RMP-PREV-004 Blood and urine sample handling and labelling: checked kit fetch, labels printed at the crewmember's side, label match, sealed transport and cold-stowage log (the robot never handles needles)

1 · Identity and scope

At the times the flight surgeon schedules a blood or urine sample, the robot prompts the crewmember; the session starts only when the crewmember or the CMO accepts. The robot brings the sample kit by a checked kit fetch. Only after the crewmember's identity is confirmed, at the crewmember's side, it prints labels with two identifiers; the CMO draws the blood or receives the urine container and labels each container in the crewmember's presence. The robot scans every label against the sample order: a mismatch means the sample is held in its own sealed bag in cold stowage, kept apart from other samples, and flagged. The CMO packs the containers in a leak-proof sealed bag; the robot carries the sealed bag to cold stowage and logs the time and the stowage temperature as displayed.

Why this protocol was chosen. Wrong-patient errors happen at every stage of care: hospitals must use at least two patient identifiers when collecting blood and other specimens (a room or location is not an identifier) and label specimen containers in the presence of the patient (Joint Commission NPSG.01.01.01, 2025). WHO asks for a label check (names, file number, date of birth, date and time), a recheck of labels before dispatch, and packing in a leak-proof bag with an outside pocket for the request form (WHO 2010). On board, the robot prints labels only at the crewmember's side after identity is confirmed and checks them against the order, so a label is never printed ahead for a container out of the crewmember's sight (design judgment). The robot never relabels a sample, because a relabelled sample can hide a wrong-patient error (design judgment).

Autonomy: Max rung 2 for a checked fetch of the sample kit, printing labels after the crewmember's identity is confirmed, scanning labels against the sample order, and carrying a sealed sample bag to cold stowage. The CMO draws blood and labels every container; the robot never handles needles, sharps or an open container and never touches anyone.

Related: RMP-INF-002 · RMP-RENAL-003 · RMP-PREV-002 · RMP-PREV-001 · RMP-PHARM-001

2 · Roles

Medical authority

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

Onboard lead

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

Others

• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Vehicle commander: leads any cabin emergency procedure
• Other crew: help as the CMO or commander directs

Commercial flights

On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.) [9]

3 · Preconditions and consent

• PRE-1 The sample session starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts it. An unaccepted prompt is logged "not accepted" and the CMO is told. A crewmember or the CMO can also start it by command.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]

Consent

The crewmember agrees to the sample, and to the sample record (identifiers, times, temperatures) being sent to the flight surgeon and the laboratory lead.

Emergency consent

If the crewmember cannot agree, this is not a scheduled sample: the robot sends an URGENT alert and a crewmember checks in person (X7).

Withdrawal

The crewmember can stop at any time; an unlabelled container is never labelled later.

4 · Required sensor inputs

5–6 · Steps and decision points

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

1. S1RobotRung 2

   At the scheduled time, show the crewmember an on-screen prompt that a sample session is due, and tell the flight surgeon and the CMO (URGENT if any red flag is stated). The session starts only when the crewmember or the CMO accepts the prompt; an unaccepted prompt is logged "not accepted" and the CMO is told. Then show the symptom prompt (feeling unwell, or having fainted before during a blood draw) and log answers word for word. 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 <set by validation> seconds is repeated and sent to the next named crewmember.

   Done when: Prompt accepted, or "not accepted" logged.

   V2 10174V1 3003V1 3006

   D4DecisionRobot decides

   Did the crewmember answer the symptom prompt, or say they want to skip it?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → 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.
2. S2RobotRung 2

   On the CMO's command, run a checked kit fetch of the sample kit (sealed collection containers, the labels roll and leak-proof sample bags; sharps stay in the CMO's kit): 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".

   Done when: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged.

   Limit: <set by validation>

   V2 7046V2 7059

   D1DecisionRobot decides

   Which kit fetch was it, and what did the checked kit fetch show?

   • EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) → Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use).
   • KIT ID AND SEAL MATCH → Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time.
   • MISMATCH, seal not intact or CANNOT VERIFY → 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.No hand-over
3. S3RobotRung 2

   At the crewmember's side, scan the crewmember's crew ID and ask them to state their name; only when both match the sample order, print one label per container with two identifiers (name and crew ID), the sample type and the date. The robot never prints a label before identity is confirmed or away from the crewmember.

   Done when: Labels printed after identity confirmed, or none printed.

   V1 7001

   D2DecisionRobot decides

   Did the scanned crew ID and the name the crewmember stated both match the sample order?

   • Yes → Print the labels at the crewmember's side and continue.
   • No, or cannot verify → No label is printed; show MISMATCH or CANNOT VERIFY with the reason and tell the CMO. No hand-over of labels; the CMO decides whether to stop the session.No hand-over
4. S4Crew

   The CMO performs hand hygiene and wears gloves, then the CMO draws the blood (or the crewmember collects the urine) under the onboard checklist and labels each container in the crewmember's presence, adding the collection time; the CMO disposes of needles in the sharps container. After the draw the CMO removes the gloves and performs hand hygiene. A spill is cleaned up under RMP-INF-002.

   Done when: Containers filled and labelled, or not collected.

   V1 3003

5. S5RobotRung 2

   Scan each container label as the CMO holds it up and compare it with the sample order and the confirmed identity; show "LABELS MATCH THE ORDER (crewmember, two identifiers, sample type, collection time). Not a check of the sample." only when every field matches, otherwise MISMATCH or CANNOT VERIFY with the fields named. The robot never touches an open container.

   Done when: Result shown and logged for each container.

   V1 7001

   D3DecisionRobot decides

   Did every container label match the sample order and the confirmed identity?

   • Yes → Continue to packing.
   • MISMATCH or CANNOT VERIFY → The sample is held: the CMO places it in a separate sealed bag marked "HELD – LABEL MISMATCH", and the robot flags it at once to the flight surgeon and the laboratory lead, who decide. The held sample goes into the cold stowage the order names, in its separate sealed "HELD – LABEL MISMATCH" bag, kept apart from other samples; it is never relabelled, discarded or used until the flight surgeon and the laboratory lead decide. The crew carry the HELD bag to cold stowage by hand; the robot does not carry it. The only exception is the stop-and-hold leak rule (S7, RF4): if a bag in the robot's gripper is found to be leaking, the robot stops and holds it still until the CMO takes it. No hand-over: the robot never relabels or discards a held sample.No hand-over
6. S6Crew

   The CMO packs the labelled containers in a rack or padded holder inside a leak-proof sample bag, with the request form in the outside pocket, rechecks the labels against the form, and then seals the bag.

   Done when: Sample bag sealed.

   V1 3003

7. S7RobotRung 2

   Carry only a sample bag the CMO states is sealed and that is not a HELD bag (the crew carry a HELD bag by hand, D3), held upright and away from every route, to the cold stowage the order names; the crew place it in stowage. If a leak is seen or stated during the carry, stop at once and hold the bag still in the gripper (never release it into the cabin air), apply RF4, and the CMO takes the bag. Log the stowage time and the stowage temperature as displayed, with the clock time; never a judgment of the temperature. After every carry, the crew clean the gripper and the robot's carry surfaces under RMP-INF-002.

   Done when: Sealed bag delivered and logged, or "temperature not obtained".

   Limit: <set by validation>

   V2 7046

   D5DecisionRobot decides

   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?

   • Yes → 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 <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
8. S8RobotRung 2

   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.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

9. S9Ground

   The flight surgeon and the laboratory lead (or the CMO under the onboard checklist when there is no link) review the sample record and decide on any held sample, a repeat sample or a stowage excursion.

   Done when: Decision logged.

   V1 3003

   D6DecisionGround decides

   What happens to any held sample, repeat sample or stowage excursion?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact.
10. S10RobotRung 2

    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.

    Done when: Kit reconciled or shown as "opened – not restocked".

    V2 7059

11. S11RobotRung 2

    Send the flight surgeon and the laboratory lead one package: identifiers checked, labels and results, collection and stowage times, temperatures as displayed, alerts and decisions.

    Done when: Package delivered or queued.

