# RMP-NEURO-005 Post-landing balance testing: a crewmember spots, the CMO runs the tests, the robot records (support-only at an Earth landing) # Version 0.3 (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: '0.3' 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 9 review: 16 required corrections, R1 to R17 with R10 dropped, of which R17 applies to RMP-PHARM-002; 20 optional suggestions); all required corrections that apply to this protocol 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-NEURO-005 slug: rmp-neuro-005 title: >- Post-landing balance testing: a crewmember spots, the CMO runs the tests, the robot records (support-only at an Earth landing) category: neuro tier: 2 rung_note: >- Raised from rung 1 in the library outline to rung 2 for supervised fetching, showing the flight surgeon's test list, keeping the fall space clear and recording results as stated, the same as RMP-EGR-003. "Spot" means a crewmember spots: the robot never touches, catches or supports anyone, never asks anyone to stand, walk or close their eyes, and never times or scores a test. At an Earth landing the robot is support-only: it fetches kit and hands over records when the landing medical lead asks. result_language: use: - result as stated by the CMO - time as called by the CMO - stopped by the crewmember - logged, not interpreted - sent to flight surgeon never: - normal - no problem found - all clear - negative - any diagnosis or cause - time reached - done - passed - failed - fit for duty - balance is fine - expected after landing - stable - recovered - back to baseline - safe - mild - minor scope: summary: >- After a landing on the Moon or Mars, on the CMO's command, the robot shows the balance and mobility tests the flight surgeon's checklist lists (for example sit-to-stand, rising from lying down, and heel-to-toe walking), keeps the fall space the CMO names clear, and logs each result word for word as the CMO states it, with the clock times the CMO calls. A crewmember spots beside the person being tested, and the CMO chooses and runs every test. The robot never touches anyone and never asks anyone to move. At an Earth landing, NASA flight surgeons and the recovery team run any tests; the robot only fetches kit and hands over records when the landing medical lead asks. why: >- Gravity transitions cause problems with posture, walking and spatial orientation, and motion sickness (OCHMO-TB-010). Field tests run on landing day after 6-month ISS missions (sit-to-stand, recovery from a fall, tandem walk, in increasing difficulty) were challenging and temporarily increased motion sickness; early movement may help recovery when it stays within each crewmember's limits, while movements past those limits may have slowed it (Rosenberg 2022). The recovery-from-fall task includes standing for up to 4 minutes, in effect a stand test, so the vital signs are logged and light-headedness is checked first (OCHMO-TB-019; RMP-CARD-004). After flight, bones may not be as strong as before the mission, and "fracture may occur for activities otherwise unlikely to induce fracture" (OCHMO-MTB-013), so a fall during testing is treated as an injury until the CMO decides otherwise. After landing on the Moon or Mars after weeks or months of weightlessness, where there is no recovery team, the CMO leads under the onboard checklist and the flight surgeon advises over the link. At an Earth landing, NASA flight surgeons and the recovery team lead with their own kit (OCHMO-TB-051); there the robot is support-only: it fetches kit and hands over records when the landing medical lead asks, never leads or directs care, and never touches or moves anyone (design judgment). Which tests run, in what order, and when to stop are set by the flight surgeon's checklist; the robot's role (records only, keeps the fall space clear, a human spotter) is design judgment and matches RMP-EGR-003. covers: - >- All balance and mobility tests after a landing, as the flight surgeon's checklist lists (RMP-EGR-003 routes every balance and walking test here) - >- At an Earth landing: support only (fetch kit and hand over records when the landing medical lead asks); NASA flight surgeons and the recovery team run any tests - Results as the CMO states them, with times the CMO calls - >- Vital signs after landing: RMP-EGR-003; light-headedness on standing: RMP-CARD-004; a fall or injury: RMP-MSK-001 and RMP-MSK-002 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) - Asking a crewmember to