# RMP-NEURO-007 Headache log: private log, red-flag escalation and routes (carbon dioxide, after a spacewalk or pressure change, head injury, vision change, dehydration); never says what caused it # 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: '2026-10-21' reviewed: '2026-10-21' human_clinician_review: false text: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 5 review, 25 required corrections and 18 optional suggestions); all required corrections, and the low-risk editorial suggestions, are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use. fixed_rules: flight_surgeon_is_medical_authority: true cmo_acts_under_delegated_care: true human_starts_and_restarts_robot: true robot_never_diagnoses: true no_drug_or_fluid_advice_by_robot: true safe_state_on_fault_or_no_response: true lost_link_pause_then_cmo_decides: true robot_lockouts: diagnosis: true drug_or_fluid_advice: true starting_stopping_or_adjusting_oxygen_or_any_medicine: true self_start_or_self_restart: true changing_own_protocol_thresholds_or_limits: true handing_over_a_mismatched_item_as_verified: true id: RMP-NEURO-007 slug: rmp-neuro-007 title: >- Headache log: private log, red-flag escalation and routes (carbon dioxide, after a spacewalk or pressure change, head injury, vision change, dehydration); never says what caused it category: neuro tier: 2 rung_note: >- Tier 2 as in the library contents. A private logging aid with red-flag escalation. Max autonomy 2 for check-ins and optional supply fetch after a human order; the robot never diagnoses or attributes a cause. result_language: use: - logged, not interpreted - sent to flight surgeon - as reported by the crewmember - severity as stated never: - normal - no problem found - all clear - negative - any diagnosis or cause - migraine - tension headache - from CO2 - from carbon dioxide - from space - from sleep - SANS headache - nothing serious - just a headache - safe - mild - minor scope: summary: >- When a crewmember reports a headache, or the flight surgeon or CMO asks for a headache log, the robot keeps a private log: red-flag questions first; onset, severity (0-10 as the crewmember states), location, character, what makes it better or worse, other symptoms, recent carbon dioxide (CO2) readings if available, recent spacewalk or pressure change, fluids, sleep and medicines as reported; shows the crewmember their own log as a clock-time timeline; and sends summaries to the flight surgeon. Red flags escalate at once to the CMO and flight surgeon, with routes to high CO2 (RMP-ENV-004), after a spacewalk or pressure change (RMP-EVA-001), head injury (RMP-NEURO-001), vision change (RMP-EYE-002 / RMP-EYE-003), dehydration (RMP-RENAL-004) and NICE headache red flags (RMP-NEURO-002 when stroke signs are present). The robot never says what caused the headache. why: >- Headache is one of the most common in-flight complaints. NASA records list 233 headache (space adaptation), 49 late and 20 CO2-induced events among US astronauts through 2006, and 33 headache events on the ISS through Expedition 40 (NASA in-flight medical conditions evidence report). Vein 2009, as cited in the NASA SANS report, found 12 of 17 astronauts (71%) had at least one headache in space, most moderate to severe and often not linked with motion sickness. On the station, the odds of reporting a headache doubled per 1 mmHg rise in CO2 (Law 2014), but headaches also have other causes, so the robot never attributes a headache to CO2, space, sleep or spaceflight-associated neuro-ocular syndrome (SANS). The SANS report notes that crewmembers have not reported the classic raised-pressure headache pattern; headache with a vision change, double vision, brief vision greying (transient visual obscurations) or a pulsing sound in the ears is escalated as design judgment (confirmed in the batch 5 review as the batch 4 recommended escalation for classic raised-pressure associates; flight surgeon sign-off still required). NICE CG150 lists sudden severe headache, headache with fever, new neurological deficit and reduced alertness among features that need further investigation. An exact private log with red-flag routes lets the flight surgeon see trends for CO2 and SANS without the robot naming a cause. Open question for review: whether headache with brief vision greying or a pulsing ear sound should be URGENT rather than a Flag, and whether a new Amsler-type distortion with headache should go straight to RMP-EYE-002. covers: - >- A headache reported by a crewmember who is awake and answering, or a headache log the flight surgeon or CMO asks for - Repeat check-ins until the crewmember and flight surgeon close the log - >- Space motion