# RMP-RESP-002 Choking or blocked airway: bring kit, steady the scene; airway care by crew # 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 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-RESP-002 slug: rmp-resp-002 title: 'Choking or blocked airway: bring kit, steady the scene; airway care by crew' category: resp tier: 1 rung_note: >- Max rung raised from 1 to 2 for supervised fetching and scene support. The robot never performs back blows, abdominal thrusts, finger sweeps or any airway procedure. result_language: use: - logged, not interpreted - sent to flight surgeon - EMERGENCY FETCH – NOT VERIFIED (CMO command) - as stated by the CMO never: - normal - no problem found - all clear - negative - any diagnosis or cause - mild choking - severe choking - cleared - obstruction gone - verified - safe - mild - minor scope: summary: >- When a crewmember is choking or has a blocked airway, the robot sends an URGENT alert at once, brings the airway / emergency kit on command, clears space, records the clock times of back blows, abdominal thrusts and any transition to CPR as the CMO states them, and streams video when the link allows. The crew assess severity and give all airway care under the onboard checklist and Resuscitation Council UK adult choking algorithm as Earth context. The robot never strikes the back, thrusts the abdomen, sweeps the mouth or starts oxygen. why: >- NASA records list 3 choking or obstructed-airway events among US astronauts through 2006 (in-flight medical conditions evidence report). On Earth, the Resuscitation Council UK adult choking algorithm splits mild obstruction (effective cough: encourage cough) from severe obstruction (ineffective cough: 5 back blows then 5 abdominal thrusts if conscious; CPR if unconscious). A loose crown or tooth fragment can be inhaled (see RMP-ENT-002). A helper that alerts, fetches the sealed kit and keeps the scene clear lets the CMO act at once. Design judgment: Earth abdominal thrusts assume a stable torso. In weightlessness the onboard checklist should name a restrained method (for example a foot restraint or bracing against structure), or chest thrusts if the checklist prefers them; no public spaceflight choking algorithm was found. The robot does not choose or teach the method. covers: - Choking, ineffective cough, or suspected inhaled foreign body with breathing difficulty, in flight - Transition to RMP-CARD-001 if the crewmember becomes unresponsive locked_out: - Back blows, abdominal or chest thrusts, finger sweeps, or any contact with the patient - Opening the kit or giving any medicine - Starting or adjusting oxygen - Saying the airway is clear or that choking is mild - Asking the choking person to walk toward the robot related: - RMP-CARD-001 - RMP-RESP-001 - RMP-RESP-003 - RMP-ENT-002 - RMP-PHARM-001 - RMP-NEURO-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: - 'Second trained CMO: helps or takes over if the CMO is the patient' - 'Other crew: help restrain the patient as the CMO directs' robot_may: - Send an URGENT alert at once - Bring the sealed airway or emergency kit on command - Clear space and hold position clear of the CMO - Stream video when the link allows - Record clock times as the CMO states them - Reconcile the kit after the event through RMP-PHARM-001 as an inventory record only robot_may_not: - Touch the patient or perform any airway manoeuvre - Open the kit or start oxygen - Say the obstruction is mild or cleared - 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 or the CMO started the protocol by command. check: human_start == true refs: - V2 10174 - id: PRE-2 text: Robot self-test passed; kit stowage location 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 CMO never waits for the robot before treating. check: link_state in [live, delayed, down] consent: standard: Emergency care; recording by the CMO's agreement when the patient cannot speak. emergency: If the patient cannot agree, the robot proceeds on the CMO's command. withdrawal: The CMO can stop video; the alert and record stand. inputs: - id: IN-1 name: 'CMO or crew statement: choking, ineffective cough, or suspected inhaled object' source: Voice required: true if_missing: Log "no response"; keep URGENT alert. - id: IN-2 name: >- Effective vs ineffective cough, consciousness, and times of back blows or thrusts, as stated by the CMO source: CMO required: false if_missing: Log "not stated". - id: IN-3 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 or the CMO's word, send an URGENT "choking / blocked airway" alert to the flight surgeon and the CMO at once. 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. success: Alert acknowledged, or escalated. refs: - V2 10174 - V1 6003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- On the CMO's command, bring the sealed airway or emergency kit to the CMO at once and restrain it within reach. 