RMP-CARD-002 Chest pain: vital signs and 12-lead ECG recording support, relay to the flight surgeon

1 · Identity and scope

When a crewmember reports chest pain or a chest-pain equivalent, the robot brings the monitor and kits, helps the crew record vital signs and a 12-lead ECG as fast as possible, and sends the recordings to the flight surgeon. It repeats the recordings on the flight surgeon's schedule. It never reads the ECG.

Why this protocol was chosen. Chest pain is time-critical and common on Earth. On Earth, guidelines ask for a 12-lead ECG to be acquired and interpreted (reviewed) within 10 minutes of arrival. The robot only acquires and sends; a human must review every ECG. On a small crew, a robot that fetches, prompts and records can free the CMO to look after the patient.

Autonomy: Raised from rung 1 in the library outline: the robot fetches the monitor and kits under supervision. It never touches the chest; the crew place the electrodes.

Related: RMP-CARD-001 · RMP-CARD-003 · RMP-EGR-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

• Onboard ECG reviewer: the CMO, or the onboard reader the flight surgeon names before flight. Reviews every ECG when the link is down or delayed beyond the live-guidance limit.
• Second crewmember: helps restrain and position the patient
• Patient: answers symptom questions and can stop the robot at any time

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.) [7]

3 · Preconditions and consent

• PRE-1 Patient is responsive and breathing normally. If not, stop this protocol and start the cardiac arrest protocol (RMP-CARD-001).patient_responsive == true and breathing_normal == true
• PRE-2 A crewmember started the run by command; CMO present and able to take over at any moment.human_start == true and cmo_present == trueV2 10174V2 10168V2 10164
• PRE-3 Patient, caregiver and kits restrained.restraints_ok == trueV2 7046
• PRE-4 Monitor and robot self-tests passed; status shown to the crew.selftest_ok == trueV2 10161
• PRE-5 Link status and current delay known.link_state in [live, delayed, down]

Consent

The patient agrees by voice or touch; the robot logs it before recording.

Emergency consent

If the patient cannot agree, the robot proceeds only on a CMO decision (and the flight surgeon's, when the link allows), logged as an emergency decision.

Withdrawal

The patient can withdraw at any time by saying stop; the robot stops and backs away.

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

   On a crew command such as "chest pain", alert the CMO and, if the link is up, send an immediate "chest pain event started" alert to the flight surgeon; start the event clock (time zero). Recordings follow as they are made.

   Done when: CMO acknowledges; flight surgeon alert delivered, or queued if there is no link.

   V2 10174V1 6003

   D1DecisionCrew decides

   Is the patient unresponsive or not breathing normally?

   • Yes → Stop this protocol; start RMP-CARD-001 (the robot brings the defibrillator; crew run the arrest).
   • No → Continue.
2. S2RobotRung 2

   Bring the monitor and ECG kit, the oxygen kit (closed; the robot never starts or adjusts oxygen) and the defibrillator (unopened) to the patient and restrain them.

   Done when: Kits restrained at the patient.

   Limit: <set by validation>

   V2 7046

3. S3Crew

   Restrain the patient and caregiver; place electrodes and the blood pressure cuff while the robot shows the placement diagram and lead-contact indicators.

   Done when: All leads in contact.

4. S4RobotRung 2

   Record a 12-lead ECG and vital signs; label each with time and patient ID.

   Done when: Recording passes the signal-quality check.

   D2DecisionRobot decides

   Did the ECG pass the signal-quality check?

   • Yes → Continue to S5.
   • No after <set by validation> attempts → Hand back to the CMO; report "ECG not obtained"; send vital signs anyway.
5. S5RobotRung 2

   Send the ECG and vital signs to the flight surgeon at once, and show them to the onboard ECG reviewer; send symptom answers as soon as S6 is complete. If there is no link, queue them and show the CMO the onboard checklist page. Sending to the ground does not count as review.

   Done when: Delivery confirmed, or queued and shown to the CMO.

   V1 6003V1 7003

   D3DecisionGround decides

   What happens next (treatment, repeat schedule, evacuation planning)?

   • Link live → Flight surgeon decides; robot logs.
   • Link down or delay too long → The CMO (or the named onboard reader) reviews each ECG against the pre-flight checklist; the CMO decides under the pre-approved onboard checklist; flight surgeon reviews at next contact.
6. S6RobotRung 2

   Ask the structured symptom questions and log the answers word for word.

   Done when: Answers logged.

7. S7RobotRung 2

   Repeat the ECG and vital signs every <set by flight surgeon> minutes, and at once if symptoms change. A first ECG without changes does not rule out a heart attack.

   Done when: Each repeat recorded, sent, and shown to the onboard ECG reviewer when the link is down or delayed.

   D4DecisionRobot decides

   Has a device alarm or a red-flag value appeared?

   • Yes → Urgent alert to the CMO and flight surgeon (see red flags). The robot reports the value only, not its meaning.
   • No → Continue the repeat schedule.
8. S8Ground

   Flight surgeon (or CMO under the onboard checklist) decides treatment, monitoring and any evacuation planning; robot logs the decisions.

   Done when: Decision logged.

   V1 3007

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 Time zero, time to first transmitted ECG, and every repeat, so the delay can be audited.

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [3] and Volume 2 Revision F [4]. 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. Recorded ECG and vital-sign data, scripted chest-pain scenarios at station, Moon and Mars delays. Pass: Time to transmitted ECG at or below <set by clinical lead>; zero cases of the robot interpreting or labeling a recording.
2. Training model. Manikin with an ECG simulator; crew place electrodes while the robot fetches and records. Pass: Lead-quality pass rate at or above <set by validation>; zero keep-out-zone violations.
3. Earth analog. Analog crews (for example an undersea or isolation habitat) with remote flight surgeons. Pass: Pass criteria set in advance by the clinical lead and safety board.
4. Flight use under flight surgeon supervision. First flight use limited to scheduled, non-urgent ECGs on healthy crew. Pass: No safety events; flight surgeon judges recordings usable.

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 any crewmember. Flight surgeon agreement when the link allows; otherwise the CMO under the onboard checklist, with flight surgeon review at the next contact.

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 v0.4.

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 [6].

Loss of signal and Mars delay

Live link

Low Earth orbit: recordings go to the flight surgeon in near real time, and the flight surgeon can watch video.

Loss of signal

• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps recording on schedule and queues everything (store-and-forward).
• The crew's ECG recording, CPR, defibrillation and oxygen continue under the onboard checklist and never wait for the link or the robot.
• With no link, the CMO (or the onboard reader the flight surgeon names before flight) reviews each ECG against the pre-flight checklist. Sending the ECG to the ground does not count as review.
• The CMO decides under the pre-approved onboard checklist; the robot never waits for the ground before urgent onboard care.
• At the next contact the robot sends one package: ECGs, vital-sign trend, symptom answers and the decision log.

Mars-class delay

• With up to about 21-23 minutes one way, and blackouts of about 2-3 weeks, no one on the ground can review an ECG within 10 minutes. The CMO (or the named onboard reader) reviews each ECG against the pre-flight checklist; repeat ECGs continue, because a first ECG without changes does not rule out a heart attack.
• Thresholds, repeat schedules and escalation rules must be set before flight; the CMO acts on them.
• The robot shows how long ago each package was sent and whether a reply has arrived.

[5]

Delay limit for live guidance

<set by validation>

Sources

1. 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.
2. 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.
3. 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: Requirement IDs beginning V1.
4. 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.
5. 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.
6. 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.
7. 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.