RMP-RESP-005 Scheduled breathing rate and oxygen saturation (SpO2) checks: reminder, preparation checklist, readings as displayed and a breathing rate counted by the CMO

1 · Identity and scope

At the times the flight surgeon schedules, the robot prompts the crewmember that a breathing check is due; the check starts only when the crewmember or the CMO accepts. The robot brings the oximeter by a checked kit fetch and shows the preparation checklist; the crewmember places the pulse oximeter. The robot records oxygen saturation (SpO2, the percentage of oxygen-carrying blood) and heart rate as displayed once the reading has stopped changing, and the breathing rate the CMO counts over one full minute on their own timer and states. A failed oximeter reading is URGENT.

Why this protocol was chosen. A raised breathing rate is "a powerful sign of acute illness and distress", and an extreme value in a single measure needs urgent review (NEWS2, 2017), so the breathing rate is counted by a human over a full minute and recorded as stated; the alert values are the clinical lead's (design judgment). A pulse oximeter reads best with a warm, relaxed hand below heart level, no nail polish, the person still, and a reading taken once it stops changing; circulation, skin pigmentation, thickness and temperature can affect it (FDA 2025). A failed reading is never reassuring: it can mean poor circulation, so it is URGENT, as in the other protocols that use the oximeter. The shared value SPO2_ALERT_PCT only raises an alert; it never gates a crew action (the crew act without waiting for a reading), and the clinical lead sets it per mission with the flight surgeon, because the cabin atmosphere can differ by mission.

Autonomy: Max rung 2 for the scheduled prompt, a checked kit fetch, showing the oximeter preparation checklist, recording oxygen saturation (SpO2) and heart rate as displayed, and recording the breathing rate the CMO counts and states. The crewmember places the oximeter; the robot never counts breaths from video and never touches anyone.

Related: RMP-RESP-001 · RMP-RESP-004 · RMP-CARD-005 · RMP-PREV-002 · RMP-INF-001 · RMP-EVA-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.) [14]

3 · Preconditions and consent

• PRE-1 The check 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 check and to readings being recorded and sent to the flight surgeon.

Emergency consent

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

Withdrawal

The crewmember can stop at any time; a stopped check is logged as "stopped", never as a value.

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 breathing check is due, and tell the CMO (URGENT if any red flag is stated). The check starts only when the crewmember or the CMO accepts the prompt; an unaccepted prompt is logged "not accepted" and the CMO is told. 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

2. S2RobotRung 2

   On the CMO's command, run a checked kit fetch of the vital-signs kit (pulse oximeter): 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

   Show the oximeter preparation checklist: hand warm and relaxed, held below heart level and restrained; no nail polish on that finger; sit still and quiet for the rest time the flight surgeon sets; take the reading once it stops changing. Then show the symptom prompt and log answers word for word. On request only, the robot shows the time elapsed since the start the CMO called, as a clock-time entry; it never announces a time, and never says "time reached", "done", "passed" or "failed".

   Done when: Checklist shown; answers logged.

   V1 3003

   D3DecisionRobot 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.
4. S4Crew

   The crewmember places the pulse oximeter. The CMO counts the breaths for one full minute on their own timer, without telling the crewmember when the count starts, and states the rate.

   Done when: Oximeter placed; rate counted and stated, or not obtained.

   V1 3003

5. S5RobotRung 2

   Record SpO2 and heart rate as displayed once the reading has stopped changing, and the breathing rate as the CMO states it, and whether the crewmember is on air or supplemental oxygen (flow and device) as the CMO states it, each with the clock time and marked "as displayed", "as counted by the CMO" or "as stated by the CMO"; a missing value is logged as "not obtained", never a value. The robot never counts breaths from video or sound. After the validated attempts (L5) with no oximeter reading, log "saturation not obtained". The robot never starts, stops or adjusts oxygen and never comments on it.

   Done when: Readings logged, or "not obtained".

   V1 7001

   D2DecisionRobot 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.
6. S6RobotRung 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

7. S7Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) reviews the readings and decides on follow-up and the next check.

   Done when: Decision logged.

   V1 3003

   D4DecisionGround decides

   What follow-up and next check apply?

   • 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.
8. S8RobotRung 2

   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.

   Done when: RMP-PHARM-001 run logged with its result, or none ordered.

   V2 7059

   D5DecisionRobot decides

   What did RMP-PHARM-001 show for the ordered item?

