{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.3", "status": "draft", "conceptual": true, "not_for_clinical_use": true, "max_autonomy": 2, "missions": [ "leo", "commercial", "moon", "mars" ], "updated": "2026-10-21", "review": { "state": "reviewed-ai-assisted", "requested": "2026-10-21", "reviewed": "2026-10-21", "human_clinician_review": false, "text": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 9 review: 16 required corrections, R1 to R17 with R10 dropped, of which R17 applies to RMP-PHARM-002; 20 optional suggestions); all required corrections that apply to this protocol are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use." }, "fixed_rules": { "flight_surgeon_is_medical_authority": true, "cmo_acts_under_delegated_care": true, "human_starts_and_restarts_robot": true, "robot_never_diagnoses": true, "no_drug_or_fluid_advice_by_robot": true, "safe_state_on_fault_or_no_response": true, "lost_link_pause_then_cmo_decides": true }, "robot_lockouts": { "diagnosis": true, "drug_or_fluid_advice": true, "starting_stopping_or_adjusting_oxygen_or_any_medicine": true, "self_start_or_self_restart": true, "changing_own_protocol_thresholds_or_limits": true, "handing_over_a_mismatched_item_as_verified": true }, "id": "RMP-SKIN-003", "slug": "rmp-skin-003", "title": "Wound photo log: standard photos at each dressing change for the flight surgeon to track healing", "category": "skin", "tier": 2, "rung_note": "Max rung 2 for moving the camera to the standard view the CMO sets, at the set distance and without contact, and for labelling, storing and sending photos. The crew remove and apply dressings and place the scale; the robot never judges healing or infection.", "result_language": { "use": [ "photo recorded", "photo not obtained", "flagged for human review", "sent to flight surgeon", "as stated by the crewmember" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "healing well", "healing", "not healing", "better", "worse", "smaller", "larger", "infected", "not infected", "clean", "safe", "mild", "minor" ] }, "scope": { "summary": "After a wound is dressed under RMP-SKIN-001 or RMP-SKIN-002, at each dressing change and whenever the crewmember or CMO sees a change, the robot takes standard photos of the wound for the flight surgeon: the same view, distance, light and plain background each time, with a single-use scale the crew place beside the wound. It labels each photo with the wound, date and clock time, shows earlier photos side by side for the CMO and flight surgeon on request, and logs symptoms as stated. Healing is judged only by the flight surgeon.", "why": "Wound photographs are useful only when they can be compared: the Institute of Medical Illustrators asks for standard equipment, lighting, background, viewpoint and magnification, the same light source each time where possible, a scale on the same plane as the wound photographed from 90 degrees, photos at each dressing change for acute wounds, and a photo whenever there is a significant change (IMI 2019). The robot can hold the camera still at the same view every time without touching anyone. IMI 2019 also asks for an establishing view that includes \"a wide area of healthy tissue\" and \"the same view without a measurement scale\" to show that nothing is hidden, so the standard set keeps a margin of surrounding skin (spreading redness stays visible). On the scale, IMI 2019 §4.6 says disposable paper scales \"may be used where there is a significant risk of infection\" but tend to \"curve or distort with the contours of the skin\"; the flight surgeon chooses a disposable scale or a reusable ABFO No. 2 scale cleaned after each use (that choice, and no automatic measurement in this version, are design judgment). Photos are stored only in the crewmember's medical record, encrypted, never shown on a shared display and never used for robot or AI training, research or outreach without separate written consent (design judgment; IMI 2019 §5 on consent). Wound infection signs and dressing care stay with RMP-SKIN-001.", "covers": [ "Serial photos of a wound or burn already dressed under RMP-SKIN-001 or RMP-SKIN-002, until the flight surgeon closes the log", "Rash and skin irritation: RMP-SKIN-004" ], "locked_out": [ "Diagnosis or naming a cause", "Any medicine, fluid or oxygen advice; starting, stopping or adjusting oxygen", "Touching the crewmember", "Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override)", "Removing, cleaning or applying a dressing, or touching the wound", "Judging healing, infection or wound size, or measuring a wound", "Photographing anything outside the area the CMO set (the wound with a margin of surrounding skin), or any photo without consent", "Sharing photos beyond the CMO, the flight surgeon and people the flight surgeon names", "Showing a photo on a shared display, or using photos for robot or AI training, research or outreach without separate written consent", "Using the robot camera for the genital, breast or buttock area unless the crewmember chooses it" ], "related": [ "RMP-SKIN-001", "RMP-SKIN-002", "RMP-INF-001", "RMP-INF-002", "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": [ "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" ], "robot_may": [ "Remind the CMO when a dressing change is due on the flight surgeon's schedule", "Move the camera to the standard view the CMO set, at the set distance, without contact", "Take, label and store photos", "Show earlier photos side by side on request", "Send photos to the flight surgeon" ], "robot_may_not": [ "Touch the crewmember or the dressing", "Say whether the wound is healing, infected or changed", "Measure a wound", "Photograph without consent", "Start without a human command" ], "commercial": "On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.)" }, "preconditions": [ { "id": "PRE-1", "text": "The CMO opened a wound photo log for this wound by command, with the crewmember's consent.", "check": "human_start == true", "refs": [ "V2 10174" ] }, { "id": "PRE-2", "text": "Robot self-test passed; kit stowage locations known.", "refs": [ "V2 10161", "V2 7059" ] }, { "id": "PRE-3", "text": "Robot and supplies restrained when not moving.", "refs": [ "V2 7046" ] }, { "id": "PRE-4", "text": "Link status known. The crew never wait for the robot before acting.", "check": "link_state in [live, delayed, down]" } ], "consent": { "standard": "The crewmember agrees to the photo series and, before the camera moves, to each session's photos; photos frame only the area the CMO set (the wound with a margin of surrounding skin). For the genital, breast or buttock area the robot camera is used only if the crewmember chooses; otherwise the CMO uses a handheld camera. Photos go only to the CMO, the flight surgeon and people the flight surgeon names.", "emergency": "If the crewmember cannot agree, no photo is taken unless the flight surgeon decides otherwise; care goes on under RMP-SKIN-001.", "withdrawal": "The crewmember can stop a photo or the whole series at any time; withdrawal stops future photos, and the flight surgeon decides on photos already taken." }, "inputs": [ { "id": "IN-1", "name": "The standard view for this wound (body position, camera angle and distance, and the area to frame: the wound with a margin of surrounding skin), set by the CMO at the first photo", "source": "CMO", "required": true, "if_missing": "The first photo is not taken until the CMO sets the view." }, { "id": "IN-2", "name": "The flight surgeon's dressing-change schedule", "source": "Flight surgeon", "required": false, "if_missing": "Photos only when the CMO asks." }, { "id": "IN-3", "name": "Symptoms in the crewmember's words (pain, redness, warmth, swelling, discharge, fever)", "source": "Crewmember", "required": false, "if_missing": "Log \"no response\"; D3 applies." }, { "id": "IN-4", "name": "Each photo, with the wound name, date and clock time", "source": "Robot camera", "required": false, "if_missing": "Log \"photo not obtained\" and tell the CMO." }, { "id": "IN-5", "name": "Link status and delay", "source": "Communications system", "required": true, "if_missing": "Treat as link down; photos are queued." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "When a dressing change is due on the flight surgeon's schedule, or a crewmember asks, tell the CMO; if the crewmember or CMO reports a change in the wound, tell the flight surgeon at once (URGENT if a red flag is stated). Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember.", "success": "Notice acknowledged.", "refs": [ "V1 3006", "V1 6003" ] }, { "id": "S2", "actor": "crew", "action": "The CMO removes the old dressing as RMP-SKIN-001 states and places the scale the flight surgeon chose (a disposable paper scale, or a reusable ABFO No. 2 scale cleaned under RMP-INF-002 after each use) beside the wound, on the same plane as the wound; the crewmember is restrained in the standard position. For the genital, breast or buttock area, the robot camera is used only if the crewmember chooses it; otherwise the CMO takes the photos with a handheld camera and adds them to the log.", "success": "Wound exposed with the scale in place.", "refs": [ "V1 3004" ] }, { "id": "S3", "actor": "robot", "rung": 2, "action": "Only after the crewmember agrees (D1), move the camera to the standard view the CMO set (the same angle, about 90 degrees to the wound, the same distance, the same light and a plain background), no closer than the set camera distance, and take the standard set: an establishing view with a margin of surrounding skin (the area the CMO set), a close-up with the scale, and the same close-up without the scale. Label each with the wound name, date, clock time and view, and mark it \"for human review\". A photo the camera cannot take is logged as \"photo not obtained\". A photo with anything outside the area the CMO set in frame is held unsent and flagged to the flight surgeon, who decides whether to keep it.", "success": "Photos taken and labelled, or \"photo not obtained\".", "limit": "", "refs": [ "V1 7001" ] }, { "id": "S4", "actor": "robot", "rung": 2, "action": "On request, show earlier