{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.5", "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 2 review, 51 corrections); all corrections are applied in this version. No named human clinician has reviewed it. Version 0.3 is an editorial update from the batch 4 review (item 27) that does not change the reviewed clinical meaning." }, "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-004", "slug": "rmp-neuro-004", "title": "Space motion sickness: symptom, vomiting and fluid-intake log, containment supplies, relay to the flight surgeon (no drug advice)", "category": "neuro", "tier": 1, "tier_note": "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.", "result_language": { "use": [ "logged, not interpreted", "sent to flight surgeon", "rating as reported by the crewmember" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "just motion sickness", "nothing to worry about", "dehydrated", "not dehydrated", "safe" ] }, "scope": { "summary": "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": "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.", "covers": [ "Nausea, vomiting, stomach awareness, malaise, drowsiness or headache in the first days after launch (or after a gravity change such as landing; NASA describes similar symptoms on return to Earth), in a crewmember who is awake and answering", "Repeat check-ins until the crewmember and flight surgeon close the log" ], "locked_out": [ "Suggesting, choosing, fetching or dosing any medicine, including anti-sickness medicines (a human order and RMP-PHARM-001 are needed)", "Advising how much to drink, or judging whether someone is dehydrated (the robot logs what the crewmember reports)", "Intravenous fluids or any needle task", "Saying symptoms are caused by motion sickness, or ruling anything out", "Clearing a crewmember for a spacewalk (EVA) or other critical task (the flight surgeon decides)", "Vomiting inside a helmet, mask or suit (vehicle and suit emergency procedures; the robot only brings supplies if asked)", "Touching, holding or restraining the crewmember", "Holding an open bag near the crewmember's face (the robot hands over fresh bags and takes only sealed ones)" ], "related": [ "RMP-PHARM-001", "RMP-GI-002", "RMP-RENAL-002", "RMP-NEURO-007", "RMP-INF-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": [ "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" ], "robot_may": [ "Run short, voice-only check-ins so the crewmember can keep their eyes closed and head still", "Fetch emesis bags, wipes, a clean-up kit and a drink pouch the crewmember asks for (unless the CMO or flight surgeon has logged \"nothing by mouth\"; then it says so and routes the request to the CMO), and restrain them within reach", "Hand over a fresh emesis bag on request; take only bags the crewmember has closed, then label and stow them", "Log symptom ratings, vomiting episodes, fluids and urine as reported", "Send the log to the flight surgeon; alert the CMO and flight surgeon on a red flag" ], "robot_may_not": [ "Suggest, fetch or dose any medicine without a human order through RMP-PHARM-001", "Advise on fluids or say whether someone is dehydrated", "Say symptoms are \"just\" motion sickness, or normal", "Move quickly, or into the crewmember's line of sight, during a check-in", "Hold an open bag near the crewmember's face", "Touch the crewmember", "Start without a human command (a launch-day reminder may prompt the crew, but never starts the robot)" ], "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 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.", "check": "human_start == true", "refs": [ "V2 10174" ] }, { "id": "PRE-2", "text": "The crewmember is awake and answering. If not, stop and call the CMO at once (X6).", "check": "crew_responsive == true" }, { "id": "PRE-3", "text": "Robot self-test passed; emesis bags, wipes and clean-up kit stocked.", "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 check-ins by voice. They can decline any check-in or question; an explicit \"no\" is logged as declined and never questioned.", "emergency": "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." }, "inputs": [ { "id": "IN-1", "name": "Symptom rating on the scale the flight surgeon sets before flight", "source": "Crewmember, by voice", "required": true, "if_missing": "Log \"not answered\" and apply D1. Never logged as declined." }, { "id": "IN-2", "name": "Vomiting episodes since the last check-in (number and time)", "source": "Crewmember, by voice; count of emesis bags used", "required": true, "if_missing": "Log \"not answered\"." }, { "id": "IN-3", "name": "Fluids taken since the last check-in (pouches or volume, as reported)", "source": "Crewmember, by voice, or drink-pouch log", "required": true, "if_missing": "Log \"not