stand, walk, turn or close their eyes - Timing, scoring or passing a test - Touching, supporting, catching or spotting a crewmember - Saying a crewmember is fit for duty or has recovered - Choosing the next test or deciding to go on - >- At an Earth landing: leading or directing any care, or any task other than fetching kit and handing over records when the landing medical lead asks related: - RMP-EGR-003 - RMP-CARD-004 - RMP-EGR-002 - RMP-MSK-001 - RMP-MSK-002 - RMP-MSK-004 - RMP-NEURO-001 - RMP-GI-002 - 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: - >- Landing medical lead: the CMO on the Moon or Mars, advised by the flight surgeon over the link; at an Earth landing, the NASA flight surgeon with the recovery team - 'Spotter: a crewmember beside the crewmember during every test, who is the only one to steady them' - 'Second trained CMO: receives every alert and takes over if the CMO is the patient' robot_may: - Bring the landing medical kit by a checked kit fetch (or an emergency fetch) - Show the flight surgeon's test list - Keep the fall space clear of loose items, then hold beyond the keep-out distance - Record results and times as the CMO states them - >- At an Earth landing: fetch kit and hand over records (RMP-EGR-001) when the landing medical lead asks robot_may_not: - Ask anyone to stand, walk or close their eyes - Time, score or pass a test - Touch, steady or catch anyone - 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: >- The CMO started the protocol by command after a Moon or Mars landing, and a spotter is named. At an Earth landing only the support role applies, on the landing medical lead's request. check: human_start == true refs: - V2 10174 - id: PRE-2 text: Robot self-test passed; kit stowage locations known. refs: - V2 10161 - V2 7059 - id: PRE-3 text: Robot and supplies restrained when not moving. refs: - V2 7046 - id: PRE-4 text: Link status known. The crew never wait for the robot before acting. check: link_state in [live, delayed, down] - id: PRE-5 text: >- Before any standing test, the RMP-EGR-003 vital signs are logged and the CMO states that the crewmember has no light-headedness on sitting up; otherwise RMP-CARD-004 runs first. refs: - V1 4010 consent: standard: The crewmember agrees to each test and to the results being recorded and sent to the flight surgeon. emergency: If the crewmember cannot agree, no test runs; the robot sends an URGENT alert (X7). withdrawal: >- The crewmember can stop any test at any time; the robot logs "stopped by the crewmember" and the CMO decides what happens next. inputs: - id: IN-1 name: The flight surgeon's balance test list for this crewmember source: Flight surgeon / program required: true if_missing: The robot shows "test list not loaded"; the CMO uses the paper checklist. - id: IN-2 name: The name of the spotter source: CMO required: true if_missing: No test is shown until a spotter is named. - id: IN-3 name: Each test result and the start and stop times, as the CMO states them source: CMO required: true if_missing: Log "not stated". - id: IN-4 name: Symptoms in the crewmember's words (dizziness or spinning, nausea, light-headedness, pain) source: Crewmember required: false if_missing: Log "no response"; D3 applies. - id: IN-5 name: Link status and delay source: Communications system required: true if_missing: Treat as link down; the CMO leads under the onboard checklist. steps: - id: S1 actor: robot rung: 2 action: >- Log the start and the landing type the person who started the protocol states (Earth landing, or Moon or Mars). At a Moon or Mars landing: tell the flight surgeon and the CMO that post-landing balance testing has started (URGENT if any red flag is 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. At an Earth landing the robot only tells the landing medical lead that it is in the support-only role. success: Notice acknowledged. refs: - V1 3006 - V2 10174 - id: S2 actor: robot rung: 2 action: >- On the CMO's command (at an Earth landing, on the landing medical lead's request), run a checked kit fetch of the landing medical kit (as the kit list states): 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: >- Moon or Mars only: before a test starts, clear the fall space the CMO names of loose items, then hold beyond the keep-out distance and outside every route. The robot clears the fall space only before a test starts; while a test is under way it does not move, except to move clear under X9 or X11. Show the flight surgeon's test