photos of the same wound side by side with the new ones for the CMO; the robot never says what has changed. Log the crewmember's symptoms word for word.", "success": "Photos shown on request; answers logged.", "refs": [ "V1 7001" ] }, { "id": "S5", "actor": "crew", "action": "The CMO applies the new dressing under RMP-SKIN-001 and disposes of a disposable scale (a reusable scale is cleaned under RMP-INF-002); the crew clean the camera and any shared surface under RMP-INF-002.", "success": "Dressing on; cleaning recorded as stated.", "refs": [ "V1 3004" ] }, { "id": "S6", "actor": "robot", "rung": 2, "action": "After any URGENT alert: After an URGENT alert the robot does not leave on its own: it stays at its rest position in the module, with its screen and voice link available, until a human has taken over or tells it to go. It never follows, blocks or touches anyone. It keeps time-stamping what humans say they did, and repeats the alert if it is not acknowledged.", "success": "Robot at rest in the module until a human releases it; alert acknowledged or escalated.", "refs": [ "V2 10173", "V1 3006" ] }, { "id": "S7", "actor": "ground", "action": "The flight surgeon (or the CMO under the onboard checklist when there is no link) reviews the photos and decides on care, the dressing schedule and when to close the log.", "success": "Decision logged.", "refs": [ "V1 3004" ] }, { "id": "S8", "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, or none ordered.", "refs": [ "V2 7059" ] }, { "id": "S9", "actor": "robot", "rung": 2, "action": "Send the flight surgeon one package: labelled photos, symptoms as stated, alerts and decisions; photos go only to the people the flight surgeon names.", "success": "Package delivered or queued.", "refs": [ "V1 6003", "V1 7003" ] } ], "decisions": [ { "id": "D1", "after": "S2", "decided_by": "robot", "question": "Before the camera moves: did the crewmember agree to this session's photos (each view is named on screen before it is taken)?", "branches": [ { "if": "Yes", "then": "Continue to S3; the crewmember can say stop before or during any view." }, { "if": "No, or no answer", "then": "The camera does not move and no photo is taken; log \"photo not taken – no consent\" and tell the CMO." } ] }, { "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 crewmember answer the symptom prompt, or say they want to skip it?", "branches": [ { "if": "Yes", "then": "Continue." }, { "if": "Declined explicitly (the crewmember says no to a question)", "then": "Log \"declined\" for that question only; the alert already sent stands." }, { "if": "No response, or the answer does not make sense", "then": "URGENT: log \"no response\" (never \"declined\"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once." } ] }, { "id": "D4", "after": "S7", "decided_by": "ground", "question": "What is the plan (care, dressing schedule, closing the log)?", "branches": [ { "if": "Link live", "then": "Flight surgeon decides; robot logs." }, { "if": "Link down or delay too long", "then": "The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact." } ] }, { "id": "D5", "after": "S8", "decided_by": "robot", "question": "What did RMP-PHARM-001 show for the ordered item?", "branches": [ { "if": "MATCH TO ORDER", "then": "RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs \"MATCH TO ORDER. Not a dose, interaction or allergy review.\" and the clock time." }, { "if": "MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check", "then": "MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.", "handoff": "none" } ] } ], "stop_rules": [ { "id": "X1", "trigger": "The patient (or the crewmember being examined) says stop, or withdraws consent", "action": "Robot stops all motion at once, backs away to its rest position and tells the CMO. Recording stops unless the patient agrees to keep it running.", "level": "stop", "refs": [ "V2 10165" ] }, { "id": "X2", "trigger": "Any crewmember presses stop or takes over control", "action": "Protective stop; robot holds its stopped position; only a human may restart it.", "level": "safe-state", "refs": [ "V2 10165", "V2 10168", "V2 10174" ] }, { "id": "X3", "trigger": "Robot fault, sensor fault, or a force, speed or reach limit is reached", "action": "Protective stop and hand control to the CMO; log the fault.", "level": "safe-state", "refs": [ "V2 10172", "V2 10168" ] }, { "id": "X4", "trigger": "CMO is asked to take over and does not respond (for example, the CMO is the patient)", "action": "Robot stays stopped; the next named crewmember is called.", "level": "safe-state", "refs": [ "V2 10173", "V2 7045" ] }, { "id": "X5", "trigger": "Loss of link, or delay longer than the limit for live guidance", "action": "Only the robot pauses: before it holds, it moves to a position clear of a hatch route or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew dressing changes and all crew care continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether the robot continues offline under the pre-approved onboard checklist; it resumes only on the CMO's confirmation.