RMP-NEURO-004 Space motion sickness: symptom, vomiting and fluid-intake log, containment supplies, relay to the flight surgeon (no drug advice)

1 · Identity and scope

In the first days of flight, or whenever a crewmember reports motion sickness, the robot runs short voice-only check-ins (symptom rating, vomiting episodes, fluids taken and urine passed, as the crewmember reports them), hands over emesis bags, wipes and any drink pouch the crewmember asks for (unless a human has logged "nothing by mouth"), collects only sealed waste bags, and sends a summary to the flight surgeon. Red-flag answers go to the CMO and flight surgeon at once. It never suggests or fetches a medicine on its own (medicines are fetched only through RMP-PHARM-001 after a human order) and never says symptoms are "just" motion sickness.

Why this protocol was chosen. NASA reports space motion sickness in up to about 73% of crew in the first 2-3 days of flight, generally worse on first flights (another NASA brief gives 50-70%). The concerns are dehydration, weakness and reduced performance; NASA's severity grading counts more than 2 vomiting episodes as severe, and severe symptoms may last beyond 72 hours. US astronaut records list 325 space motion sickness events. Simple, low-effort logging gives the flight surgeon a picture between private medical conferences (on the ISS these are held on launch day and daily for 5 days; other programs may differ), and a robot that fetches supplies lets a sick crewmember keep still. Head movement and unpleasant sights make symptoms worse and closing the eyes helps, so the robot works by voice, moves slowly and keeps out of the crewmember's line of sight.

Priority: Moved up from Tier 2: NASA reports space motion sickness in up to about 73% of crew in the first 2-3 days of flight, worse on first flights (another NASA brief gives 50-70%), with dehydration and reduced performance as the main concerns.

Related: RMP-PHARM-001 · RMP-GI-002 · RMP-RENAL-002 · RMP-NEURO-007 · RMP-INF-001

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Crewmember with symptoms: answers check-ins and can stop or pause them at any time
• Flight surgeon: reviews the log, usually at the daily private medical conference in the first days of flight

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [13]

3 · Preconditions and consent

• PRE-1 A crewmember (the one with symptoms, or the CMO) started the log by command. A reminder set before flight may prompt the crew on launch day, but never starts the robot.human_start == trueV2 10174
• PRE-2 The crewmember is awake and answering. If not, stop and call the CMO at once (X6).crew_responsive == true
• PRE-3 Robot self-test passed; emesis bags, wipes and clean-up kit stocked.V2 10161
• PRE-4 Robot and supplies restrained when not moving.V2 7046
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to check-ins by voice. They can decline any check-in or question; an explicit "no" is logged as declined and never questioned.

Emergency consent

If the crewmember cannot answer, the robot does not continue the log; it calls the CMO at once (X6).

Withdrawal

The crewmember can stop or pause check-ins at any time.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   On a crewmember's command, open the log, tell the CMO, and send a "motion sickness log started" note to the flight surgeon (queued if the link is down).

   Done when: CMO acknowledges; note delivered or queued.

   V2 10174V1 6003

2. S2RobotRung 2

   Bring emesis bags, wipes, a clean-up kit and, if the crewmember asks, a drink pouch, unless the CMO or flight surgeon has logged "nothing by mouth" (if so, the robot says so and routes the request to the CMO); restrain them within reach. Approach slowly and from outside the crewmember's line of sight where possible.

   Done when: Supplies restrained within reach.

   Limit: <set by validation>

   V2 7046

3. S3RobotRung 2

   Run a voice-only check-in (the crewmember can keep their eyes closed): the red-flag questions first, then symptom rating, vomiting episodes, fluids taken and urine passed. Log answers word for word.

   Done when: Answers logged, or "not answered" logged.

   D1DecisionRobot decides

   Did the crewmember answer the check-in?

   • Yes → Continue to S4.
   • Declined explicitly → Log "declined"; offer again at the next check-in.
   • No answer, and the crewmember is not known to be asleep → URGENT: alert the CMO, who checks on the crewmember in person. Never logged as declined.
4. S4RobotRung 2

   Compare the answers and counts with the red-flag list (section 7). On any match, apply the action listed for that red flag (URGENT alert, stop, or private flag) with the answer itself, never a cause.

   Done when: Each matching red flag actioned as listed, or no red flag.

   D2DecisionRobot decides

   Does any answer or count meet a red flag?

   • Yes → Apply the action listed for each matching red flag (URGENT alert, stop, or private flag); the robot reports the answer, not its meaning. On any URGENT flag the CMO assesses in person.
   • No → Continue.
5. S5RobotRung 2

   On request, hand over a fresh emesis bag; the crewmember closes it; the robot takes only sealed bags, then labels and stows them per the biohazard procedure and cleans its surfaces per the cleaning protocol (RMP-INF-002). It never holds an open bag near the crewmember's face.

   Done when: Sealed waste stowed; cleaning logged.

   V2 10172

6. S6Crew

   The CMO sees the crewmember in person when asked or on any red flag. Any medicine is ordered by the CMO or flight surgeon and fetched through RMP-PHARM-001.

   Done when: CMO decision logged.

7. S7RobotRung 2

   Before each private medical conference, or every <set by flight surgeon> hours, send the flight surgeon a summary: ratings over time, vomiting count, fluids and urine as reported, medicines logged by humans, and any alerts.

   Done when: Summary delivered or queued.

   V1 6003V1 7001V1 7003

   D3DecisionGround decides

   What is the plan (treatment, fluids, work limits)?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
8. S8Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides treatment, fluids, "nothing by mouth" or wake-check orders, work limits and whether an EVA or other critical task should wait. (For context, NASA schedules no EVAs within 72 hours of launch, and each EVA needs ground medical clearance [V1 6006].) The robot logs the decisions.