list on screen where the CMO can see it; the CMO, not the robot, tells the crewmember each test. success: Fall space clear; list in view. limit: refs: - V1 6003 - V2 10172 - id: S4 actor: crew action: >- The CMO runs each test on the list, in order, with the spotter beside the crewmember; the crewmember sits or lies down at once on any symptom, and the CMO stops the series at the limit the checklist sets. success: Tests done or stopped as the CMO states. refs: - V1 4010 - V1 3017 - id: S5 actor: robot rung: 2 action: >- Moon or Mars only: log each result word for word as the CMO states it, with the start and stop clock times the CMO calls; the robot never gives its own score. On request only, the robot shows the time elapsed since the start the CMO called, as a clock-time entry; it never announces a time, and never says "time reached", "done", "passed" or "failed". Show an on-screen symptom prompt between tests that the crewmember can accept, and log answers word for word. success: Results and answers logged. 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 activity limits, repeat testing and the reconditioning plan. success: Decision logged. refs: - V1 3017 - V1 4010 - id: S8 actor: robot rung: 2 action: >- Moon or Mars only: 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: Kit reconciled or shown as "opened – not restocked". refs: - V2 7059 - id: S10 actor: robot rung: 2 action: >- Send the flight surgeon one package: results and times as stated, answers, alerts and decisions. At an Earth landing: hand over the records under RMP-EGR-001 when the landing medical lead asks. success: Package delivered or queued. refs: - V1 6003 - V1 7003 decisions: - id: D1 after: S2 decided_by: robot question: Which kit fetch was it, and what did the checked kit fetch show? branches: - if: EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) then: >- Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use). - if: KIT ID AND SEAL MATCH then: >- Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time. - if: MISMATCH, seal not intact or CANNOT VERIFY then: >- Shown with the reason. No hand-over under this protocol: the kit stays sealed 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 kit go to the CMO, logged there as an override with the reason, and flagged to the flight surgeon. If the need becomes an emergency, a crewmember or the CMO states it and the emergency fetch applies. 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 symptom prompt, or say they want to skip it? 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 activity limits, repeat tests and reconditioning plan apply? 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 - after: S1 decided_by: crew question: >- Is this an Earth landing, as the person who started the protocol states (the robot never decides it)? branches: - if: Yes (Earth landing) then: >- Support-only: only the kit-fetch step (checked kit fetch, or the emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request; every step marked "Moon or Mars only" is skipped, and the robot holds outside every route until asked. - if: No (Moon or Mars landing) then: Continue with every step. id: D6 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: before it holds, it moves to a position clear of a hatch route or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew tests already under way, help sitting or lying down, CPR and the CMO's care 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; it resumes only on the CMO's confirmation. 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 crewmember sways, stumbles or starts to fall action: Robot stops at once, away from them; it never catches or supports anyone; the spotter and CMO act. level: safe-state refs: - V2 10172 - id: X10 trigger: No spotter is beside the crewmember action: Robot shows "no spotter" and does not show the next test; the CMO decides. level: stop - id: X11 trigger: Someone needs the space or route the robot is in action: Robot moves clear at once without contact and holds; it never pauses in a hatch route. level: safe-state refs: - V2 10172 red_flags: - id: RF1 sign: A fall or near-fall during a test (design judgment) threshold: any action: >- URGENT alert; the crewmember sits or lies down; see RMP-MSK-001 and RMP-MSK-002 for injury and RMP-NEURO-001 for a head strike - id: RF2 sign: Pain, swelling or deformity, or unable to bear weight, after a fall, misstep or test threshold: any action: URGENT alert; the crewmember stays