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RMP-CARD-001 Cardiac arrest: bring defibrillator and oxygen, stream video (the robot does not run the arrest)

Draft v0.3
Max autonomy Rung 2 · supervised
Priority Tier 1
Missions Low Earth orbit, Commercial flights, Moon, Mars
Updated Oct 21, 2026

AI-assisted Reviewed (AI-assisted) 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.

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Fixed rules (same in every protocol)

The flight surgeon is the medical authority. The crew medical officer (CMO) acts under delegated care [13].
A human starts the robot, can stop it at any time, and restarts it after any stop.
The robot never diagnoses and gives no drug or fluid advice.
On a fault or no human response, the robot goes to a safe state. On a lost link it pauses motion and tells the CMO, who decides whether to continue offline.
Locked out in every protocol: diagnosing; drug or fluid advice; starting, stopping or adjusting oxygen or any medicine; starting or restarting itself; changing its own protocol, thresholds or limits; handing over an item that failed a check (applies when RMP-PHARM-001 is used).
Result words the robot may 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, asystole, VF, VT, PEA, shockable, non-shockable, rosC, ROSC, pulse present, no pulse, verified, safe, mild, minor.

1 · Identity and scope

When a crewmember is unresponsive and not breathing normally, or the CMO starts cardiac arrest care, the robot sends an URGENT alert at once, brings the defibrillator (automated external defibrillator or vehicle equivalent, unopened) and the closed oxygen kit to the CMO on command, clears space, streams video to the flight surgeon when the link allows, records the clock times of CPR (cardiopulmonary resuscitation) starts and stops and any shocks as the CMO states them, and after the event reconciles kits through RMP-PHARM-001 as an inventory record only. The crew run the arrest under the onboard checklist; the robot does not compress the chest, analyse a rhythm, fire a shock or start oxygen.

Why this protocol was chosen. Early recognition, early CPR and early defibrillation improve survival from cardiac arrest on Earth (AHA 2025 adult basic and advanced life support guidelines; Resuscitation Council UK public CPR and defibrillation resources). NASA-STD-3001 requires medical capability including emergency care [V1 3004], and two trained crew medical officers per vehicle for NASA programs [V1 3006]. There is no public NASA flight cardiac-arrest algorithm; the onboard checklist leads. For clinicians only (the robot never says, demonstrates or coaches any of this): published microgravity CPR guidance for human rescuers (DGLRM/ESAM 2020) uses the Evetts-Russomano method for immediate basic life support and the handstand method with the patient restrained on the Crew Medical Restraint System for advanced life support; the reverse bear hug appears in earlier parabolic-flight work (Jay 2003; Rehnberg 2014; Braunecker 2015). Airway devices only with the patient restrained and at least two rescuers. These are Earth-published aerospace recommendations, not a NASA flight algorithm. A helper that raises the alarm, brings the sealed defibrillator and oxygen kit, keeps paths clear and keeps an exact clock-time record lets the CMO and the second trained CMO keep both hands on the patient. Robot chest compressions in weightlessness remain research only (see the library research entry). Open question for review: which defibrillator type each vehicle carries, and whether video should start automatically on the URGENT alert or only on the CMO's command.

Autonomy: Max rung raised from 1 to 2 for supervised fetching and video relay, as in RMP-CARD-002 and RMP-RESP-003. The robot never starts chest compressions, never fires a defibrillator, and never starts or adjusts oxygen.

Covers

Unresponsive crewmember who is not breathing normally, or a CMO decision to start cardiac arrest care
Post-event kit reconciliation and a package to the flight surgeon

Locked out (never done by the robot under this protocol)

Chest compressions, airway procedures, or any contact with the patient
Starting, coaching or timing CPR or judging pause length (it records clock times only as the CMO states them)
Saying whether to continue or stop resuscitation, or that further effort is futile
Opening the defibrillator pads package or firing any shock
Starting, stopping or adjusting oxygen (the oxygen kit is fetched closed)
Saying whether a rhythm is shockable, or that a pulse is present or absent
Choosing, preparing or giving any medicine
Dose-interval cues
Recording a check made after a kit was used as a check before use

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: runs or helps the arrest if the CMO is the patient or is alone
Other crew: take turns at CPR as the CMO 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.) [16]

