# RMP-NEURO-001 Head injury: urgent relay, supplies, and recording of the checks the CMO does, with prompt-only repeat checks (the robot does not assess) # Version 0.4 (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: '0.4' 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: '2026-10-20' reviewed: '2026-10-20' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 3 review, 54 corrections); all corrections are applied in this version. No named human clinician has reviewed it. 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-NEURO-001 slug: rmp-neuro-001 title: >- Head injury: urgent relay, supplies, and recording of the checks the CMO does, with prompt-only repeat checks (the robot does not assess) category: neuro tier: 1 rung_note: >- Max rung raised from 1 to 2 for supervised fetching and recording, as in batch 1. The robot never moves the head or neck and never scores a check. result_language: use: - logged, not interpreted - sent to flight surgeon - score as entered by the CMO - answer as given never: - normal - no problem found - all clear - negative - any diagnosis or cause - concussion - no concussion - minor - fine - cleared - safe - mild scope: summary: >- After any blow to the head, the robot tells the flight surgeon and CMO at once (URGENT on any red flag), brings the medical kit and any items the CMO asks for, shows the onboard head-injury checklist, records the answers and the checks the CMO does (alertness score, pupils, limb strength and sensation, memory questions) with exact times, and then offers prompt-only repeat checks on the schedule the flight surgeon sets. It never scores, interprets, compares or clears. Because CT is not available, the flight surgeon works from a list of findings that on Earth would mean CT within 1 hour or transfer. why: >- NICE (NG232) lists the reasons a person with a head injury should be referred from the community to an emergency department, including any loss of consciousness, a Glasgow Coma Scale score below 15, memory loss, persistent headache, any vomiting, a seizure, new neurological signs, anticoagulant or antiplatelet medicines, and continuing concern; CT is the primary test, and it is not yet readily available in spaceflight. There are no adequate observational data on head injuries in orbit; NASA has modeled the risk instead. The red flags therefore come from Earth guidance (NICE NG232, cross-checked against the Canadian CT Head Rule, which was derived in adults with GCS 13-15 in emergency departments with CT) and are applied here without CT. An exact, time-stamped record of each check helps the flight surgeon see a change early, and the decision to watch, treat or evacuate stays with humans. covers: - >- Any blow or bump to the head in flight, during an EVA or after landing, in a crewmember who is answering - Repeat checks the flight surgeon sets, as prompts to the CMO locked_out: - Putting a lower alertness level down to medicine or intoxication - Moving, holding or supporting the head or neck - Scoring alertness or any neurological check (the robot records what the CMO enters) - >- Saying there is or is not a concussion or brain injury, or clearing a crewmember to return to duty or to an EVA - Choosing or advising any medicine - Shining lights into the eyes or touching the crewmember related: - RMP-MSK-004 - RMP-MSK-001 - RMP-NEURO-002 - RMP-NEURO-003 - RMP-EYE-001 - RMP-ENT-001 - RMP-SKIN-001 - RMP-EGR-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: - 'Injured crewmember: answers questions if able; can stop recording' - 'Second trained CMO: receives alerts and does the checks if the CMO is the patient' - 'Any crewmember who saw the injury: describes what happened' robot_may: - Send the alert and the description of the injury to the CMO and flight surgeon - Bring the medical kit and items the CMO asks for, closed, and restrain them within reach - Show the onboard head-injury checklist on its screen - Ask the injured crewmember the checklist questions by voice and log answers word for word - Record the checks the CMO does and enters, with times - Offer prompt-only repeat checks to the CMO at the times the flight surgeon sets robot_may_not: - Touch, move or support the head or neck, or touch the crewmember - >- Score, interpret or compare checks, or mark a change with arrows, colours, highlighting or difference values - Say the crewmember is fine, concussed or cleared - Put a lower alertness level down to medicine or intoxication - Advise any medicine, or suggest stopping, holding or reversing one - 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 injured one, a witness or the CMO) started the protocol by command. check: human_start == true refs: - V2 10174 - id: PRE-2 text: >- The injured crewmember is answering. If not, URGENT alert at once and a crewmember checks in person (X7); the robot only fetches on request. check: crew_responsive == true - id: PRE-3 text: Robot self-test passed; it knows the stowage location of the medical kit. refs: - V2 10161 - id: PRE-4 text: Robot and supplies restrained when not moving. refs: - V2 7046 - id: PRE-5 text: Link status and current delay known. check: link_state in [live, delayed, down] consent: standard: >- The crewmember agrees to