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "An URGENT alert is not acknowledged within the set time", "action": "Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own.", "level": "urgent", "refs": [ "V1 3006", "V2 10173" ] }, { "id": "X7", "trigger": "The crewmember stops responding, or seems confused or drowsy, at any point", "action": "URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person.", "level": "urgent" }, { "id": "X8", "trigger": "A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice", "action": "Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.", "level": "stop" }, { "id": "X9", "trigger": "The crewmember or CMO asks to stop photos, or anything outside the area the CMO set is in frame", "action": "Robot stops the camera at once and logs it; any photo with something outside the set area in frame is held unsent and flagged to the flight surgeon, who decides whether to keep it.", "level": "stop" }, { "id": "X10", "trigger": "Someone needs the space or route the robot is in", "action": "Robot moves clear at once without contact and holds; it never pauses in a hatch route.", "level": "safe-state", "refs": [ "V2 10172" ] } ], "red_flags": [ { "id": "RF1", "sign": "Redness spreading from the wound, increasing warmth or swelling, or pus, as stated by the crewmember or the CMO (design judgment)", "threshold": "any", "action": "Flag to the flight surgeon at once; see RMP-SKIN-001" }, { "id": "RF2", "sign": "Pain in the wound that is getting worse, or severe, as stated (design judgment)", "threshold": "any", "action": "URGENT alert; the CMO examines at once" }, { "id": "RF3", "sign": "Fever, shaking chills or new confusion, as stated", "threshold": "any", "action": "URGENT alert; see RMP-INF-001", "source": "ng253" }, { "id": "RF4", "sign": "The wound opens, or bleeds and does not stop with pressure, as stated (design judgment)", "threshold": "any", "action": "URGENT alert; the crew apply pressure; see RMP-SKIN-001 and RMP-MSK-001" } ], "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": "Camera distance from the crewmember", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] }, { "name": "Photo shown on a shared display, or used for robot or AI training, research or outreach without separate written consent", "value": "not allowed", "enforced": "Photos are stored only in the crewmember's medical record, encrypted in storage and in transit as the program requires; access is limited to the CMO, the flight surgeon and people the flight surgeon names", "refs": [ "V1 7003" ], "id": "L3" }, { "id": "L4", "name": "Automatic wound measurement or healing score", "value": "not allowed", "enforced": "No such function is loaded" }, { "id": "L5", "name": "Robot speed near the crewmember", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] } ], "logs": [ { "id": "LOG-1", "text": "Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.", "refs": [ "V2 10163", "V2 10164" ] }, { "id": "LOG-2", "text": "Mode changes and safety-limit events are announced to the operator as they happen and logged.", "refs": [ "V2 10162", "V2 10172" ] }, { "id": "LOG-3", "text": "Records are stored and sent as private medical data, encrypted, with access limited to the medical team.", "refs": [ "V1 6003", "V1 7003" ] }, { "id": "LOG-4", "text": "Results are kept in a permanent, retrievable format so the flight surgeon can see trends.", "refs": [ "V1 7001" ] }, { "id": "LOG-5", "text": "Each photo with the wound name, date, time and the standard view used; photos not obtained or not taken; consent for each photo; symptoms as stated; who viewed the photos. Photos held unsent (something outside the set area in frame) and the flight surgeon's decision; photos taken by the CMO with a handheld camera." }, { "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 3004", "use": "In-mission care includes wound care; the crew dress the wound and the flight surgeon reviews the photos." }, { "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 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." }, { "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 photo series with a missed consent, a reported change, fever, CMO as patient, lost link.", "pass": "Zero contact; zero healing words; every red flag raised." }, { "stage": "training model", "what": "Photo series on a wound model across several dressing changes.", "pass": "Photos comparable (same view, light and scale); every photo labelled." }, { "stage": "parabolic or station demonstration", "what": "Camera positioning and hold in weightlessness.", "pass": "Camera distance limit held." }, { "stage": "flight use under flight surgeon supervision", "what": "First use for a dressed wound.", "pass": "No safety or privacy 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": "Opened by the CMO with the crewmember's consent. The crew handle the dressing; the flight surgeon judges healing." }, "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 photos 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 dressing changes and all crew care