing": "Log \"no response\"; URGENT." }, { "id": "IN-2", "name": "Pain score 0-10 as stated", "source": "Crewmember", "required": false, "if_missing": "Log \"not stated\"." }, { "id": "IN-3", "name": "CMO's stated checks for both limbs, as the onboard neurovascular form lists them (pulses or capillary refill, colour, warmth, feeling and movement), with the nerves and functions tested (NICE NG37 1.3.7)", "source": "CMO", "required": false, "if_missing": "Log \"not stated\"; never fill a blank." }, { "id": "IN-4", "name": "Photos on the CMO's request", "source": "Robot camera", "required": false, "if_missing": "Log \"no photo\"." }, { "id": "IN-5", "name": "Link status and delay", "source": "Communications system", "required": true, "if_missing": "Treat as link down." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "Send a \"limb injury\" alert to the flight surgeon and the CMO at once (URGENT if a red flag is already 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 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 command, run a checked kit fetch of the splint and immobilisation medical kit: 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\".", "success": "Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged.", "limit": "", "refs": [ "V2 7046", "V2 7059" ] }, { "id": "S3", "actor": "robot", "rung": 2, "action": "Show the onboard splinting checklist and the both-limbs neurovascular form on the robot's screen, held clear of the crewmember.", "success": "Checklist and form on screen.", "refs": [ "V2 7045" ] }, { "id": "S4", "actor": "crew", "action": "A crewmember holds the limb steady; the CMO checks both limbs and splints under the onboard checklist (Earth context: NICE NG37).", "success": "Human-led care; robot logs what is stated.", "refs": [ "V1 3004" ] }, { "id": "S5", "actor": "robot", "rung": 2, "action": "Log each stated check, pain score and time word for word; take photos only when the CMO asks; stream video when the link allows unless the crewmember stops it. After the splint is on, show an on-screen prompt the crew accept every hours for a -hour watch, to re-ask the RF3 and RF7 questions (Earth context: NICE NG37 1.2.7); the robot never loosens or adjusts anything.", "success": "Record complete or gaps logged as \"not stated\".", "refs": [ "V1 6003" ] }, { "id": "S6", "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": "S7", "actor": "ground", "action": "The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on imaging (crew-held ultrasound, see RMP-MSK-003), splint checks, activity limits and any evacuation [V1 3007].", "success": "Decision logged.", "refs": [ "V1 3007" ] }, { "id": "S8", "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": "S9", "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; kit shown as opened – not restocked until resealed.", "refs": [ "V2 7059" ] }, { "id": "S10", "actor": "robot", "rung": 2, "action": "Send the flight surgeon one package: stated checks for both limbs, pain scores, photos, times and decisions.", "success": "Package delivered or queued.", "refs": [ "V1 6003", "V1 7001", "V1 7003" ] } ], "decisions": [ { "id": "D1", "after": "S2", "decided_by": "robot", "question": "What did the checked kit fetch show for the kit ID and seal?", "branches": [ { "if": "Kit ID and seal match", "then": "Hand the kit to the CMO; log the check." }, { "if": "MISMATCH of kit ID or seal, or cannot read", "then": "Quarantine the kit with no hand-over; tell the CMO; the CMO may command an emergency fetch of another kit.", "handoff": "none" } ] }, { "id": "D2", "after": "S5", "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": "S5", "decided_by": "robot", "question": "Did the crewmember answer the last question?", "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": "S7", "decided_by": "ground", "question": "What is the plan (imaging, splint checks, activity, 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": "S8", "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, holding and splinting the limb, oxygen 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 crew need 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" ] } ], "red_flags": [ { "id": "RF1", "sign": "Bone visible or an open wound over the injury", "threshold": "any", "action": "URGENT alert; see RMP-MSK-001; the CMO follows the onboard open-fracture checklist. The RMP-SKIN-001 wound-irrigation steps are not used for an open fracture unless the flight surgeon directs (Earth context: NICE NG37 1.1.8-1.1.10). Any antibiotic is a flight-surgeon order through RMP-PHARM-001", "source": "ng37" }, { "id": "RF2", "sign": "Limb pale, cold, blue, numb or weak, or no pulse felt, as stated, on either check", "threshold": "any", "action": "URGENT alert; the CMO acts under the checklist", "source": "ng37" }, { "id": "RF3", "sign": "Pain getting worse despite the splint, or pain out of proportion, as stated (design judgment; Earth context: NICE NG37 1.2.7, awareness