# RMP-CARD-005 Scheduled heart rate and blood pressure checks: reminder, preparation checklist and record (the crewmember places the cuff) # Version 0.3 (Draft). CONCEPTUAL. NOT FOR CLINICAL USE. # Space Medicine Foundation robot-readable protocol library. Format: https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/ # Every threshold marked must be set by the named owner (see the schema) before any use. 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-CARD-005 slug: rmp-card-005 title: >- Scheduled heart rate and blood pressure checks: reminder, preparation checklist and record (the crewmember places the cuff) category: cardio tier: 2 rung_note: >- Max rung 2 for the scheduled reminder, a checked fetch of the vital-signs kit, showing the preparation checklist and recording readings as displayed. The crewmember or CMO places the cuff; the robot never touches anyone and never judges a reading. result_language: use: - reading as displayed - reading not obtained - check not done - logged, not interpreted - sent to flight surgeon never: - normal - no problem found - all clear - negative - any diagnosis or cause - high - low - in range - out of range - good - better - worse - stable - reading is reassuring - hypertension - hypotension - safe - mild - minor scope: summary: >- At the times the flight surgeon schedules, the robot reminds the crewmember that a heart rate and blood pressure check is due, brings the vital-signs kit by a checked kit fetch, shows the preparation checklist (rest, position, cuff size, arm support, no talking), records each reading as displayed with the clock time and position, and sends the log to the flight surgeon. A displayed value past the alert values set by the clinical lead, or any symptom, raises an alert; the robot never says a reading is high, low or fine. why: >- Accurate blood pressure needs a standard technique: the American Heart Association lists an empty bladder, at least 5 minutes of quiet rest, no talking, a supported back and arm at heart level, feet flat, a bare arm and a correctly sized cuff, with repeat readings 1-2 minutes apart, no caffeine, exercise or smoking in the 30 minutes before, an arm that is supported rather than held up, and the middle of the cuff at heart level; a cuff that is too small reads falsely high and one too large falsely low (Muntner 2019). Those positions are for Earth: in weightlessness the crewmember is restrained in the position the flight surgeon's checklist sets, and the same position is used every time so readings can be compared (design judgment). Heart rate and blood pressure change with spaceflight and on return to gravity (OCHMO-TB-019). The schedule, the number of readings and the alert values are set by the flight surgeon and clinical lead; the robot's role (reminder, checklist, record only) is design judgment. 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. covers: - Routine scheduled heart rate and blood pressure checks, in flight or on a planetary surface - Readings as displayed by a crew-placed automatic cuff - 'Chest pain: RMP-CARD-002; light-headedness on standing after landing: RMP-CARD-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) - Placing, inflating or removing the cuff, or touching the arm - Saying whether a reading is high, low, normal or changed - Changing the schedule, the number of readings or the alert values - Any medicine advice, including about blood pressure medicine related: - RMP-CARD-002 - RMP-CARD-003 - RMP-CARD-004 - RMP-CARD-001 - RMP-RESP-001 - RMP-EGR-003 - 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 crewmember at the scheduled time - Bring the vital-signs kit by a checked kit fetch (or an emergency fetch) - Show the preparation checklist - Record readings as displayed, with time and position - Send alerts and the log to the flight surgeon robot_may_not: - Place or adjust the cuff, or touch anyone - Say what a reading means - Change the schedule or alert values - Suggest a medicine - Start an unscheduled check 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: >- A scheduled check starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts it. An unaccepted prompt is logged "not accepted" and the CMO is told. A crewmember or the CMO can also start a check by command. 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 schedule and to the readings being recorded and sent to the flight surgeon; they place the cuff themselves or the CMO does. emergency: >- If the crewmember cannot agree, this is not a scheduled check: the robot sends an URGENT alert and a crewmember checks in person (X7). withdrawal: >- The crewmember can skip or stop any check; the robot logs "skipped by the crewmember" and tells the CMO. inputs: - id: IN-1 name: The flight surgeon's check schedule, number of readings and position for this crewmember source: Flight surgeon required: true if_missing: The robot shows "schedule not loaded" and runs only on a human command. - id: IN-2 name: Heart rate and blood pressure as displayed by the automatic cuff, each with the clock time source: Crew-placed automatic cuff required: true if_missing: Log "reading not obtained" (never a value) and tell the CMO. - id: IN-3 name: Cuff size and arm used, as stated source: Crewmember required: false if_missing: Log "not stated". - id: IN-4 name: >- Symptoms in the crewmember's words (chest pain, light-headedness, a racing or irregular heartbeat, shortness of breath) source: Crewmember required: false if_missing: Log "no response"; D3 applies. - id: IN-5 name: Link status and delay source: Communications system required: true if_missing: Treat as link down; readings are queued. steps: - id: S1 actor: robot rung: 2 action: >- At the scheduled time, show the crewmember an on-screen prompt that a heart rate and blood pressure check is due, and tell the flight surgeon and the CMO (URGENT if any red flag is stated). The check starts only when the crewmember or the CMO accepts the prompt; an unaccepted prompt is logged "not accepted" and the CMO is told. If the crewmember says not now, ask again once at the time the CMO sets, then log "check not done" and tell the CMO and flight surgeon. 