continue under the onboard checklist and never wait for the link or the robot.", "Photos are queued; the CMO decides on care under the onboard checklist." ], "mars_delay": [ "Mars: photos arrive with delay; the dressing schedule and onboard checklist are set before flight and the CMO decides." ] }, "sources": [ { "key": "imi2019", "text": "Institute of Medical Illustrators. IMI National Guidelines: Wound Management Photography (2019).", "url": "https://www.imi.org.uk/wp-content/uploads/2019/04/2019_Apr_IMINatGuidelines_Wound-Management.pdf", "supports": "Standardise equipment, lighting, background, viewpoint and magnification so serial photographs can be compared; use the same light source each time where possible; hold a measurement scale on the same plane as the wound and photograph from 90 degrees; acute wounds are photographed at each dressing change, and any significant change is photographed; p. 23: an establishing view with \"a wide area of healthy tissue\", and \"the same view without a measurement scale\" to demonstrate that no important detail was concealed; §4.6: \"Disposable paper scales may be used where there is a significant risk of infection\" but \"have a tendency to curve or distort with the contours of the skin and are therefore of limited value\"; §5: valid consent is central to clinical photography. Earth hospital context. Saved copy read Oct 21, 2026 (a 2025 version 2.0 exists)." }, { "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": "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 6003, V1 7001 (medical records), V1 7003." }, { "key": "v2", "text": "NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems.", "url": "https://standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2", "supports": "Requirement IDs beginning V2." }, { "key": "tb044", "text": "NASA OCHMO. Medical Operations. Technical Brief OCHMO-TB-044 (2025).", "url": "https://www.nasa.gov/wp-content/uploads/2025/08/ochmo-tb-044-medical-operations.pdf", "supports": "The crew surgeon keeps medical authority when care is delegated; crew medical officers train on the JSC 48522 medical checklist." }, { "key": "marsdelay", "text": "NASA. Mars communications disruption and delay (fact sheet, 2023 Moon to Mars Architecture Concept Review).", "url": "https://www.nasa.gov/wp-content/uploads/2024/01/mars-communications-disruption-and-delay.pdf", "supports": "One-way Earth-Mars delay up to about 21-23 minutes, plus blackouts of about 2-3 weeks near solar conjunction." }, { "key": "pccp", "text": "U.S. Food and Drug Administration. Marketing submission recommendations for a predetermined change control plan for artificial intelligence-enabled device software functions (guidance).", "url": "https://www.fda.gov/regulatory-information/search-fda-guidance-documents/marketing-submission-recommendations-predetermined-change-control-plan-artificial-intelligence", "supports": "A model for planning, validating and rolling back software updates." }, { "key": "faa460", "text": "U.S. Code of Federal Regulations, Title 14, Part 460: Human space flight requirements.", "url": "https://www.ecfr.gov/current/title-14/chapter-III/subchapter-C/part-460", "supports": "Federal rules for crew and spaceflight participants on licensed commercial flights; they set no medical standards for spaceflight participants." } ], "corrections": [ { "date": "2026-10-21", "version": "0.2", "source": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 9 review)", "items": [ "Consent comes before the camera moves: D1 now follows S2, S3 runs only on \"Yes\", and \"No, or no answer\" means the camera does not move, no photo is taken, \"photo not taken – no consent\" is logged and the CMO is told (R14).", "Framing: the standard set is an establishing view with a margin of surrounding skin set by the CMO, a close-up with the scale, and the same close-up without the scale; the stop rule applies to anything outside the area the CMO set, so spreading redness (RF1) stays visible (R16, IMI 2019 p. 23).", "Scale: the flight surgeon chooses a disposable paper scale or a reusable ABFO No. 2 scale cleaned under RMP-INF-002; IMI 2019 §4.6 is cited for the disposable scale and its limits, and the choice is labelled design judgment (S17, Q5).", "Image storage and privacy: photos are stored only in the crewmember's medical record, encrypted in storage and in transit, never shown on a shared display and never used for robot or AI training, research or outreach without separate written consent; for the genital, breast or buttock area the robot camera is used only if the crewmember chooses (otherwise the CMO uses a handheld camera); a photo with anything outside the set area is held unsent and flagged to the flight surgeon; withdrawal stops future photos and the flight surgeon decides on photos already taken (R15).", "Batch 9 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Batch 11 editorial (AI-assisted), Oct 21, 2026", "items": [ "Cross-links to the batch 11 drafts no longer say \"(planned)\" now that those protocols exist as v0.1 drafts." ] } ] }