of compartment syndrome for 48 hours after a lower-leg fracture)", "threshold": "any", "action": "URGENT alert; the CMO checks the splint and limb at once" }, { "id": "RF4", "sign": "Obvious deformity, as stated (design judgment)", "threshold": "any", "action": "URGENT alert" }, { "id": "RF5", "sign": "Injury from a high-energy impact, or other injuries", "threshold": "any", "action": "URGENT alert; see RMP-MSK-001", "source": "ng39" }, { "id": "RF6", "sign": "Neck or back pain with the injury", "threshold": "any", "action": "URGENT alert; see RMP-MSK-004 and RMP-MSK-001", "source": "ng41" }, { "id": "RF7", "sign": "Numbness or tingling getting worse, or the splint feels too tight, as stated (design judgment)", "threshold": "any", "action": "URGENT alert; the CMO checks the splint and limb at once; the robot never loosens anything" } ], "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": "Limb holding or splinting by the robot", "value": "not allowed", "enforced": "No limb-hold or splint task is loaded" }, { "id": "L3", "name": "Robot speed near the crewmember", "value": "", "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": "Stated both-limbs checks, pain scores, photos, splint time as stated, and decisions, with clock times." }, { "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 imaging; the crew splint." }, { "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 sprain-like and deformity cases, numb limb, kit seal mismatch, CMO as patient, lost link.", "pass": "Zero contact; seal mismatch quarantined; no injury named." }, { "stage": "training model", "what": "CMO splint drills with the robot fetching supplies and recording.", "pass": "Both-limbs form complete or gaps marked." }, { "stage": "parabolic or station demonstration", "what": "Kit fetch and checklist display in weightlessness without a patient.", "pass": "Kit 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 or the CMO. The crew hold and splint the limb." }, "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 holding and splinting the limb and bleeding control continue under the onboard checklist and never wait for the link or the robot." ], "mars_delay": [ "Splinting cannot wait for the ground; the onboard checklist and two trained CMOs lead." ] }, "sources": [ { "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": "1.1.8 Do not irrigate open fractures of the long bones, hindfoot or midfoot in pre-hospital settings; 1.1.9 consider a saline-soaked dressing covered with an occlusive layer; 1.1.10 consider prophylactic intravenous antibiotics as soon as possible (Earth pre-hospital context; any antibiotic is a flight-surgeon order). 1.1.11 Consider pre-hospital splinting of suspected long-bone fractures of the leg. 1.2.7 In tibial fractures, maintain awareness of compartment syndrome for 48 hours after injury. 1.3.7 When assessing neurovascular status in a limb injury, document for both limbs which nerves and functions were tested and the findings. The robot never says fracture or sprain and never splints." }, { "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": "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": "Bone fracture risk on exploration missions is assessed by model because observable fracture events in flight are rare; ultrasound has been proposed to help bone healing (research)." }, { "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, 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": [ "NG37 cited by its correct title, \"Fractures (complex): assessment and management\" (2016, last updated 2022); its support text now quotes 1.1.8-1.1.11, 1.2.7 and 1.3.7 (item 9).", "RF1 (bone visible or open wound): the CMO follows the onboard open-fracture checklist; the RMP-SKIN-001 irrigation steps are not used for an open fracture unless the flight surgeon directs (NG37 1.1.8-1.1.10 Earth context); any antibiotic is a flight-surgeon order through RMP-PHARM-001. Covers updated to match, here and in RMP-MSK-001 (item 10).", "RF3 labelled design judgment (NG37 1.2.7 context); new URGENT RF7 (numbness or tingling getting worse, or the splint feels too tight); S5 shows a crew-accepted prompt every hours for a -hour watch to re-ask these questions; the robot never loosens anything (item 11).", "RF4 labelled design judgment; RF6 (neck or back pain) now cites NICE NG41 (item 12).", "X5 and the comms loss-of-signal branch: only the robot pauses; crew holding and splinting, bleeding control and oxygen never wait for the link or the robot (item 24).", "IN-3 aligned with the onboard neurovascular form and NG37 1.3.7 (suggestion 32); never-words \"only a small knock\", \"low force\" and \"just a bruise\" (suggestion 33).", "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." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Batch 9 editorial (AI-assisted), Oct 21, 2026", "items": [ "Imaging now links to RMP-MSK-003 (musculoskeletal ultrasound assist), drafted in batch 9." ] } ] }