questions and recording by voice. Any question can be declined; an explicit "no" is logged as declined for that question only. emergency: >- If the crewmember cannot answer, the URGENT alert stands, the robot asks nothing more and a crewmember checks in person; the CMO's entries are recorded as part of the medical record. withdrawal: The crewmember can stop recording at any time; any alert already sent is not withdrawn. inputs: - id: IN-1 name: >- What happened: how the head was hit, by what, and how hard, as described by the crewmember or a witness source: Crewmember or witness, by voice required: true if_missing: Log "no response" for the crewmember (D2); ask a witness. - id: IN-2 name: >- Red-flag questions: knocked out, memory gap, headache, vomiting, fit, vision change, weakness or numbness, neck pain, tingling, clear fluid from nose or ear, alcohol or a sedating medicine taken; and previous brain surgery (from the record) source: Crewmember, by voice; CMO observation; medical record required: true if_missing: Log "no response"; URGENT; the CMO checks in person. Never logged as declined. - id: IN-3 name: >- Checks done by the CMO: Glasgow Coma Scale (GCS) score, pupils, limb strength and sensation, memory and orientation (entered by the CMO; recorded, not interpreted) source: Entered by the CMO required: true if_missing: Log "not done"; prompt the CMO once; a missing check is never treated as reassuring. - id: IN-4 name: >- Anticoagulant, antiplatelet or aspirin use, and any bleeding or clotting disorder, in the record or as the crewmember or CMO states, including any medicine taken in the last day (for example before an EVA), with the time of the last dose (shown to the CMO; the robot does not advise) source: Medical record and dose log (RMP-PHARM-003); crewmember or CMO, by voice required: false if_missing: Note "record not available"; ask the crewmember; a missing answer is never treated as "none". - id: IN-5 name: Time of the injury source: Crewmember, witness or mission clock required: true if_missing: Log "time not known"; the CMO estimates it. - id: IN-6 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 command, open the log and send a "head injury" note to the flight surgeon and the CMO at once, with the time of the injury and what happened; it becomes an URGENT alert on any red flag. 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: Note or alert acknowledged, or escalated to the next named crewmember. refs: - V2 10174 - V1 6003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- Ask the red-flag questions first by voice and log answers word for word. D1 is checked after every answer. success: Answers logged, or "no response" logged. - id: S3 actor: robot rung: 2 action: >- Bring the medical kit and any item the CMO asks for, closed, and restrain them within reach. 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". Show the onboard head-injury checklist on its screen. success: Items within reach; checklist shown; override logged. limit: refs: - V2 7046 - id: S4 actor: crew action: >- The CMO does the checks on the checklist (Glasgow Coma Scale score, pupils, limb strength and sensation, memory and orientation) and decides about cervical spine protection under the onboard checklist (NICE NG232 section 1.6). Nobody moves the head or neck for the robot. success: Checks done and entered by the CMO. refs: - V1 3004 - id: S5 actor: robot rung: 2 action: >- Record each check the CMO enters with its time, and show the CMO the earlier checks in time order, in an identical layout whatever the values, headed "Entries as recorded by the CMO – not compared by the robot". No arrows, colours, highlighting or difference values. success: Entries time-stamped. refs: - V1 3004 - 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 the watch plan, wake checks, work limits, return to duty, and any evacuation [V1 3007]. Because CT is not yet readily available in spaceflight, findings that on Earth would mean CT within 1 hour or transfer (NG232 1.5.5, 1.5.8, 1.5.9, 1.5.13, 1.9.13) are passed to the flight surgeon as reasons to consider evacuation: a GCS score of 12 or less at the first check, or below 15 two hours after the injury; a suspected open, depressed or basal skull fracture; a seizure after the injury; a focal neurological deficit; more than 1 episode of vomiting; loss of consciousness or amnesia together with a bleeding or clotting disorder; anticoagulant or antiplatelet treatment other than aspirin alone; and any sign of deterioration on repeat checks. The Canadian CT Head Rule is a cross-check only. The robot applies none of this list; it shows it to the flight surgeon with the entries. On Mars-class missions evacuation may not be possible, and the CMO follows the pre-approved checklist. The robot logs the decisions. success: Decision logged. refs: - V1 3007 - id: S8 actor: robot rung: 2 action: >- Every hours for hours after the injury (the repeat-check schedule the flight surgeon sets), prompt the CMO to repeat the checks. At each scheduled time the robot prompts the crewmember on their own screen; it approaches only when the crewmember (or the CMO) accepts, and a prompt never starts the robot. Wake checks happen only if the flight surgeon or CMO set them; a wake check with no response is URGENT. success: Each prompt accepted and the checks entered, or escalated. refs: - V2 10174 - id: S9 actor: robot rung: 2 action: >- Send the flight surgeon one package: what happened, answers, each check with its time, alerts and decisions. 