still; see RMP-MSK-001 and RMP-MSK-002 source: mtb013 - id: RF3 sign: Fainting, or light-headedness on standing threshold: any action: URGENT alert; see RMP-CARD-004 source: tb019 - id: RF4 sign: >- New weakness or numbness on one side, trouble speaking or seeing, or a sudden severe headache (design judgment) threshold: any action: URGENT alert; see RMP-NEURO-002 - id: RF5 sign: New back or neck pain after landing threshold: any action: URGENT alert; see RMP-MSK-004 source: johnston - id: RF6 sign: Unresponsive, or not breathing normally threshold: any action: URGENT alert; start RMP-CARD-001 now source: aha2025bls - id: RF7 sign: Spinning, vomiting, or unable to sit up because of dizziness threshold: any action: Flag to the flight surgeon; the CMO stops the series; see RMP-GI-002 for vomiting source: tb010 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: Asking a crewmember to stand, walk or close their eyes, or scoring a test value: not allowed enforced: No such prompt or task is loaded - id: L3 name: >- Clear fall space kept around the crewmember during a test (cleared before the test; no robot motion during it) value: enforced: Keep-out zone in the robot controller - id: L4 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: >- Test results and times as the CMO states them; the spotter named; tests stopped and by whom; answers as stated. - 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 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 3017 use: Post-mission reconditioning starts at egress; the package goes to the flight surgeon's plan. - id: V1 4010 use: Post-mission sensorimotor reconditioning is monitored; the robot records the CMO's test results. - 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 tests with a near-fall, no spotter, a fall with pain, new back pain, CMO as patient, lost link. pass: Zero prompts to stand or walk; zero contact; every red flag raised. - stage: training model what: Balance test drill with a spotter. pass: Results logged as the CMO states them; fall space clear. - stage: parabolic or station demonstration what: Not applicable (landing only); a surface analogue test instead. pass: Keep-out held. - stage: flight use under flight surgeon supervision what: First use after a surface landing. 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 the CMO after a Moon or Mars landing, with a named spotter; at an Earth landing, support only, on the landing medical lead's request. The CMO chooses and runs every test. 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: >- Earth landing site: NASA flight surgeons and the recovery team are present and lead; the robot fetches kit and hands over records only. Moon: the flight surgeon advises over a link with a few seconds of delay; the CMO leads on the surface. loss_of_signal: - >- Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation. - >- Crew tests already under way, help sitting or lying down, CPR and the CMO's care continue under the onboard checklist and never wait for the link or the robot. - The CMO leads under the onboard checklist; results are queued. mars_delay: - 'Mars: no real-time guidance; the test list and stop limits are set before flight.' sources: - key: tb010 text: NASA OCHMO. Sensorimotor Overview. Technical Brief OCHMO-TB-010 Rev A (2023). url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-010-sensorimotor.pdf supports: >- Gravity transitions (weightlessness to a planetary surface or Earth) cause decrements in postural control and locomotion, spatial disorientation and motion sickness during and after the transition; these affect egress and early surface activity. - key: rosenberg2022 text: >- Rosenberg MJ, Reschke MF, Tomilovskaya ES, Wood SJ. Multiple field tests on landing day: early mobility may improve postural recovery following spaceflight. Front Physiol. 