   • MATCH TO ORDER → 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.
   • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → 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.No hand-over
9. S9RobotRung 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

10. S10RobotRung 2

    Send the flight surgeon one package: readings as displayed or as counted with times, answers as stated, alerts and decisions.

    Done when: Package delivered or queued.

    V1 6003V1 7001

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; checklist shown; each reading as displayed or as counted by the CMO with the clock time; readings not obtained; answers as stated.
• 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-8 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.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 [9] and Volume 2 Revision F [10]. 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 checks with an unaccepted prompt, a failed oximeter reading, a breathing rate past an alert value, a cabin alarm, CMO as patient, lost link. Pass: Every failed reading URGENT; zero robot-counted rates; zero contact.
2. Training model. Check drill with a crew-placed oximeter. Pass: Every reading logged as displayed after it stops changing.
3. Parabolic or station demonstration. Checklist display and kit fetch in weightlessness. Pass: Keep-out held.
4. Flight use under flight surgeon supervision. First scheduled check. Pass: No 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

Scheduled by the flight surgeon and accepted by the crewmember or CMO, or started by command. The CMO counts the breathing rate; the flight surgeon judges every reading.

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 v0.2.

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 [13].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives the readings 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 oxygen, breathing care and every check already under way continue under the onboard checklist and never wait for the link or the robot.
• Checks continue offline; the record is queued; any red flag goes to the CMO at once.

Mars-class delay

• Mars: the alert values are set before flight and the CMO decides.

[12]

Sources

1. Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS (2017). www.rcp.ac.uk/improving-care/resources/national-early-warnin… Supports: A respiration rate of 12 to 20 breaths per minute scores 0; 8 or fewer, or 25 or more, scores 3; a single red score (3 in one parameter, an extreme value) should prompt an urgent review; "an elevated respiration rate is a powerful sign of acute illness and distress". Hospital context for the clinical lead's alert values only. Read Oct 21, 2026 (saved copy in src/b11).
2. US Food and Drug Administration. Pulse Oximeter Basics (consumer update, 2025). www.fda.gov/consumers/consumer-updates/pulse-oximeter-basics Supports: For an accurate reading: the hand warm, relaxed and held below the level of the heart; remove fingernail polish; sit still; wait until the reading stops changing and settles on one number. Poor circulation, skin pigmentation, skin thickness, skin temperature, tobacco use and fingernail polish can affect accuracy. Content current as of March 26, 2025; read Oct 21, 2026 (saved copy in src/b11).
3. British Thoracic Society. Guideline for oxygen use in healthcare and emergency settings (emergency oxygen guideline page). Fetched Oct 21, 2026. www.brit-thoracic.org.uk/quality-improvement/guidelines/emer… Supports: Recommended target saturation range for acutely ill patients not at risk of hypercapnic respiratory failure is 94-98%; for known COPD or other risk factors for hypercapnic respiratory failure, 88-92% pending blood gas results. Context for the CMO and flight surgeon only; the robot never starts, stops or adjusts oxygen.
4. 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). www.nice.org.uk/guidance/ng253/chapter/Face-to-face-assessme… 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.
5. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation. 2021;144(22):e368-e454. PMID 34709879. doi:10.1161/CIR.0000000000001029 Supports: On Earth, a 12-lead ECG should be acquired and interpreted within 10 minutes of arrival; an initial normal ECG does not exclude acute coronary syndrome, so ECGs are repeated while symptoms continue; chest pain includes pressure, tightness or discomfort in the chest, shoulders, arms, neck, back, upper abdomen or jaw; sudden ripping pain radiating to the back is suspicious of an acute aortic syndrome.
6. Agency for Toxic Substances and Disease Registry (CDC). Medical Management Guidelines for Ammonia (NH3). Fetched Oct 21, 2026. wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=7&toxid=2 Supports: NIOSH IDLH (immediately dangerous to life or health) 300 ppm. Ammonia is corrosive to eyes, skin and airways; upper airway swelling and pulmonary edema may lead to airway obstruction; after severe exposure, injury to the eyes, lungs and skin may continue to develop for 18 to 24 hours. Eye exposure: irrigate with plain water or saline for at least 15 minutes. Rescuers should be trained and appropriately attired before entering the contaminated (hot) zone. No antidote; treatment is supportive (humidified oxygen is given by clinicians).
7. NASA OCHMO. Decompression Sickness (DCS) Risk Mitigation. Technical Brief OCHMO-TB-037 Rev D (Oct 5, 2026). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-037-decompr… 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.
8. 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.
9. 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. 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.