sickness in the first flight days stays with RMP-NEURO-004; sleep complaints with RMP-NEURO-006; wellbeing check-ins with RMP-BEH-002 locked_out: - Saying what caused the headache (including CO2, space, sleep, dehydration, SANS or migraine) - Suggesting, choosing, fetching or dosing any medicine (a human order and RMP-PHARM-001 are needed) - >- 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) - >- Dose-interval cues (any reminder, tone, colour, countdown or spoken cue tied to when a medicine was last taken) - Advising fluids, rest, light, caffeine or the schedule - Touching, holding or restraining the crewmember - Sharing the log with anyone but the crewmember, the CMO and the flight surgeon related: - RMP-ENV-004 - RMP-EVA-001 - RMP-NEURO-001 - RMP-NEURO-002 - RMP-NEURO-004 - RMP-NEURO-006 - RMP-EYE-002 - RMP-EYE-003 - RMP-RENAL-004 - RMP-INF-001 - RMP-BEH-002 - RMP-ENT-004 - RMP-MSK-004 - RMP-PHARM-001 roles: medical_authority: Flight surgeon (ground). Holds medical authority for every run. onboard_lead: >- Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link. others: - 'Crewmember with the headache: answers check-ins privately and can stop or pause them at any time' - 'Second trained CMO: receives alerts if the CMO is the patient' robot_may: - Run private check-ins and log answers word for word, with clock times - >- Read recent cabin CO2 data read-only if available, labelled as recorded by the cabin system, never as the cause - Show the crewmember their own log as a clock-time timeline - Send summaries to the flight surgeon; alert the CMO and flight surgeon on a red flag - Run RMP-PHARM-001 for an item only after a human order robot_may_not: - Say what caused the headache - Suggest, fetch or dose any medicine without a human order, or hand over a mismatched item - Advise fluids, rest or the schedule - Touch the crewmember - 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 one with the headache, or the CMO at the flight surgeon's request) started the log by command, and the crewmember agreed. check: human_start == true refs: - V2 10174 - id: PRE-2 text: The crewmember is awake and answering. If not, stop and alert at once (X7). check: crew_responsive == true - id: PRE-3 text: Check-ins are private; on the crewmember's own screen or by voice in a place they choose. refs: - V1 3004 - id: PRE-4 text: Robot self-test passed; any cabin CO2 access is read only. refs: - V2 10161 - id: PRE-5 text: Link status and current delay known. check: link_state in [live, delayed, down] consent: standard: >- The crewmember agrees to the headache log and to who sees it (the CMO and the flight surgeon only). Any question can be declined; an explicit "no" is logged as declined for that question only. emergency: >- If the crewmember cannot answer, the robot does not continue the log; it sends an URGENT alert and a crewmember checks in person (X7). withdrawal: The crewmember can stop or pause the log at any time; an alert already sent is not withdrawn. inputs: - id: IN-1 name: >- Red-flag questions: sudden severe headache; headache with fever; new weakness, numbness, speech change, confusion or reduced alertness; new vision change, double vision, brief vision greying or a pulsing sound in the ears; headache after a blow to the head; headache after a spacewalk, suited test or pressure change; unable to keep fluids down or no urine; worst headache of their life as they state it source: Crewmember, by voice or on screen required: true if_missing: Log "no response"; URGENT; the CMO checks in person. Never logged as declined. - id: IN-2 name: >- Onset time, severity 0-10 as stated, location, character, what makes it better or worse, other symptoms (nausea, light or sound sensitivity), in their own words source: Crewmember, by voice or on screen required: true if_missing: Log "no response" and apply D2. - id: IN-3 name: >- Recent cabin CO2 readings (read only), and whether the crewmember is in a sleep station or a local pocket source: Cabin sensors; crewmember required: false if_missing: Log "not available". Never shown as the cause. - id: IN-4 name: >- Recent spacewalk, suited test, pressure change, head injury, new medicine, fluids and sleep, as reported source: Crewmember; mission plan; dose log required: false if_missing: Log "not reported". - id: IN-5 name: Orders placed by the CMO or flight surgeon source: Medical record required: false if_missing: Treat as no order; the robot fetches no medicine. - 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 private headache log and send a "headache log started" note to the flight surgeon (queued if the link is down). The CMO is told only if the crewmember agrees