   Done when: Decision logged.

   V1 3004V1 6006

9. S9RobotRung 2

   Offer a check-in every <set by flight surgeon> hours until the crewmember and flight surgeon close the log. 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. A routine check-in never wakes a sleeping crewmember unless the CMO or flight surgeon has set wake checks (for example after a sedating medicine or a red flag); D1 still applies when the crewmember is not known to be asleep.

   Done when: Each prompt accepted, postponed or answered; log closed by a human.

   V2 10174

   D4DecisionRobot decides

   Are symptoms lasting longer than the time the flight surgeon set, or new after the first flight days?

   • Yes → Flag to the flight surgeon and CMO: late or lasting symptoms are not assumed to be motion sickness.
   • No → Continue the schedule.

7 · Stop and escalate rules, red flags

Red flags

The robot reports the sign or value only, never what it means. Numeric thresholds are placeholders for the clinical lead.

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Each check-in time, answer and alert, so the flight surgeon can follow the trend across the first flight days.

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [9] and Volume 2 Revision F [10]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted check-ins with simulated answers covering every red flag and missed answer, at station, Moon and Mars delays. Pass: Every red flag alerts; every unanswered check-in escalates; zero advice or cause statements; zero self-starts.
2. Earth analog. Volunteers in an Earth motion-sickness setting (for example parabolic flight campaigns) using the voice check-ins and supply fetching. Pass: Volunteers rate the robot as not making symptoms worse; data completeness at or above <set by validation>.
3. Parabolic or station demonstration. Supply fetching, fresh-bag hand-over and sealed-bag collection in weightlessness, without a patient. Pass: Hand-over and sealed-waste collection work as specified; zero open-bag holding.
4. Flight use under flight surgeon supervision. First use as a logging aid alongside the usual private medical conferences. Pass: No safety events; the flight surgeon finds the log useful.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by a crewmember. The flight surgeon reviews the log at each private medical conference; red flags go to the CMO and flight surgeon at once.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.5.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [12].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon sees the log at the daily private medical conference in the first days of flight and can be alerted at any time.

Loss of signal

• Only the robot pauses; crew care never waits for the link or the robot.
• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps running check-ins and logging offline.
• Red flags go to the CMO at once; the CMO decides under the pre-approved onboard checklist.
• At the next contact the robot sends one package: the symptom trend, counts, alerts and decisions.

Mars-class delay

• Motion sickness is most common in the first days after launch, when Earth is still close. After a gravity change far from Earth, replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks.
• Red-flag thresholds and the check-in schedule are set before flight; the CMO acts on them.

[11]

Sources

1. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Space motion sickness affects up to 73% of crewmembers during the first 2-3 days of flight and is generally worse on initial flights (70-90% for space adaptation sickness overall); symptoms include stomach awareness, nausea, vomiting, malaise, drowsiness and headache; head movements and unpleasant sights or odors make it worse, and restricting head motion and closing the eyes help; NASA's severity grading counts more than 2 episodes of vomiting as severe (with no time window), with symptoms that may persist beyond 72 hours; concerns are dehydration and weakness and reduced performance; intramuscular promethazine is the most-used medicine, and drowsiness is a symptom and a possible medicine effect; no EVAs are scheduled within 72 hours of launch; ISS crew have private medical conferences on launch day and daily for 5 days (other programs may differ); similar symptoms can occur on return to Earth.
2. NASA OCHMO. Spaceflight Experience and Medical Care. Technical Brief OCHMO-TB-033 (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-033-spacefl… Supports: Space motion sickness affects 50-70% of crewmembers.
3. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 2: 325 space motion sickness events among US astronauts (Shuttle, Mir and ISS through 2006).
4. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. www.nice.org.uk/guidance/cg150/chapter/Recommendations Supports: Headache features that need further investigation or referral include worsening headache with fever, sudden-onset headache reaching maximum intensity within 5 minutes, new-onset neurological deficit, and impaired level of consciousness.
5. National Institute for Health and Care Excellence. Suspected sepsis in people aged 16 or over: recognition, assessment and early management. NICE guideline NG253 (2025, last updated Sept 23, 2026). www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessme… Supports: People with sepsis may feel very unwell and may not have a high temperature; do not rely on fever alone; a rise in temperature can be a physiological response; assess temperature, heart rate, breathing rate, blood pressure, level of consciousness and oxygen saturation; look for mottled or ashen skin, blue skin, lips or tongue, a non-blanching rash, and breaks in the skin; ask how often the person passed urine in the past 18 hours and about fever or shaking chills (rigors); pay attention to new changes in behavior and to concerns raised by others.
6. National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. Clinical guideline CG141 (2012). www.nice.org.uk/guidance/cg141 Supports: Management of acute upper gastrointestinal bleeding. Cited only as context for vomiting blood as a red flag: it is a management guideline, not a symptom list.
7. U.S. Food and Drug Administration. FDA requires updates to labeling for promethazine hydrochloride injection products (Drug Alerts and Statements, Dec 27, 2023). www.fda.gov/drugs/drug-alerts-and-statements/fda-requires-up… Supports: Labeling updates to further reduce the risk of severe chemical irritation and damage to tissues from intravenous administration of promethazine hydrochloride injection; FDA recommends deep intramuscular administration instead. (The alert is about intravenous use; this protocol flags any injection-site problem after any injected medicine.)
8. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
9. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: Requirement IDs beginning V1.
10. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
11. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
12. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
13. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

Checked on 2026-10-20: links opened (HTTP 200 or publisher redirect), DOIs and PubMed IDs matched, NASA documents read in full text. The framework comes from Part 1.