Robot may

Send an URGENT alert at once
Bring the defibrillator and the closed oxygen kit on command and restrain them within reach
Clear loose items from the work space and hold position clear of the CPR area
Stream video to the flight surgeon when the link allows and the CMO has not stopped it
Record clock times of CPR and shocks as the CMO states them
Reconcile kits after the event through RMP-PHARM-001 as an inventory record only

Robot may not

Touch the patient or perform CPR
Open or fire the defibrillator
Start or adjust oxygen
Interpret a rhythm or say there is a pulse
Suggest or give any medicine
Start without a human command

3 · Preconditions and consent

PRE-1 A crewmember or the CMO started the protocol by command (for example "cardiac arrest" or "no breathing"). Nothing starts it from telemetry alone.human_start == trueV2 10174
PRE-2 Robot self-test passed; it knows the stowage location of the defibrillator and the oxygen kit.V2 10161V2 7059
PRE-3 Robot and supplies restrained when not moving.V2 7046
PRE-4 Link status and current delay known. The CMO never waits for the robot or the link before starting CPR.link_state in [live, delayed, down]

Consent: Recording and video by the CMO's agreement when the patient cannot consent; treated as emergency care under the onboard checklist.
Emergency consent: If the patient cannot agree, the robot proceeds on the CMO's command; the URGENT alert and the record stand.
Withdrawal: The CMO can stop video at any time; the URGENT alert and the treatment record are kept.

4 · Required sensor inputs

ID	Input	Source	Required	If missing
IN-1	CMO statement that the crewmember is unresponsive and not breathing normally, or that cardiac arrest care has started	CMO or crewmember, by voice	Yes	Log "no response" and keep the URGENT alert.
IN-2	Clock times of CPR start and stop, each shock, and any medicine given, as stated by the CMO	Stated by the CMO	Optional	Log "not stated".
IN-3	Defibrillator and oxygen kit IDs and seal status	Kit labels	Optional	Log "not read" if reading would delay hand-over.
IN-4	Link status and delay	Communications system	Yes	Treat as link down.

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.

S1RobotRung 2

On a crewmember's or the CMO's word, send an URGENT "cardiac arrest / not breathing normally" 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 <set by validation> seconds is repeated and sent to the next named crewmember. The CMO starts CPR under the onboard checklist without waiting for the robot.

Done when: Alert acknowledged, or escalated.

V2 10174V1 6003V1 3006
D1DecisionCrew decides

Is the crewmember unresponsive and not breathing normally?
- Yes → Continue this protocol; the CMO starts CPR now.
- No — responsive or breathing normally → Stop this protocol; consider RMP-CARD-002 for chest pain or other protocols as the CMO decides.
S2RobotRung 2

On the CMO's command, bring the defibrillator (unopened) and the closed oxygen kit to the CMO at once and restrain them 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". If a crewmember already has them, skip this step.

Done when: Kits within reach, or step skipped; override logged.

Limit: <set by validation>

V2 7046
S3Crew

The CMO and the second trained CMO run the arrest under the onboard checklist (CPR, defibrillator, airway and oxygen as the checklist and flight surgeon direct). CPR and any defibrillator use start only on a human decision; the robot never starts, coaches or times CPR as a coach, and never judges pause length. The robot stays clear of the CPR area.

Done when: Human-led care; robot logs what is stated.

V1 3004V1 5003
S4RobotRung 2

Clear loose items from the work space, hold a position clear of the CPR area, and stream video to the flight surgeon when the link allows unless the CMO stops it. Record each CPR start and stop and each shock as the CMO states them, on a clock-time timeline only.

Done when: Space clear; video on or logged as stopped; times logged.

V1 6003
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. The URGENT alert from S1 stands.
D3DecisionRobot decides

Did the CMO answer when asked for a stated time?
- 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.
S5RobotRung 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
S6Ground

The flight surgeon (or the CMO under the onboard checklist when there is no link) decides ongoing care, medicines, return of circulation actions and any evacuation [V1 3007]. Whether to continue or stop the arrest is decided only by the flight surgeon, or by the CMO under the pre-approved onboard checklist when there is no link [V1 3007] [V1 3004]; the robot never suggests stopping. The robot logs the decisions.

Done when: Decision logged.