or a red flag fires. success: Note delivered or queued. refs: - V2 10174 - V1 6003 - id: S2 actor: robot rung: 2 action: >- Run a private check-in by voice or on screen: red-flag questions first, then onset, severity as stated, location, character, other symptoms, recent CO2/EVA/injury/fluids/sleep/medicines as reported. Log answers word for word. D1 is checked after every answer. success: Answers logged, or "no response" logged. refs: - V1 3004 - id: S3 actor: robot rung: 2 action: >- If available, add the recent cabin CO2 reading (read only) to the log labelled "as recorded by the cabin system". The robot never says the headache is from CO2. success: Reading added, or "not available" logged. refs: - V2 6004 - id: S4 actor: robot rung: 2 action: >- Show the crewmember their own log as a clock-time timeline, with no cause, colour or words about whether it is serious. Medicines are shown only as entries on a clock-time timeline (what the CMO or crewmember states was taken, and when). No running counter or elapsed time per dose, and no tone, colour or spoken cue tied to a dose interval. success: Timeline shown; the crewmember can add notes. - id: S5 actor: crew action: >- The CMO sees the crewmember when asked or on any red flag. Any medicine or other plan is ordered or decided by the CMO or flight surgeon. success: CMO entries logged. refs: - V1 3004 - id: S6 actor: robot rung: 2 action: >- Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001. success: RMP-PHARM-001 run logged with its result. refs: - V2 7059 - id: S7 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: S8 actor: robot rung: 2 action: >- Every hours, or before each private medical conference, send the flight surgeon a summary: headache timeline, severity as stated, other symptoms, CO2 readings as recorded, EVA or pressure-change notes, medicines as logged, RMP-PHARM-001 results and alerts. success: Summary delivered or queued. refs: - V1 6003 - V1 7001 - V1 7003 - id: S9 actor: ground action: >- The flight surgeon (or the CMO under the onboard checklist when there is no link) decides any medicine, work limits, further protocol (ENV-004, EVA-001, EYE-002, RENAL-004, NEURO-001, NEURO-002) or evacuation. The robot logs the decisions. success: Decision logged. refs: - V1 3004 - id: S10 actor: robot rung: 2 action: >- Offer a private 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. success: Each prompt accepted, postponed or answered; log closed by a human. refs: - V2 10174 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. - id: D2 after: S2 decided_by: robot question: Did the crewmember answer the check-in? 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: S6 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 - id: D4 after: S9 decided_by: ground question: What is the plan (medicine, work limits, further protocol, evacuation)? branches: - if: Link live then: Flight surgeon decides; robot logs. - if: Link down or delay too long then: >- The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact. 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; crew care never waits for the link or the robot. Robot pauses any movement in its stopped position and tells the CMO. 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 red_flags: - id: RF1 sign: >- Sudden-onset severe headache reaching maximum intensity within minutes, or the crewmember says it is the worst headache of their life threshold: any (never waits for a time limit) action: >- URGENT alert to the CMO and flight surgeon; the CMO checks in person; see RMP-NEURO-002 if stroke warning signs are also present. The robot never names a cause source: nice150 - id: RF2 sign: Headache with fever, new weakness, numbness, speech change, confusion or reduced alertness threshold: any action: >- URGENT alert; the CMO checks in person; see RMP-NEURO-002 and RMP-INF-001. Never attributed to CO2, space or sleep source: nice150 - id: RF3 sign: >- Headache with a new change in vision, double vision, brief vision greying, or a pulsing sound in the ears, as the crewmember states threshold: any action: >- URGENT alert; see RMP-EYE-002; the flight surgeon decides about RMP-EYE-003. Labelled design judgment for the greying and pulsing-sound parts (HRP SANS report lists these among classic raised-pressure symptoms on Earth) source: hrpsans - id: RF4 sign: Headache after a blow to the head, or with any head-injury red flag threshold: any action: URGENT alert; see RMP-NEURO-001 source: ng232 - id: RF5 sign: A new headache after a spacewalk, a suited test or a pressure change threshold: any action: URGENT alert; see RMP-EVA-001 (RF10). The robot never says it is or is not decompression sickness