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: Package delivered or queued; kit reconciled or shown as opened – not restocked. refs: - V1 6003 - V1 7001 - V1 7003 - V2 7059 decisions: - id: D1 after: S2 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; the flight surgeon still receives the head-injury note. - id: D2 after: S2 decided_by: robot question: Did the injured crewmember answer the 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: D3 after: S5 decided_by: crew question: Is any check the CMO entered worse than an earlier one, or does the CMO have any concern? branches: - if: Yes (the CMO says so) then: >- URGENT alert (RF11) at once; the robot records the CMO's words. If a second trained CMO is available, they repeat the check to confirm; this never delays the URGENT alert. - if: 'No' then: Continue the watch plan. - id: D4 after: S7 decided_by: ground question: What is the watch plan? 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. 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: it pauses any movement in its stopped position and tells the CMO. This pauses robot movement only: crew protection of the airway and spine, and CPR, continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether to continue 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: A seizure starts action: >- Robot moves to its rest position, clears its items from the area and sends an URGENT alert; see RMP-NEURO-003. level: urgent refs: - V2 10172 red_flags: - id: RF1 sign: Any loss of consciousness, or not fully alert (for example trouble keeping eyes open) threshold: any; a CMO-entered Glasgow Coma Scale (GCS) score below 15 (the full score) action: URGENT alert to the CMO and flight surgeon source: ng232 - id: RF2 sign: Memory loss for events before or after the injury threshold: any action: URGENT alert source: ng232 - id: RF3 sign: Headache that persists since the injury threshold: any (no waiting period) action: URGENT alert source: ng232 - id: RF4 sign: Any vomiting since the injury threshold: any action: URGENT alert source: ng232 - id: RF5 sign: A seizure (fit) since the injury threshold: any action: URGENT alert; see RMP-NEURO-003 source: ng232 - id: RF6 sign: New weakness, numbness, speech or vision change, or a pupil difference the CMO enters threshold: any action: URGENT alert; see RMP-NEURO-002 source: ng232 - id: RF7 sign: >- Clear fluid or blood from the nose or ear, bruising around the eyes or behind the ear, or a suspected skull fracture or penetrating injury threshold: any action: URGENT alert source: ng232 - id: RF8 sign: Neck pain or tenderness, or tingling or weakness in the arms or legs threshold: any action: >- URGENT alert; nobody moves the head or neck for the robot; the CMO decides about cervical spine protection (NG232 section 1.6); see RMP-MSK-004 source: ng232 - id: RF9 sign: >- A bleeding or clotting disorder, or an anticoagulant or antiplatelet medicine other than aspirin alone, in the record or as the crewmember or CMO states threshold: any action: >- URGENT alert (shown to the CMO and flight surgeon). Aspirin alone is shown to the CMO and flight surgeon as information, not as an alert. source: ng232 - id: RF10 sign: >- A high-energy impact (for example a hatch, a moving mass or a fall during partial-gravity operations) or a blow along the line of the head and neck (axial load), as described (spaceflight translation of the NG232 "dangerous mechanism"; design judgment) threshold: as judged by the CMO action: URGENT alert source: ng232 - id: RF11 sign: >- A repeat check is worse than an earlier one, or a crewmember says the injured person is not themselves threshold: any action: URGENT alert source: ng232 - id: RF12 sign: Irritability, poor concentration or behavior change in the following days threshold: any action: Flag to the flight surgeon at the next contact; URGENT if it is sudden or with any other red flag source: ng232 - id: RF13 sign: >- Drug or alcohol intoxication, or a sedating medicine taken (as stated), or previous brain surgery, or continuing concern by the CMO about the diagnosis threshold: any action: URGENT alert. The robot never puts a lower alertness level down to medicine or intoxication. source: ng232 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: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L3 name: Closest approach to the crewmember's head value: enforced: Distance sensing; the robot stays outside it - id: L4 name: Check-in length value: enforced: Timer; then the check-in ends 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: >- Each CMO check with its time, so the flight surgeon can see change over time; the robot never compares them. - 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 requirements: - id: V1 3004 use: >- In-mission care includes recording the history and the physical exam (d, e), vital signs (h), and restraints for patient and caregiver (k); the exam is done by