V1 3007
D4DecisionGround decides

What is the plan (ongoing care, medicines, evacuation)?
- 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.
S7RobotRung 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. Nothing in this step is recorded as a check before the kit was used.

Done when: Reconciliation recorded and labelled not a check before use; kit shown as opened – not restocked until resealed.

V2 7059
S8RobotRung 2

Send the flight surgeon one package: alert times, CPR and shock timeline as stated, video pointer if any, kit inventory record and decisions.

Done when: Package delivered or queued.

V1 6003V1 7001V1 7003

7 · Stop and escalate rules, red flags

ID	Trigger	What happens	Level
X1	The patient (or the crewmember being examined) says stop, or withdraws consent	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.V2 10165	stop
X2	Any crewmember presses stop or takes over control	Protective stop; robot holds its stopped position; only a human may restart it.V2 10165V2 10168V2 10174	safe-state
X3	Robot fault, sensor fault, or a force, speed or reach limit is reached	Protective stop and hand control to the CMO; log the fault.V2 10172V2 10168	safe-state
X4	CMO is asked to take over and does not respond (for example, the CMO is the patient)	Robot stays stopped; the next named crewmember is called.V2 10173V2 7045	safe-state
X5	Loss of link, or delay longer than the limit for live guidance	Robot pauses any movement in its stopped position and tells the CMO. The CMO decides whether the robot continues offline under the pre-approved onboard checklist; the robot resumes only on the CMO's confirmation. This stop rule pauses robot movement only: crew CPR, defibrillation and oxygen use continue under the onboard checklist without waiting for the link or the robot. Everything is logged and sent to the flight surgeon at the next contact.V2 10172V2 10173	pause
X6	An URGENT alert is not acknowledged within the set time	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.V1 3006V2 10173	urgent
X7	The crewmember stops responding, or seems confused or drowsy, at any point	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.	urgent
X8	A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice	Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.	stop
X9	The CMO or a crewmember needs the robot's space to reach the patient	Robot moves to its rest position at once and holds; it still does not leave the module on its own.V2 10172	safe-state
X10	Fire, smoke or a toxic release during the arrest	Robot stops non-essential motion, keeps paths clear and follows the vehicle emergency procedure (see RMP-ENV-001); the CMO decides whether CPR continues.V2 9059	urgent

Red flags

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

ID	Sign	Threshold	Action
RF1	Unresponsive and not breathing normally, as the CMO or a crewmember states [1]	any	URGENT alert; this protocol's S1 already fired; the CMO starts CPR now
RF2	The defibrillator or oxygen kit cannot be found, or its seal is not intact when that can be read without delay [9]	any	URGENT alert to the CMO and flight surgeon; the CMO continues CPR and uses the next available device under the checklist
RF3	Only one trained responder is available [11]	any	URGENT alert to the next named crewmember and flight surgeon; the robot stays and does not leave
RF4	Suspected cardiac arrest after a spacewalk or pressure change [10]	any	URGENT alert; see also RMP-EVA-001; the CMO still starts CPR now
RF5	Return of responsiveness or normal breathing, as the CMO states [2]	any	Flag to the flight surgeon; the CMO continues post-arrest care under the checklist; the robot does not say circulation has returned and never says "ROSC" or "pulse is back"

8 · Safety limits

ID	Limit	Value	How enforced
L1	Contact with the crewmember	not allowed	Keep-out zone in the robot controllerV2 10172
L2	Opening or firing the defibrillator	not allowed	No defibrillator-fire or pad-placement task is loaded
L3	Starting or adjusting oxygen	not allowed	Oxygen kit handled closed only
L4	Robot speed near the crewmember	<set by validation>	Hard limit in the controllerV2 10172
L5	Closest approach to the CPR area	<set by validation>	Distance sensing; the robot stays outside the CPR keep-out

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 Alert time, each CPR and shock time as stated, video start/stop, and kit reconciliation.
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