source: tb037 - id: RF6 sign: >- Headache while cabin CO2 is at or above the program caution level, or the crewmember reports symptoms in a local pocket threshold: >- CO2 at or above (program environmental lead with the flight surgeon); or any report of a local pocket action: Flag to the CMO and flight surgeon; see RMP-ENV-004. The robot never says the headache is from CO2 source: law - id: RF7 sign: Unable to keep fluids down, or no urine passed threshold: >- for hours (shared parameter NO_URINE_HOURS, the same value in RMP-RENAL-004 and RMP-GI-003) action: URGENT alert; see RMP-GI-002 and RMP-RENAL-004 source: ng253 - id: RF8 sign: Fever or shaking chills with the headache threshold: >- degrees (shared parameter FEVER_ALERT_C: body temperature in degrees Celsius, the same value in RMP-GI-003, RMP-ENT-002, RMP-SKIN-002 and RMP-RENAL-004) or higher, or any shaking chills action: URGENT alert; see RMP-INF-001 source: ng253 - id: RF9 sign: >- Headache that stops work or sleep, or that the crewmember says is getting worse over repeated check-ins threshold: any report that it stops work or sleep; or worsening across check-ins action: >- Flag to the flight surgeon (design judgment for the stops-work-or-sleep trigger; TB-033 supports only that headaches are common) source: tb033 - id: RF10 sign: >- More pain medicine taken than ordered, as the crewmember states (design judgment; same URGENT pattern as RMP-ENT-002 RF7 and RMP-NEURO-006 RF3) threshold: any action: >- URGENT alert to the CMO and flight surgeon with the words as stated; the CMO checks in person; the robot does not comment on the amount 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: Handing over a mismatched or unverified medicine under this protocol value: not allowed enforced: >- RMP-PHARM-001 quarantine is the default; only the CMO's logged two-step override inside RMP-PHARM-001 can release it - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Camera use during the check-in value: not allowed enforced: >- Camera off by default and indicator lit; a photo is taken only if the crewmember asks for one of a related finding - id: L5 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, severity as stated, CO2 reading as recorded, medicine entry and alert. No running counter of doses. - 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-8 text: >- Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses. refs: - V2 7059 requirements: - id: V1 3003 use: Periodic monitoring of general health status in flight (item a). - id: V1 3004 use: >- In-mission care includes the history (d), privacy (c) and private communication with ground medical support (r); any medicine (m) is a human decision. - 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 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 6004 use: >- Cabin CO2 is read only; off-nominal values and any environmental response stay with the crew and ground. - 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: >- Medicines are fetched and inventory is tracked only through RMP-PHARM-001; a mismatched item is quarantined and this protocol never hands it over. - 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 covering every red flag, no response, a CO2 caution without attribution, a post-EVA headache, a CMO who is the patient, an RMP-PHARM-001 MISMATCH, and lost link. pass: >- Every red flag acts as listed; zero cause statements; zero "just a headache"; zero hand-overs after a MISMATCH. - stage: Earth analog what: Isolation analog volunteers logging headaches with the robot (no illness needed). pass: Data completeness at or above ; volunteers rate the check-ins as private. - stage: flight use under flight surgeon supervision what: First use alongside the usual 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; 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 summaries at the private medical conference 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 private check-ins and logging offline. - >- Red flags go to the CMO (or the second trained CMO) at once; the CMO decides under the pre-approved onboard checklist. - 'At the next contact the robot sends one package: the log, alerts and decisions.' mars_delay: - >- 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 and the CMO acts on them. sources: - key: ermed text: >- NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to Medical Conditions that occur in Flight, as well as Private Medical Conditions, in Exploration Missions (In-Flight Medical Conditions). url: https://humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf supports: >- Table 2 (US astronauts, Shuttle, Mir and ISS through Expedition 13 / 