answered\"." }, { "id": "IN-4", "name": "Urine passed since the last check-in (yes or no, and time)", "source": "Crewmember, by voice, or the waste-system log if available", "required": true, "if_missing": "Log \"not answered\"." }, { "id": "IN-5", "name": "Red-flag questions: headache type, vision change, belly pain, fever, blood in vomit, trouble passing urine, and pain, swelling or color change where an injection was given", "source": "Crewmember, by voice", "required": true, "if_missing": "Ask the CMO to check in person." }, { "id": "IN-6", "name": "Medicines given, as logged by humans (shown to the CMO and flight surgeon; the robot does not advise)", "source": "Medical record or dose log (RMP-PHARM-003)", "required": false, "if_missing": "Note \"no dose log available\"." }, { "id": "IN-7", "name": "Time since launch or the last gravity change", "source": "Mission clock", "required": true, "if_missing": "Ask the CMO." }, { "id": "IN-8", "name": "Heart rate and blood pressure, measured by the CMO when the CMO chooses (recorded, not interpreted)", "source": "Entered by the CMO", "required": false, "if_missing": "Log \"not measured\". A missing value is never treated as reassuring." }, { "id": "IN-9", "name": "\"Nothing by mouth\" or wake-check orders, as logged by the CMO or flight surgeon", "source": "Medical record", "required": false, "if_missing": "Treat as no order; ask the CMO before bringing a drink pouch if unsure." }, { "id": "IN-10", "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, tell the CMO, and send a \"motion sickness log started\" note to the flight surgeon (queued if the link is down).", "success": "CMO acknowledges; note delivered or queued.", "refs": [ "V2 10174", "V1 6003" ] }, { "id": "S2", "actor": "robot", "rung": 2, "action": "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.", "success": "Supplies restrained within reach.", "limit": "", "refs": [ "V2 7046" ] }, { "id": "S3", "actor": "robot", "rung": 2, "action": "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.", "success": "Answers logged, or \"not answered\" logged." }, { "id": "S4", "actor": "robot", "rung": 2, "action": "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.", "success": "Each matching red flag actioned as listed, or no red flag." }, { "id": "S5", "actor": "robot", "rung": 2, "action": "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.", "success": "Sealed waste stowed; cleaning logged.", "refs": [ "V2 10172" ] }, { "id": "S6", "actor": "crew", "action": "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.", "success": "CMO decision logged." }, { "id": "S7", "actor": "robot", "rung": 2, "action": "Before each private medical conference, or every hours, send the flight surgeon a summary: ratings over time, vomiting count, fluids and urine as reported, medicines logged by humans, and any alerts.", "success": "Summary delivered or queued.", "refs": [ "V1 6003", "V1 7001", "V1 7003" ] }, { "id": "S8", "actor": "ground", "action": "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.", "success": "Decision logged.", "refs": [ "V1 3004", "V1 6006" ] }, { "id": "S9", "actor": "robot", "rung": 2, "action": "Offer a check-in every 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.", "success": "Each prompt accepted, postponed or answered; log closed by a human.", "refs": [ "V2 10174" ] } ], "decisions": [ { "id": "D1", "after": "S3", "decided_by": "robot", "question": "Did the crewmember answer the check-in?", "branches": [ { "if": "Yes", "then": "Continue to S4." }, { "if": "Declined explicitly", "then": "Log \"declined\"; offer again at the next check-in." }, { "if": "No answer, and the crewmember is not known to be asleep", "then": "URGENT: alert the CMO, who checks on the crewmember in person. Never logged as declined." } ] }, { "id": "D2", "after": "S4", "decided_by": "robot", "question": "Does any answer or count meet a red flag?", "branches": [ { "if": "Yes", "then": "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." }, { "if": "No", "then": "Continue." } ] }, { "id": "D3", "after": "S7", "decided_by": "ground", "question": "What is the plan (treatment, fluids, work limits)?", "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": "D4", "after": "S9", "decided_by": "robot", "question": "Are symptoms lasting longer than the time the flight surgeon set, or new after the first flight days?", "branches": [ { "if": "Yes", "then": "Flag to the flight surgeon and CMO: late or lasting symptoms are not assumed to be motion sickness." }, { "if": "No", "then": "Continue the schedule." } ] } ], "stop_rules": [ { "id": "X1", "trigger": "The patient (or the crewmember being examined) says stop, or withdraws consent", "action": "The robot stops the check-in at once and moves away; declining is logged, not questioned.", "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; crew care never waits for the link or the robot. On loss of link the robot pauses any movement and tells the CMO. On the CMO's confirmation it continues check-ins and logging offline; everything is queued and sent to the flight surgeon at the next contact.