RMP-CARD-004 Light-headedness on standing after landing: alert, kit fetch and vital-sign record (the crew help the crewmember lie down)

1 · Identity and scope

When a crewmember feels light-headed, faint or dizzy on sitting up or standing after landing, the robot alerts the flight surgeon and the CMO, brings the landing medical kit, and records blood pressure, heart rate and oxygen saturation as displayed, with the position the CMO states. The crew help the crewmember lie down and decide every position change.

Why this protocol was chosen. Orthostatic intolerance (light-headedness, near-fainting or fainting on standing) is a major concern after landing, from reduced plasma volume and altered blood-pressure control after weightlessness (OCHMO-TB-019); fluid loading and compression garments are NASA countermeasures, and NASA-STD-3001 requires countermeasures for the transition to gravity (V2 7042). It is more common after long flights: on landing day only 2 of 6 ISS astronauts completed a 10-minute tilt test, against 52 of 65 Shuttle astronauts, and recovery took days (Lee 2015). Dizziness and nausea after landing can also come from the balance system (OCHMO-TB-010; terrestrial readaptation motion sickness, OCHMO-MTB-004). After landing on the Moon or Mars after weeks or months of weightlessness, where there is no recovery team, the CMO leads under the onboard checklist and the flight surgeon advises over the link. At an Earth landing, NASA flight surgeons and the recovery team lead with their own kit (OCHMO-TB-051); there the robot is support-only: it fetches kit and hands over records when the landing medical lead asks, never leads or directs care, and never touches or moves anyone (design judgment). Blood pressure and heart rate alert values reuse RMP-CARD-002 owners; which position changes are timed, and when, is design judgment for the onboard checklist. 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 supervised fetching of the landing medical kit, holding the display and recording vital signs as displayed. The planned title said the robot helps the crewmember lie flat; the library's no-contact rule means the crew do that, and the robot never supports, lifts or positions anyone.

Related: RMP-EGR-002 · RMP-EGR-003 · RMP-CARD-001 · RMP-CARD-002 · RMP-CARD-003 · RMP-NEURO-001 · RMP-GI-002 · RMP-PHARM-001 · 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

• Landing medical lead: the CMO on the Moon or Mars, advised by the flight surgeon over the link; at an Earth landing, the NASA flight surgeon with the recovery team
• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Other crew: help the crewmember lie down and move

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 crewmember, the CMO or the landing medical lead started the protocol by command after light-headedness on sitting up or standing.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 readings being recorded; the crew place the cuff and the oximeter probe.

Emergency consent

If the crewmember cannot agree, the robot proceeds on the CMO's or commander's command.

Withdrawal

The crewmember can stop recording at any time; the alert already sent stands.

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

   Log the start and the landing type the person who started the protocol states (Earth landing, or Moon or Mars). At a Moon or Mars landing: send an alert "light-headed on standing after landing" to the flight surgeon and the CMO at once (URGENT if any 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 <set by validation> seconds is repeated and sent to the next named crewmember. At an Earth landing the robot only tells the landing medical lead that it is in the support-only role.

   Done when: Alert acknowledged, or escalated.

   V1 3006V2 10174

   D6DecisionCrew decides

   Is this an Earth landing, as the person who started the protocol states (the robot never decides it)?

   • Yes (Earth landing) → Support-only: only the kit-fetch step (checked kit fetch, or the emergency fetch) and the RMP-EGR-001 record hand-over run, each on the landing medical lead's request; every step marked "Moon or Mars only" is skipped, and the robot holds outside every route until asked.
   • No (Moon or Mars landing) → Continue with every step.
2. S2RobotRung 2

   On the CMO's command (at an Earth landing, on the landing medical lead's request), run a checked kit fetch of the landing medical kit (blood pressure cuff, pulse oximeter, emesis bags and thermometer, as the kit list states): 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. S3Crew

   The crew help the crewmember lie down, or sit with the legs raised, as the onboard checklist states, and place the blood pressure cuff and oximeter probe. They do not wait for the robot or the link.

   Done when: Crewmember lying or sitting as the CMO states.

   V2 7042

4. S4RobotRung 2

   Moon or Mars only: hold the display where the CMO can see it, out of every route. Record blood pressure, heart rate and saturation as displayed, with the clock time and the position the CMO states. A missing reading is logged as "reading not obtained". Each position change happens only on the CMO's word; the robot never prompts it. Whether a stand is timed, and for how long, is set by the flight surgeon's onboard checklist, and the CMO calls each time point. On request only, the robot shows the time elapsed since the position change the CMO called, as a clock-time entry; it never says "time reached", "done" or "passed".

   Done when: Readings logged with positions and times.