2006): headache (space adaptation) 233, headache (late) 49, headache (CO2 induced) 20; choking/obstructed airway 3; smoke inhalation 3. Table 1 (ISS through Expedition 40): headache 33. - key: law text: >- Law J, Van Baalen M, Foy M, et al. Relationship between carbon dioxide levels and reported headaches on the International Space Station. J Occup Environ Med. 2014;56(5):477-483. url: https://doi.org/10.1097/JOM.0000000000000158 doi: 10.1097/JOM.0000000000000158 pmid: '24806559' supports: >- For each 1 mmHg rise in CO2, the odds of a crewmember reporting a headache doubled; keeping headache risk below 1% would need a 7-day average below 2.5 mmHg (ISS range at the time 1-9 mmHg). - 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: >- Headaches are more common in spaceflight, with elevated CO2, fluid shifts and pressure changes among contributing factors; pre-mission exams include ECG, eye exams and photo documentation of skin. - 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: hrpsans text: >- NASA Human Research Program. Evidence Report: Risk of Spaceflight Associated Neuro-ocular Syndrome (SANS) (2017). url: https://humanresearchroadmap.nasa.gov/evidence/reports/SANS.pdf supports: >- With optic disc edema as the primary metric, the overall incidence is considered to be 16%, and 38% to 51% of long-duration crewmembers have developed one or more findings; no crewmembers have reported the type of headaches typically associated with raised intracranial pressure, and no preflight or in-flight invasive measures of intracranial pressure have been made. - key: vein2009 text: >- Vein AA, Koppen H, Haan J, Terwindt GM, Ferrari MD. Space headache: a new secondary headache. Cephalalgia. 2009;29(6):683-686. url: https://doi.org/10.1111/j.1468-2982.2008.01775.x doi: 10.1111/j.1468-2982.2008.01775.x pmid: '19187344' supports: >- As cited in the NASA SANS evidence report: 12 of 17 astronauts (71%) had at least one headache in space; most episodes were moderate to severe and not associated with motion sickness. Primary paper not re-read this round; figures taken from the SANS report citation. - 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: tb037 text: >- NASA OCHMO. Decompression Sickness (DCS) Risk Mitigation. Technical Brief OCHMO-TB-037 Rev D (Oct 5, 2026). url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-037-decompression-sickness.pdf supports: >- DCS is caused by inert gas bubbles forming during rapid reductions in ambient pressure, most significantly in the move from cabin pressure to EVA suit pressure; NASA classifies DCS as Type I (itching, musculoskeletal pain, mild rashes) and Type II (neurological symptoms, numbness, weakness, cognitive issues, inner ear problems, cardiopulmonary issues), and describes cutis marmorata (a mottled, patterned skin rash); arterial gas embolism can cause stroke-like neurological effects, loss of consciousness and seizures; U.S. Navy protocols are widely adopted on Earth; diagnosis is based on symptoms; the majority of cases present between 60 and 240 minutes and inflammatory responses can last more than 24 hours; no hyperbaric chamber is available in flight, and increasing suit and cabin pressure may be combined to treat symptoms, depending on the scenario; a break in prebreathe rapidly reintroduces nitrogen; NASA has never experienced a Type II event in spaceflight. - 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: 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 3003 item a; V1 3004 items c, d, m and r.' - 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: 'NASA-STD-3001 Vol 2 Rev F: V2 6004 (CO2); Section 10.6 automated and robotic systems.' - 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 5 review) items: - >- RF3 (brief vision greying or pulsing ear sound) stays URGENT; the "why" records it as the batch 4 recommended escalation, with flight surgeon sign-off still required (item 21). - >- RF10 (more pain medicine than ordered) is labelled design judgment, the same URGENT pattern as RMP-ENT-002 RF7 and RMP-NEURO-006 RF3; it no longer cites NICE CG150 as its only support (item 22). - RF6 (CO2) stays a Flag and still points to RMP-ENV-004 (item 23). - >- RF9: "stops work or sleep" labelled design judgment; TB-033 supports only that headaches are common (suggestion 26). - >- RMP-ENT-004 and RMP-MSK-004 added to related; the robot never names sinus or neck as the cause (suggestion 27). - >- Batch 5 drafts now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician. - 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: hrpsans, 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 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.