    V1 6003V1 7003

7 · Stop and escalate rules, red flags

Red flags

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

8 · Safety limits

9 · Logs and audit

• LOG-1 Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.V2 10163V2 10164
• LOG-2 Mode changes and safety-limit events are announced to the operator as they happen and logged.V2 10162V2 10172
• LOG-3 Records are stored and sent as private medical data, encrypted, with access limited to the medical team.V1 6003V1 7003
• LOG-4 Results are kept in a permanent, retrievable format so the flight surgeon can see trends.V1 7001
• LOG-5 Prompt and acceptance; crew ID scan and stated name; labels printed with times; each label result; held samples and the decision; stowage time and temperature as displayed.
• LOG-6 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.V2 10163
• LOG-7 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".V2 7059
• LOG-9 Each checked kit fetch: time, who asked, kit ID, seal status and result (KIT ID AND SEAL MATCH, MISMATCH, seal not intact or CANNOT VERIFY), and any quarantine.V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [4] and Volume 2 Revision F [5]. NASA-STD-3001 binds NASA programs; it is not a regulation for commercial flights. Its robot rules are general automation requirements, not medical-device rules.

11 · Validation

1. Simulation. Scripted sessions with a wrong crew ID, a label mismatch, a spill, a faint, a stowage excursion, CMO as patient, lost link. Pass: Zero labels printed before identity is confirmed; every mismatch held; zero contact.
2. Training model. Labelling and packing drill with dummy containers. Pass: Every label scanned; every bag sealed before the robot carries it.
3. Parabolic or station demonstration. Carrying a sealed bag in weightlessness. Pass: Keep-out and speed limits held.
4. Flight use under flight surgeon supervision. First scheduled sample. Pass: No identification or safety events.

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

12 · Human sign-off

Before any use

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

Each run

Ordered by the flight surgeon and accepted by the crewmember or CMO. The CMO draws and labels; the flight surgeon and laboratory lead decide on every held sample.

Restart after a stop

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

None of these sign-offs has happened. This is a Draft v0.3.

13 · Change control for learning

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

Change-plan model: FDA guidance [8].

Loss of signal and Mars delay

Live link

Low Earth orbit: the laboratory lead receives the record when the link allows.

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 sampling already under way and all other care continue under the onboard checklist and never wait for the link or the robot.
• The session follows the onboard checklist; the record is queued.

Mars-class delay

• Mars: held samples wait in sealed stowage until the flight surgeon decides.

[7]

Sources

1. The Joint Commission. National Patient Safety Goals effective January 2025 for the Hospital Program (2025). digitalassets.jointcommission.org/api/public/content/9be3834… Supports: NPSG.01.01.01 EP 1: use at least two patient identifiers when collecting blood samples and other specimens for clinical testing; the room number or physical location is not an identifier. EP 2: label containers used for blood and other specimens in the presence of the patient. Read Oct 21, 2026 (saved copy in src/b11).
2. World Health Organization. WHO guidelines on drawing blood: best practices in phlebotomy (2010). www.who.int/publications/i/item/9789241599221 Supports: Step 9: check the label and forms for accuracy (typically the patient's first and last names, file number, date of birth, and the date and time the blood was taken) and recheck the labels on the tubes and the forms before dispatch. Step 10: pack laboratory samples in a plastic leak-proof bag with an outside compartment for the request form, with multiple tubes in a rack or padded holder. Step 11: clean up spills of blood or body fluids. Read Oct 21, 2026 (saved copy in src/b11).
3. 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. PMID 41122888. doi:10.1161/CIR.0000000000001369 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.
4. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: NASA-STD-3001 Vol 1 Rev C: V1 3003, V1 3006, V1 6003, V1 7001, V1 7003.
5. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
6. NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025). www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical… Supports: The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist.
7. NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review). www.nasa.gov/wp-content/uploads/2024/01/mars-communications-… Supports: One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction.
8. U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance). www.fda.gov/regulatory-information/search-fda-guidance-docum… Supports: A model for planning, validating and rolling back software updates.
9. U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements. www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-… Supports: Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants.

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