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, or skipped; override logged. limit: refs: - V2 7046 - id: S3 actor: crew action: >- The CMO assesses severity and treats under the onboard checklist, which names a restrained thrust method for weightlessness (design judgment). Checklist context for the CMO only (Earth RCUK adult choking algorithm): encourage cough if effective; back blows and abdominal thrusts if conscious with ineffective cough; CPR if unconscious. The robot never demonstrates, counts or coaches blows or thrusts, and stays clear. success: Human-led care; robot logs what is stated. refs: - V1 3004 - id: S4 actor: robot rung: 2 action: >- Clear loose items, hold clear of the CMO, stream video when the link allows unless the CMO stops it, and log each stated manoeuvre on a clock-time timeline. success: Space clear; times logged. refs: - V1 6003 - id: S5 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: S6 actor: ground action: >- The flight surgeon (or the CMO under the onboard checklist when there is no link) decides ongoing airway care, imaging, and any evacuation [V1 3007]. success: Decision logged. refs: - V1 3007 - id: S7 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: Reconciliation recorded; kit shown as opened – not restocked until resealed. refs: - V2 7059 - id: S8 actor: robot rung: 2 action: 'Send the flight surgeon one package: alert times, stated manoeuvres, video pointer and decisions.' success: Package delivered or queued. refs: - V1 6003 - V1 7001 - V1 7003 decisions: - id: D1 after: S3 decided_by: crew question: Has the crewmember become unresponsive? branches: - if: 'Yes' then: Start RMP-CARD-001 at once; this protocol's record continues as context. - if: 'No' then: Continue airway care under the checklist. - id: D2 after: S4 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: S4 decided_by: robot question: Did the CMO answer when asked for a stated time? 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: S6 decided_by: ground question: What is the plan (airway care, observation, 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: >- Robot pauses its own movement in its stopped position and tells the CMO and the commander. This pauses robot movement only: crew back blows, thrusts, CPR and oxygen 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; 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 - id: X9 trigger: The CMO needs the robot's space action: Robot moves to its rest position at once and holds; it does not leave the module on its own. level: safe-state refs: - V2 10172 red_flags: - id: RF1 sign: Ineffective cough, silent cough, inability to speak, or blue lips, as stated threshold: any action: URGENT alert; the CMO treats as severe obstruction under the checklist source: rcukchoke - id: RF2 sign: Unresponsive during choking threshold: any action: URGENT alert; start RMP-CARD-001 now source: rcukchoke - id: RF3 sign: Suspected inhaled tooth, crown or object (see RMP-ENT-002) threshold: any action: >- URGENT alert; the CMO checks in person now; if the crewmember becomes unresponsive, start RMP-CARD-001 (RF2) source: sdceprest - id: RF4 sign: Wheeze or breathlessness after a possible allergic trigger threshold: any action: URGENT alert; see RMP-RESP-003 source: rcuk - id: RF5 sign: Symptoms improve, as the CMO states threshold: any action: Flag to the flight surgeon; the CMO continues observation; the robot never says the airway is clear source: rcukchoke 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: Airway manoeuvres by the robot value: not allowed enforced: No strike, thrust or sweep task is loaded - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Closest approach to the patient and CMO value: enforced: Distance sensing 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: Alert time, each stated manoeuvre time, video start/stop, kit reconciliation. - 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 3004 use: In-mission care includes medical kits and emergency procedures; the crew deliver airway care. - 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 3007 use: Medical evacuation when needed; the flight surgeon decides. - 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 mild and severe choking, unresponsive transition to CARD-001, missing kit, CMO as patient, lost link. pass: Zero patient contact; every emergency fetch logged as an override; transition to CARD-001 works. - stage: training model what: CMO drills with the robot fetching the airway kit. pass: Kit within seconds; CMO never obstructed. - stage: parabolic or station demonstration what: Kit fetch and restraint in weightlessness without a patient. pass: Kit closed and restrained. - stage: flight use under flight surgeon supervision what: First use in drills. 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 a crewmember or the CMO. Alerts go to the CMO and flight surgeon at once; the crew give airway care. 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 receives the alert and video when the link allows.' loss_of_signal: - >- The robot pauses non-essential motion and tells the CMO; recording continues offline on confirmation. - >- Crew back blows, thrusts, CPR and oxygen continue under the onboard checklist and never wait for the link or the robot. - The CMO treats under the onboard checklist; nothing waits for the link. mars_delay: - Airway care cannot wait for the ground; the onboard checklist and two trained CMOs lead. sources: - key: rcukchoke text: Resuscitation Council UK. Adult choking algorithm (2021). PDF fetched Oct 21, 2026. url: https://www.resus.org.uk/sites/default/files/2021-04/Adult%20Choking%20Algorithm%202021.pdf supports: >- Assess severity. Mild obstruction (effective cough): encourage cough. Severe obstruction (ineffective cough): if conscious, 5 back blows then 5 abdominal thrusts, continuing to check for deterioration; if unconscious, start CPR. - key: rcukchokeg text: 'Resuscitation Council