humans. - 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 illness or injury is beyond onboard capability (CT is not yet readily available in spaceflight); the flight surgeon decides, working from the NG232-based list in S7. - 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 injuries with every red flag, a worsening repeat check, a missed wake check, a CMO who is the patient, and lost link. pass: >- Every red flag alerts at once; aspirin alone shown as information, not an alert; zero scores, comparisons or clearance statements; zero head or neck contact; unacknowledged alerts escalate. - stage: training model what: CMO training with a manikin and an actor following scripts, the robot fetching and recording. pass: Recording accuracy at or above ; the CMO is never obstructed. - stage: parabolic or station demonstration what: >- Fetching and restraining the medical kit and showing the checklist in weightlessness, without a patient. pass: Items delivered and restrained; keep-out zone held. - stage: flight use under flight surgeon supervision what: First use as a recording aid during drills, then real events. pass: No safety events; the flight surgeon finds the record useful. 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 flight surgeon receives every head-injury note; red flags go to the CMO and flight surgeon at once; the CMO does every check. 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 note at once and can join by voice and video.' loss_of_signal: - >- The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps recording offline. - >- Crew protection of the airway and spine, and CPR, continue under the onboard checklist and never wait for the link or the robot. - >- Red flags go to the CMO (or the second trained CMO); the CMO decides under the pre-approved onboard checklist. - >- At the next contact the robot sends one package: what happened, checks and times, alerts and decisions. mars_delay: - >- Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; evacuation may not be possible, so the watch plan and its timings are set before flight. sources: - key: ng232 text: >- National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232 (May 18, 2023). url: https://www.nice.org.uk/guidance/ng232/chapter/Recommendations supports: >- Recommendation 1.2.4: community services should refer to an emergency department anyone with a head injury and any of: a Glasgow Coma Scale score below 15 on initial assessment; any loss of consciousness; any focal neurological deficit; suspected complex skull fracture or penetrating head injury; amnesia for events before or after the injury; persistent headache; any vomiting since the injury; any seizure; previous brain surgery; a high-energy head injury; a bleeding or clotting disorder; current anticoagulant or antiplatelet treatment (except aspirin alone); intoxication; or continuing concern about the diagnosis. Signs of basal skull fracture include blood behind the eardrum, "panda" eyes, cerebrospinal fluid leaking from the ear or nose and Battle's sign (1.5.8). With a suspected neck injury, paraesthesia in the arms or legs or a focal peripheral deficit is a high-risk factor (1.6.2). CT is the primary investigation, and people who need CT where none is available are transferred (1.5.1, 1.5.5). CT within 1 hour for a GCS score of 12 or less on initial assessment, below 15 at 2 hours after the injury, a suspected open or depressed skull fracture, any sign of basal skull fracture, a post-traumatic seizure, a focal neurological deficit, or more than 1 episode of vomiting (1.5.8); CT within 8 hours after loss of consciousness or amnesia with a bleeding or clotting disorder or a dangerous mechanism (1.5.9); consider CT for anticoagulant or antiplatelet treatment other than aspirin alone (1.5.13). Only assume a depressed conscious level is due to intoxication after an important brain injury has been excluded (1.4.2). Consider referral for irritability or altered behaviour (1.2.5). Signs of deterioration include agitation or abnormal behaviour, a drop in GCS, severe or increasing headache, persistent vomiting, and new neurological signs (1.9.13); a second competent person confirms deterioration if possible, otherwise the supervising doctor is contacted without waiting (1.9.14). With a suspected neck injury, an axial load to the head is a high-risk factor (1.6.2). - key: stiell text: >- Stiell IG, Wells GA, Vandemheen K, et al. The Canadian CT Head Rule for patients with minor head injury. Lancet. 