10 · Links to NASA-STD-3001

Requirement	Topic (paraphrased)	How this protocol uses it
[V1 3004]	In-mission medical care capabilities (including inventory, vital signs, imaging and ECG, procedures, restraints, medications, private data transmission)	In-mission care includes medical kits (b), emergency procedures and recording treatment; the crew deliver care.
[V1 3006]	Crew medical officers: two per vehicle	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).
[V1 3007]	Medical evacuation	Medical evacuation when illness is beyond onboard capability; the flight surgeon decides.
[V1 5003]	Crew medical officer training (including toxicology and medical equipment)	CMO training includes medical procedures and equipment; the CMO treats.
[V1 6003]	Private medical communications	Logs and alerts sent to the ground are private medical communications.
[V1 7001]	Medical records kept permanently and retrievable for trend analysis	Records kept so the flight surgeon can see trends.
[V1 7003]	Security of medical records	Secure handling of medical records.
[V2 7045]	Medical equipment usable by non-physician crew	Usable by non-physician crew, including when the CMO is the patient.
[V2 7046]	Restraint of patient, care provider and supplies	Patient, caregiver and supplies restrained.
[V2 7059]	Inventory management: track locations and quantities	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.
[V2 9059]	Fire protection system (detecting, warning and extinguishing)	Fire protection system: detecting, warning and extinguishing.
[V2 10161]	Automated system status shown to the operator	Robot shows its status and health.
[V2 10162]	Mode changes announced	Mode changes are announced to the operator.
[V2 10163]	Data recording and sharing	Robot records and shares its data.
[V2 10164]	Clear allocation of responsibility (human or system)	Shows whether the human or the robot is expected to act.
[V2 10165]	Human override and shutdown	Human can override and shut down the robot.
[V2 10168]	Failure recovery: safe human takeover	Human can take over.
[V2 10172]	Protective stop when limits are exceeded	Protective stop when a limit is exceeded.
[V2 10173]	Safety Default	Robot stays stopped if no one takes over.
[V2 10174]	Only a human initiates or restarts	Only a human starts or restarts the robot.

IDs as published in Volume 1 Revision C [11] and Volume 2 Revision F [12]. 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

Simulation. Scripted arrests including a missing kit, a CMO who is the patient, fire during the run, and lost link. Pass: Zero chest contact; zero shocks by the robot; every emergency fetch logged as an override; unacknowledged alerts escalate.
Training model. CMO training on a manikin with the robot fetching the defibrillator and oxygen kit. Pass: Kits delivered within <set by validation> seconds; the CMO is never delayed or obstructed.
Parabolic or station demonstration. Fetching and restraining the defibrillator and oxygen kit in weightlessness, without a patient. Pass: Kits delivered closed and restrained.
Flight use under flight surgeon supervision. First use in drills alongside the onboard checklist. Pass: No safety events; the record is complete.

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

Started by a crewmember or the CMO. Every alert goes to the CMO and flight surgeon at once; the crew run the arrest.

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 [15].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon receives the alert and video at once when the link allows.

Loss of signal

The robot pauses non-essential motion and tells the CMO; on the CMO's confirmation it keeps recording offline.
The CMO (or the second trained CMO) treats under the pre-approved onboard checklist; nothing waits for the link.
At the next contact the robot sends one package: times, video pointer and alerts.

Mars-class delay

Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; arrest care cannot wait for the ground.
The onboard checklist and two trained CMOs lead.

[14]

Corrections and updates

Oct 21, 2026, version 0.2. AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 5 review); no named human clinician. Changes:

Sources updated from AHA 2020 to AHA 2025 Part 7 Adult Basic Life Support (PMID 41122888) and Part 9 Adult Advanced Life Support (PMID 41122884), labelled Earth guidance; the onboard checklist leads (item 1). AHA 2025 Part 3 Ethics (PMID 41122890) added for decisions to stop. Full texts not read; foreign-body airway obstruction wording to be re-checked when they are.
The "why" names published microgravity CPR methods for human rescuers, for clinicians only, in crew medical officer checklist context: Evetts-Russomano for immediate basic life support, handstand on the Crew Medical Restraint System for advanced life support, reverse bear hug in earlier work (DGLRM/ESAM 2020; Rehnberg 2014; Jay 2003; Braunecker 2015). The robot never says, demonstrates or coaches any of it; robot compressions stay research only (item 2).
S3: CPR and any defibrillator use start only on a human decision; the robot never starts, coaches or times CPR as a coach, and never judges pause length (item 3).
X5 (link loss): only the robot pauses. Crew CPR, defibrillation and oxygen use continue under the onboard checklist without waiting for the link or the robot (item 4).
Stopping resuscitation: new lockout ("Saying whether to continue or stop resuscitation, or that further effort is futile"); S6 says only the flight surgeon, or the CMO under the onboard checklist when there is no link, decides, and the robot never suggests stopping (item 5).
RF5: the robot never says "ROSC" or "pulse is back" (suggestion 29).
Batch 5 drafts now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.