UK. Guidance: Choking (additional guidance page). Fetched Oct 21, 2026.' url: https://www.resus.org.uk/library/additional-guidance/guidance-choking supports: Additional RCUK choking guidance page (public). Cross-check for the adult choking algorithm. - 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: menon text: >- Menon A. Review of Spaceflight Dental Emergencies. NASA/TM-2012-217368 (NASA Johnson Space Center, September 2012). url: https://ntrs.nasa.gov/api/citations/20120002807/downloads/20120002807.pdf supports: >- No written record of an in-flight dental emergency in US astronauts, but a NASA dentist described an in-flight crown displacement temporarily repaired by the crewmember with onboard supplies; cosmonauts reported lost fillings and crowns in flight, thought to be dislodged by launch vibration, and incapacitating dental pain on a 96-day flight; repair must weigh the risk of aspiration (inhaling) of a loose crown; Integrated Medical Model estimates (events per person-year) include dental abscess 0.0230, exposed pulp 0.0201, crown replacement 0.00518 and filling replacement 0.00511, and a dental abscess was the condition most likely to end in evacuation from the ISS in that model; fillings can be linked with tooth pain on pressure change (barodontalgia). - key: sdceprest text: >- Scottish Dental Clinical Effectiveness Programme (SDCEP). Management of Acute Dental Problems, 2nd edition (2026): Cracked, fractured, loose or displaced tooth fragments and restorations (guidance website, read Oct 20, 2026). url: >- https://www.acutedentalproblems.sdcep.org.uk/guidance/management-of-oral-conditions/common-oral-conditions/cracked-fractured-loose-or-displaced-tooth-fragments-and-restorations/ supports: >- An inhaled or swallowed tooth fragment or restoration needs immediate emergency care (SDCEP restorations page). - key: rcuk text: >- Resuscitation Council UK. Emergency treatment of anaphylaxis: guidelines for healthcare providers (May 2021; printed review date May 2026, which has passed. The RCUK guideline page, as fetched on Oct 20, 2026, still lists May 2021 as the most recent version; a newer version was not found). url: >- https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf supports: >- Anaphylaxis is characterised by sudden onset and rapid progression of symptoms, Airway and/or Breathing and/or Circulation problems, and usually skin or mucosal changes; airway problems include throat or tongue swelling, hoarse voice and stridor; breathing problems include wheeze, persistent cough, increased work of breathing, tiredness and hypoxaemia (SpO2 below 94%); circulation problems include pale clammy skin, fast heart rate, low blood pressure, dizziness, decreased conscious level and collapse; skin or mucosal changes alone are not a sign of anaphylaxis and may be absent in up to 20% of reactions; in up to 30% of cases there may be no obvious trigger; gastrointestinal symptoms without airway, breathing or circulation problems do not usually indicate anaphylaxis; call for help early; biphasic reactions occur in around 5% of patients, also after milder reactions, with a median time of around 12 hours, and observation for 6-12 hours may miss over half of them; adrenaline is the first-line treatment, given intramuscularly, and is repeated after 5 minutes if airway, breathing or circulation problems persist; medication accounts for 39% of anaphylaxis-related deaths (Table 1), and allergens given by a parenteral route (for example an IV drug or intramuscular injection) cause a more rapid onset; patients must not walk or stand during acute reactions. - key: ismpadc text: >- Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019). url: https://www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Guideline-020719_final.pdf supports: >- Override is limited to medicines needed in emergent circumstances where waiting could harm the patient (3.3b); limit what is available on override (3.4b); require documentation of the override rationale (3.4d); routinely analyze override reports (3.6). Used for the emergency-fetch pattern by analogy (a robot fetching a sealed kit is not a dispensing cabinet). - 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: 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 3004, V1 3006, V1 3007.' - 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 5 review) items: - >- S3: the Earth RCUK algorithm is labelled checklist context for the CMO; the onboard checklist names a restrained thrust method for weightlessness (design judgment); the robot never demonstrates, counts or coaches blows or thrusts (items 6 and 8). - >- RF3 (inhaled tooth or crown): cites the SDCEP restorations page; action stands alone: "the CMO checks in person now; if the crewmember becomes unresponsive, start RMP-CARD-001 (RF2)" (item 7). - >- The open question on thrusts in weightlessness is closed in the "why" as design judgment: a restrained method or chest thrusts if the checklist prefers them; no public spaceflight choking algorithm was found; the robot does not choose or teach the method (item 8). - >- 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: v2). Editorial; no change to steps, thresholds or limits. - >- X5 and the comms loss-of-signal branch now say only the robot pauses: crew back blows, thrusts, CPR and oxygen never wait for the link or the robot (batch 6 review item 24 / suggestion 40). Editorial; robot behaviour unchanged.