2022;13:921368. url: https://doi.org/10.3389/fphys.2022.921368 doi: 10.3389/fphys.2022.921368 supports: >- Field tests (for example sit-to-stand, recovery from a fall from prone to standing, and tandem walk, in increasing difficulty) were run on landing day after 6-month ISS missions; the protocol was challenging and temporarily increased motion sickness symptoms; early movement may help recovery when kept within individual thresholds, while movements above aversive thresholds may have impaired adaptation in others. Full text read Oct 21, 2026. pmid: '36187781' - key: mtb013 text: NASA OCHMO. Bone Loss. Medical Technical Brief OCHMO-MTB-013 Rev D (2026). url: https://www.nasa.gov/wp-content/uploads/2026/02/ochmo-mtb-013-bone-loss.pdf supports: >- Bones during and after spaceflight may not be as strong as before the mission, and "fracture may occur for activities otherwise unlikely to induce fracture prior to space missions". Saved copy read Oct 21, 2026. - key: tb051 text: NASA OCHMO. Crew Medical Support for Entry, Descent, and Landing. Technical Brief OCHMO-TB-051. url: >- https://www.nasa.gov/wp-content/uploads/2026/05/ochmo-tb-051-crew-medical-support-entry-descent-landing.pdf supports: >- Flight surgeons are present at the landing site; launch and landing sites need medical capability for contingencies; depending on the location, transport may be by ground, water or air, with rescue vehicles able to give advanced trauma life support until transfer to a definitive medical care facility (DMCF) [V1 3013, V1 3014]. Read Oct 21, 2026. - key: tb019 text: NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B. url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthostatic-intolerance.pdf supports: >- Spaceflight reduces intravascular fluid volume by around 15%; fluid loading before reentry is an important countermeasure to decrease orthostatic intolerance, and current protocols include 24-48 oz of salt-water solution before deorbit, depending on body weight. - key: johnston text: >- Johnston SL, Campbell MR, Scheuring R, Feiveson AH. Risk of herniated nucleus pulposus among U.S. astronauts. Aviat Space Environ Med. 2010;81(6):566-574. url: https://doi.org/10.3357/asem.2427.2010 doi: 10.3357/asem.2427.2010 pmid: '20540448' supports: >- In-flight back pain is presumably due to elongation of the spine; disc herniation was 4.3 times more common in US astronauts (321) than matched controls (983), relatively more often in the neck, with evidence that the risk is increased immediately after spaceflight. - key: aha2025bls text: >- Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. url: https://doi.org/10.1161/CIR.0000000000001369 doi: 10.1161/CIR.0000000000001369 pmid: '41122888' supports: >- Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read. - 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 adaptation sickness and its parts (motion sickness, congestion, headache, back pain, urinary retention) in the first days of flight. - 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 3006, V1 3017 (reconditioning starts at egress), V1 4010 (sensorimotor reconditioning monitored), V1 6003, V1 7003. - 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 9 review) items: - >- Rosenberg 2022 author list corrected to Rosenberg MJ, Reschke MF, Tomilovskaya ES, Wood SJ (PMID 36187781) (R7). - >- New precondition: before any standing test, the RMP-EGR-003 vital signs are logged and the CMO states that the crewmember has no light-headedness on sitting up; otherwise RMP-CARD-004 runs first (R8; OCHMO-TB-019; the recovery-from-fall task includes standing for up to 4 minutes, Rosenberg 2022). - >- S3: the robot clears the fall space only before a test starts; while a test is under way it does not move, except to move clear under X9 or X11 (R9). - >- All post-landing balance and walking tests now run only under this protocol; RMP-EGR-003 keeps vital signs, symptoms and egress and routes here, so one rule set applies (spotter required, robot still during tests, never cue, time or score) (S21, Q3). - >- Batch 9 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician. - date: '2026-10-21' version: '0.2' source: Scope decision by the foundation owner (Oct 21, 2026) items: - >- Scope: Earth landings are back in scope in a support-only role (missions restored to low Earth orbit, commercial, Moon and Mars). At an Earth landing, NASA flight surgeons and the recovery team lead; the robot only fetches kit and hands over records (RMP-EGR-001) when the landing medical lead asks, never leads care, and never touches or moves anyone. - >- Moon and Mars wording is kept: there the CMO leads under the onboard checklist, advised by the flight surgeon. - date: '2026-10-21' version: '0.3' source: Batch 10 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026 items: - >- Earth landing gated at step level: a new decision after S1 asks whether this is an Earth landing; if yes, only the kit-fetch step (checked or emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request, and every other robot step is marked "Moon or Mars only" (R10; owner scope decision of Oct 21, 2026; OCHMO-TB-051).