   Limit: <set by validation>

   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.
5. S5RobotRung 2

   Moon or Mars only: ask the crewmember, on screen or by voice, how they feel now (light-headed, faint, spinning, sick, chest pain, short of breath), and log the answers word for word.

   Done when: Answers logged or "no response".

   V1 6003

   D3DecisionRobot decides

   Did the crewmember answer when asked how they feel?

   • 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.
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) decides on fluids, garments, further position changes and any transport.

   Done when: Decision logged.

   V2 7042V1 3017

   D4DecisionGround decides

   What care and what next position change are needed?

   • 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

   Moon or Mars only: 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: symptoms as stated, readings with positions and times, countermeasures as stated, alerts and decisions. At an Earth landing: hand over the records under RMP-EGR-001 when the landing medical lead asks.

    Done when: Package delivered or queued.

    V1 6003V1 7003

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 Symptoms as stated, each reading as displayed with position and time, countermeasures 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

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 light-headedness with falling blood pressure, fainting, a failed oximeter reading, CMO as patient, lost link. Pass: Every red flag raised; zero contact; no stand prompted by the robot.
2. Training model. Post-landing drill on a tilt table or couch with a crew-placed cuff. Pass: Readings and positions logged as stated.
3. Parabolic or station demonstration. Not applicable (landing only); a surface analogue test instead. Pass: Keep-out held in a crowded landing area.
4. Flight use under flight surgeon supervision. First use after a surface landing. 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

Started by the crewmember, the CMO or the landing medical lead. The crew decide every position change.

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 [13].

Loss of signal and Mars delay

Live link

Earth landing site: NASA flight surgeons and the recovery team are present and lead; the robot fetches kit and hands over records only. Moon: the flight surgeon advises over a link with a few seconds of delay; the CMO leads on the surface.

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 help lying down, CPR, oxygen and the CMO's care continue under the onboard checklist and never wait for the link or the robot.
• The CMO leads under the onboard checklist; readings are queued.

Mars-class delay

• Mars: no real-time guidance; alert values and the onboard checklist are set before flight and the CMO decides.

[12]

Sources

1. NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B. www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthost… Supports: Orthostatic intolerance is triggered by upright positioning and can cause presyncope and syncope; it is a major concern after landing (reduced plasma volume, altered sympathetic response); fluid loading and compression garments are countermeasures [V2 7042].
2. Lee SMC, Feiveson AH, Stein S, Stenger MB, Platts SH. Orthostatic intolerance after ISS and Space Shuttle missions. Aerosp Med Hum Perform. 2015;86(12 Suppl):A54-A67. PMID 26630196. doi:10.3357/AMHP.EC08.2015 Supports: Abstract: on landing day only 2 of 6 ISS astronauts completed a 10-minute 80-degree head-up tilt test, against 52 of 65 Space Shuttle astronauts; by 3 days after landing 13 of 15 ISS and 19 of 19 Shuttle astronauts completed it. Orthostatic intolerance is more common, and recovery slower, after long-duration flight.
3. NASA OCHMO. Sensorimotor Overview. Technical Brief OCHMO-TB-010 Rev A (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-010-sensori… Supports: Gravity transitions (weightlessness to a planetary surface or Earth) cause decrements in postural control and locomotion, spatial disorientation and motion sickness during and after the transition; these affect egress and early surface activity.
4. NASA OCHMO. Space Adaptation Sickness (SAS) and Space Readaptation Syndrome. Medical Technical Brief OCHMO-MTB-004 Rev A (Sept 25, 2025). www.nasa.gov/wp-content/uploads/2025/09/ochmo-mtb-004-space-… Supports: Terrestrial readaptation motion sickness after landing: dizziness, nausea, pallor and sweating, made worse by heat, head movements and noxious stimuli.
5. NASA OCHMO. Crew Medical Support for Entry, Descent, and Landing. Technical Brief OCHMO-TB-051. www.nasa.gov/wp-content/uploads/2026/05/ochmo-tb-051-crew-me… Supports: Flight surgeons are present at the landing site with a landing medical kit (for example blood pressure cuff, pulse oximeter, emesis bags, thermometer and fluids); expected re-adaptation issues include orthostatic intolerance, nausea, deconditioning and neurovestibular impairment; "Due to muscle weakness and balance issues, astronauts often need assistance" with mobility. Read Oct 21, 2026.
6. 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.
7. 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.
8. 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.
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 3006, V1 3017, V1 6003, V1 7003.
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: NASA-STD-3001 Vol 2 Rev F: V2 7042 (orthostatic intolerance countermeasures), V2 12045, V2 7059, and Section 10.6 automated and robotic systems.
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.