2001;357(9266):1391-1396. url: https://doi.org/10.1016/s0140-6736(00)04561-x doi: 10.1016/s0140-6736(00)04561-x pmid: '11356436' supports: >- A decision rule derived in adults with minor head injury (GCS 13-15) in emergency departments with CT; its high-risk factors (failure to reach GCS 15 within 2 hours, suspected open skull fracture, signs of basal skull fracture, vomiting more than 2 episodes, age over 65, as given in the abstract) overlap NG232. Used only as a cross-check; its full exclusion criteria were not read. (PECARN is a paediatric rule and is not used.) - key: ermed text: >- NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). url: https://humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf supports: >- Head injury is among the exploration medical conditions that do not have adequate observational data on prior head injury events in orbit; NASA's Integrated Medical Model estimates the risk with a head-injury model instead. - key: renal text: 'NASA Human Research Program. Evidence Report: Risk of Renal Stone Formation (2024).' url: https://humanresearchroadmap.nasa.gov/evidence/other/2024%20Renal%20Evidence%20Report_Final.pdf supports: >- CT imaging is not yet readily available in spaceflight (stated in the renal stone report; cited here only for that fact). - key: hypdcs text: >- NASA Human Research Program. Evidence Report: Risk of Reduced Crew Health and Performance due to Decompression Sickness and Hypoxia (2023). url: >- https://humanresearchroadmap.nasa.gov/evidence/reports/Evidence%20Report%20Hypoxia%20and%20DCS_FINAL_1-8-2024.pdf supports: >- Many astronauts take aspirin before an EVA (cited only for why aspirin alone is shown as information rather than an alert). - key: ismpadc text: >- Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019). url: https://www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Guideline-020719_final.pdf supports: >- Override is limited to medicines needed in emergent circumstances where waiting could harm the patient (3.3b); limit what is available on override (3.4b); require documentation of the override rationale (3.4d); routinely analyze override reports (3.6). Used for the emergency-fetch pattern by analogy (a robot fetching a sealed kit is not a dispensing cabinet). - 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: 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: Requirement IDs beginning V1. - 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: 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: '2026-10-20' version: '0.2' source: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 3 review) items: - >- RF9 applies the NG232 aspirin-alone exception (aspirin alone is shown as information) and counts medicine the crewmember or CMO states, including medicine taken in the last day (items 26, 52). - >- New RF13: intoxication, a sedating medicine taken, previous brain surgery, or continuing concern by the CMO is URGENT; the robot never puts lower alertness down to medicine or intoxication (NG232 1.2.4, 1.4.2; "sedating medicine" is design judgment) (item 27). - >- S7 gives the flight surgeon an evacuation-consideration list in place of CT, built from NG232 1.5.5, 1.5.8, 1.5.9, 1.5.13 and 1.9.13, with the Canadian CT Head Rule as a cross-check only (PECARN is paediatric and not used); the robot applies none of it (item 28). - >- D3: a second trained CMO confirms worsening if available, but this never delays the URGENT alert (NG232 1.9.14, applied more strictly) (item 29). - >- S5 shows earlier checks in time order in an identical layout, headed "Entries as recorded by the CMO – not compared by the robot", with no arrows, colours or differences (item 30). - >- Scope "why" says plainly that there are no adequate in-orbit observational data and that the flags come from Earth guidance applied without CT (item 31). - >- S4 and RF8 name cervical spine protection as the CMO's decision (NG232 section 1.6); RF10 adds an axial load and is labelled as a spaceflight translation (item 32). - RF12 now cites NG232 1.2.5 and 1.9.13 (item 33). - RF1 names the Glasgow Coma Scale (below 15, the full score) (item 34). - >- Flight-surgeon windows and schedules that were prose only are now placeholder tokens the build can track, with context figures only where the review quoted a source (item 50). - >- One emergency-fetch pattern: kits are fetched on a human command with no barcode gate, logged as an override ("EMERGENCY FETCH – NOT VERIFIED"), never called verified, reconciled afterwards through RMP-PHARM-001 as an inventory record only (never a check before use), and shown as "opened – not restocked" until resealed (item 51; ISMP). - '"Mild" and "minor" are never-words in every batch 3 protocol (item 54).' - >- Cross-links added for the new routes; the build checks that each target exists in the library, and planned protocols link to their library entry (item 53). - date: '2026-10-21' version: '0.2' source: Batch 5 editorial (AI-assisted), Oct 21, 2026; batch 4 review item 49 items: - >- Inherited stop-rule and requirement wording: "holds a safe position" → "holds its stopped position"; "stays in its safe state" → "stays stopped"; "take over safely" → "take over"; "Robot stays safe if no one takes over" → "Robot stays stopped if no one takes over". Schema level name safe-state and never-word list entry "safe" unchanged. - date: '2026-10-21' version: '0.3' source: Batch 7 editorial (AI-assisted), Oct 21, 2026 items: - >- 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: ermed, hypdcs, renal, v2). Editorial; no change to steps, thresholds or limits. - date: '2026-10-21' version: '0.4' source: Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026 items: - >- X5 and the comms loss-of-signal branch now say only the robot pauses: crew protection of the airway and spine, and CPR, continue under the onboard checklist and never wait for the link or the robot (batch 7 review item 13). Editorial; robot behaviour unchanged.