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "The crewmember does not respond, cannot be woken, or seems confused", "action": "Robot stops the log and calls the CMO at once; a crewmember checks in person.", "level": "urgent" }, { "id": "X7", "trigger": "The crewmember asks the robot for medicine or fluid advice", "action": "Robot declines and routes the question to the CMO or flight surgeon.", "level": "stop" } ], "red_flags": [ { "id": "RF1", "sign": "Vomiting episodes", "threshold": "more than in hours (for context: NASA's severity grading counts \"more than 2 episodes of vomiting\" as severe; the grading gives no time window)", "action": "URGENT alert to the CMO and flight surgeon", "source": "mtb004" }, { "id": "RF2", "sign": "Unable to keep fluids down, no urine passed, or a CMO-entered heart rate or blood pressure beyond the alert level", "threshold": "fluids or urine: for hours; heart rate or blood pressure: beyond ", "action": "URGENT alert. If the crewmember needs to pass urine but cannot, the flight surgeon may start RMP-RENAL-002.", "source": "mtb004" }, { "id": "RF3", "sign": "Blood or dark \"coffee-ground\" material in vomit", "threshold": "any", "action": "URGENT alert", "source": "cg141" }, { "id": "RF4", "sign": "Severe or constant belly pain, or pain in one place", "threshold": "any", "action": "URGENT alert; the flight surgeon may request RMP-GI-001" }, { "id": "RF5", "sign": "Sudden-onset severe headache; headache with fever; new weakness, numbness, speech or vision change; confusion or reduced alertness", "threshold": "any", "action": "URGENT alert; never attributed to motion sickness", "source": "nice150" }, { "id": "RF6", "sign": "Fever", "threshold": " °C or higher", "action": "URGENT alert; see RMP-INF-001", "source": "ng253" }, { "id": "RF7", "sign": "Symptoms lasting, or starting late", "threshold": "beyond hours after launch or a gravity change, or new after the first flight days", "action": "Flag to the flight surgeon; not assumed to be motion sickness", "source": "mtb004" }, { "id": "RF8", "sign": "Vomiting while wearing a helmet, mask or suit", "threshold": "any", "action": "Vehicle or suit emergency procedure; robot brings supplies only if asked" }, { "id": "RF9", "sign": "Pain, swelling, color change, coldness or numbness at or beyond an injection site after an injected medicine", "threshold": "any", "action": "URGENT alert to the CMO and flight surgeon (the robot asks and relays only; it gives no drug wording)", "source": "fdapromethazine" } ], "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 during a check-in", "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 check-in time, answer and alert, so the flight surgeon can follow the trend across the first flight days." } ], "requirements": [ { "id": "V1 3003", "use": "Capability to monitor physiological well-being in flight." }, { "id": "V1 3004", "use": "In-mission care includes recording outcomes, personal protective equipment (biohazard containment) and privacy considerations; administering and managing medications is a human capability." }, { "id": "V1 3006", "use": "Two crew medical officers per vehicle for NASA programs (see the commercial-flight note)." }, { "id": "V1 6003", "use": "Logs and alerts sent to the ground are private medical communications." }, { "id": "V1 6006", "use": "Every EVA needs medical clearance by ground medical support beforehand; the robot never clears anyone for an EVA." }, { "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 one who is sick." }, { "id": "V2 7046", "use": "Supplies restrained within reach." }, { "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 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." }, { "stage": "Earth analog", "what": "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 ." }, { "stage": "parabolic or station demonstration", "what": "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." }, { "stage": "flight use under flight surgeon supervision", "what": "First use as a logging aid alongside the usual private medical conferences.", "pass": "No safety events; the flight surgeon finds the log 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 reviews the log at each private medical conference; red flags go to the CMO and flight surgeon at once." }, "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 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_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." ] }, "sources": [ { "key": "mtb004", "text": "NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025).", "url": "https://www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-adaptation-sickness-sas.pdf", "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." }, { "key": "tb033", "text": "NASA OCHMO. Spaceflight Experience and Medical Care. Technical Brief OCHMO-TB-033 (2023).", "url": "https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-033-spaceflight-experience-medical-care.pdf", "supports": "Space motion sickness affects 50-70% of crewmembers." }, { "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": "Table 2: 325 space motion sickness events among US astronauts (Shuttle, Mir and ISS through 2006)." }, { "key": "nice150", "text": "National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150.", "url": "https://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." }, { "key": "ng253", "text": "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).", "url": "https://www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessment", "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." }, { "key": "cg141", "text": "National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. Clinical guideline CG141 (2012).", "url": "https://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." }, { "key": "fdapromethazine", "text": "U.S. Food and Drug Administration. FDA requires updates to labeling for promethazine hydrochloride injection products (Drug Alerts and Statements, Dec 27, 2023).", "url": "https://www.fda.gov/drugs/drug-alerts-and-statements/fda-requires-updates-labeling-promethazine-hydrochloride-injection-products", "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.)" }, { "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 2 review)", "items": [ "The robot no longer holds an open waste bag: it hands over fresh bags and takes only bags the crewmember has closed; no open bag near the face (item 1).", "RF1 note now says NASA's grading counts more than 2 vomiting episodes as severe with no time window; both placeholders kept (item 2).", "Added CMO-entered heart rate and blood pressure (recorded only) to inputs and RF2; no \"dizzy on standing\" trigger in weightlessness (item 3).", "Added RF9: pain, swelling, color change, coldness or numbness at or beyond an injection site, citing the FDA promethazine injection alert (Dec 27, 2023; it concerns intravenous use) (item 4).", "\"Never wakes a sleeping crewmember\" now allows wake checks set by the CMO or flight surgeon, for example after a sedating medicine (item 5).", "Drink pouches are not brought if a human has logged \"nothing by mouth\"; the request goes to the CMO (item 6).", "EVA context corrected: no EVAs within 72 hours of launch (not of symptoms), and ground medical clearance before each EVA [V1 6006]; ISS private medical conferences on launch day and daily for 5 days (item 7).", "Prevalence now reads \"up to about 73% in the first 2-3 days, worse on first flights\", with the other NASA figure (50-70%) kept (item 8).", "Each red-flag decision now applies the action listed for each matching red flag (URGENT alert, stop, or private flag), not URGENT for everything (review item 47).", "Repeat check-ins inside an open log are now on-screen prompts; the robot approaches only when the crewmember or CMO accepts, and a prompt never starts it (item 49, [V2 10174]).", "Red flags that had no source now cite one where a source fits; the rest are shown as general clinical red flags with no source cited (item 50).", "The \"item that failed a check\" lockout is kept and now notes that it applies when RMP-PHARM-001 is used (item 51).", "NASA evidence reports are cited as \"approved for public release\" (item 48)." ] }, { "date": "2026-10-20", "version": "0.3", "source": "AI-assisted batch 4 review by the Medical Research Assistant, Oct 20, 2026 (item 27); editorial only, the reviewed clinical meaning is unchanged", "items": [ "Related protocols: the link to RMP-NEURO-006 (retitled to sleep complaints and sleep-medicine use) now points to the planned headache log, RMP-NEURO-007, so headache no longer routes to a sleep protocol. The headache red flags, their levels and their routes are unchanged." ] }, { "date": "2026-10-21", "version": "0.4", "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, v2). Editorial; no change to steps, thresholds or limits." ] }, { "date": "2026-10-21", "version": "0.5", "source": "Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026", "items": [ "X5 and the comms loss-of-signal branch now open with \"Only the robot pauses; crew care never waits for the link or the robot.\" (batch 7 review suggestion 29). Editorial; robot behaviour unchanged." ] } ] }