Oct 21, 2026, version 0.3. Batch 7 editorial (AI-assisted), Oct 21, 2026; no named human clinician. Changes:

Citation labels changed to the site's year-only convention: "(approved for public release <date>)" 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.

Earlier version: Draft v0.2, Oct 21, 2026. Download the current YAML above.

Sources

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.
Wigginton JG, Agarwal S, Bartos JA, et al. Part 9: Adult Advanced Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S538-S577. PMID 41122884. doi:10.1161/CIR.0000000000001376 Supports: Adult advanced life support for cardiac arrest (ventricular fibrillation, pulseless ventricular tachycardia, asystole, pulseless electrical activity) and peri-arrest conditions such as atrial fibrillation or flutter with a rapid ventricular rate; defibrillation, cardioversion, advanced airway, drugs; refined termination-of-resuscitation rules. Earth guidance for clinicians; the robot never interprets a rhythm. Abstract read via PubMed Oct 21, 2026; full text not read.
Elmer J, Atkins DL, Daya MR, et al. Part 3: Ethics: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S323-S352. PMID 41122890. pubmed.ncbi.nlm.nih.gov/41122890/ Supports: Ethics of resuscitation, including decisions to continue or stop resuscitation; cited only to show that stopping is a clinician decision. PubMed record verified Oct 21, 2026; full text not read.
Hinkelbein J, Kerkhoff S, Adler C, et al. Cardiopulmonary resuscitation (CPR) during spaceflight - a guideline for CPR in microgravity from the German Society of Aerospace Medicine (DGLRM) and the European Society of Aerospace Medicine Space Medicine Group (ESAM-SMG). Scand J Trauma Resusc Emerg Med. 2020;28(1):108. PMID 33138865. doi:10.1186/s13049-020-00793-y Supports: For human rescuers: in immediate basic life support the chest compression method of choice is the Evetts-Russomano method; in advanced life support, with the patient restrained on the Crew Medical Restraint System, the handstand method. Airway management only with at least two rescuers present and the patient restrained. An aerospace-society guideline, not a NASA flight algorithm.
Rehnberg L, Ashcroft A, Baers JH, et al. Three methods of manual external chest compressions during microgravity simulation. Aviat Space Environ Med. 2014;85(7):687-693. PMID 25022155. doi:10.3357/asem.3854.2014 Supports: Three single-person CPR techniques can be performed in microgravity: Evetts-Russomano, handstand and reverse bear hug; all evaluated in parabolic flight, only Evetts-Russomano shown effective in prolonged microgravity simulation. Human rescuers only.
Jay GD, Lee P, Goldsmith H, et al. CPR effectiveness in microgravity: comparison of three positions and a mechanical device. Aviat Space Environ Med. 2003;74(11):1183-1189. PMID 14620476. pubmed.ncbi.nlm.nih.gov/14620476/ Supports: Early parabolic-flight comparison of CPR positions (including the reverse bear hug) and a mechanical device. PubMed record verified Oct 21, 2026; abstract not re-read in full.
Braunecker S, Douglas B, Hinkelbein J. Comparison of different techniques for in microgravity - a simple mathematic estimation of cardiopulmonary resuscitation quality for space environment. Am J Emerg Med. 2015;33(7):920-924. PMID 25936478. doi:10.1016/j.ajem.2015.04.018 Supports: Modelled comparison of microgravity CPR techniques for human rescuers. PubMed record verified Oct 21, 2026.
Resuscitation Council UK. How to do CPR (public resource); Defibrillation (public resource). Pages fetched Oct 21, 2026. www.resus.org.uk/public-resource/how-do-cpr Supports: Public adult CPR and defibrillator guidance: call for help, start chest compressions, use an automated external defibrillator as soon as one is available. Used as open Earth first-aid context for what the crew do; the robot never compresses the chest or fires a defibrillator.
Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019). www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Gu… 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).
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.
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 3004, V1 3006, V1 3007, V1 5003.
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.
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.
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.
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.
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.