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: Reminder acknowledged, or "check not done" logged and sent. refs: - V1 3006 - V1 6003 - id: S2 actor: robot rung: 2 action: >- On the CMO's command, run a checked kit fetch of the vital-signs medical kit (automatic blood pressure cuff in the sizes the kit list states, and a pulse oximeter): check the kit ID and seal before hand-over, and quarantine a kit whose ID or seal does not match (no hand-over; the CMO is told). Any medicine goes only through RMP-PHARM-001. If an URGENT red flag has fired or a human states an emergency, bring it instead as an emergency fetch: This is an emergency fetch on a human command (CMO): no barcode check runs before hand-over and nothing waits for one. The robot reads the kit's own label and seal status only if that adds no delay, says "EMERGENCY FETCH – NOT VERIFIED (CMO command)", and "seal not intact" if so, and hands the kit over anyway. The fetch is logged as an override: time, who asked, the reason as stated, kit ID and seal status. It never says "verified". success: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged. limit: refs: - V2 7046 - V2 7059 - id: S3 actor: robot rung: 2 action: >- Show the preparation checklist on screen: the position the flight surgeon's checklist sets, the same each time; an empty bladder; quiet rest for the time the checklist states, with no talking; no exercise, caffeine or nicotine in the last 30 minutes (if there was, the robot logs "within 30 minutes of exercise, caffeine or nicotine" as stated and the reading is taken anyway); a bare arm, held at heart level by a strap or restraint, not by the crewmember's own effort; the middle of the cuff at mid-chest (breastbone) level; the cuff size the kit chart gives for the arm. The robot does not time the rest: On request only, the robot shows the time elapsed since the start the CMO called, as a clock-time entry; it never announces a time, and never says "time reached", "done", "passed" or "failed". success: Checklist shown; the crewmember says when they are ready. refs: - V1 6003 - id: S4 actor: crew action: >- The crewmember (or the CMO) places the cuff and starts each reading, and repeats it as many times as the schedule states, about 1-2 minutes apart. success: Readings taken, or "not obtained". refs: - V1 6003 - id: S5 actor: robot rung: 2 action: >- Record each reading as displayed, with the clock time, the arm and position stated, and the cuff size; a missing reading is logged as "reading not obtained", never a value. Show an on-screen symptom prompt the crewmember can accept and log the answers word for word. success: Readings and answers logged, or "no response". refs: - V1 6003 - V1 7001 - 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 readings and decides on any change to the schedule, repeat checks or care. 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: >- 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. success: Kit reconciled or shown as "opened – not restocked". refs: - V2 7059 - id: S10 actor: robot rung: 2 action: >- Send the flight surgeon one package: readings as displayed with times, arm, position and cuff size; answers; alerts and decisions; checks not done. success: Package delivered or queued. refs: - V1 6003 - V1 7003 decisions: - id: D1 after: S2 decided_by: robot question: Which kit fetch was it, and what did the checked kit fetch show? branches: - if: EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) then: >- Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use). - if: KIT ID AND SEAL MATCH then: >- Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time. - if: MISMATCH, seal not intact or CANNOT VERIFY then: >- 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. handoff: none - id: D2 after: S5 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: S5 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 schedule, repeat checks or care apply? 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: readings already under way 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: 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: Displayed systolic blood pressure low or high (design judgment; same values as RMP-CARD-002 RF1) threshold: below or above mmHg action: >- URGENT alert; see RMP-CARD-003 (monitoring and rhythm); if low blood pressure with light-headedness, or after landing, see RMP-CARD-004 - id: RF2 sign: Displayed heart rate low or high (design judgment; same values as RMP-CARD-002 RF2) threshold: below or above beats per minute action: >- URGENT alert; see RMP-CARD-003 (monitoring and rhythm); if after landing with light-headedness, see RMP-CARD-004 - id: RF3 sign: Chest pain, pressure or tightness, as stated threshold: any action: URGENT alert; see RMP-CARD-002 source: gulati - id: RF4 sign: Fainting, or light-headedness, as stated threshold: any action: URGENT alert; the crewmember sits or lies down; see RMP-CARD-004 source: tb019 - id: RF5 sign: A racing, pounding or irregular heartbeat, or new shortness of breath, as stated (design judgment) threshold: any action: >- URGENT alert; the CMO checks the crewmember now; see RMP-CARD-003; for shortness of breath, RMP-RESP-001 - id: RF6 sign: Unresponsive, or not breathing normally threshold: any action: URGENT alert; start RMP-CARD-001 now source: aha2025bls - id: RF7 sign: Displayed oxygen saturation (pulse oximeter) below the shared alert value threshold: below percent (shared parameter SPO2_ALERT_PCT) action: URGENT alert; see RMP-RESP-001; the crew act without waiting for a reading source: btso2 - id: RF8 sign: >- The oximeter cannot get a reading after the validated attempts (L4), and "saturation not obtained" is logged threshold: any action: >- URGENT alert; the CMO checks the crewmember now (possible poor circulation); the robot never says "probe error" and never treats a missing reading as reassuring source: ng253 - id: RF9 sign: >- The cuff cannot get a reading after the attempts the schedule allows, and "reading not obtained" is logged (design judgment) threshold: any action: >- Flag to the CMO, who checks the crewmember and the cuff; the robot never treats a missing reading as reassuring 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: Cuff placement, inflation or adjustment by the robot value: not allowed enforced: No cuff task is loaded - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Failed oximeter readings before "saturation not obtained" value: enforced: Software 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 reading as displayed with time, arm, position and cuff size; readings not obtained; checks not done; answers as stated. - 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-7 text: >- 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". refs: - V2 7059 requirements: - id: V1 3004 use: >- In-mission medical care capabilities, including inventory monitoring and the flight surgeon's decisions on care. - 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; 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. - 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 schedules with a missed check, a reading past the alert value, chest pain, a failed oximeter reading, CMO as patient, lost link. pass: Zero contact; zero interpretation; every red flag raised. - stage: training model what: Scheduled check drill with an automatic cuff. pass: Every reading logged as displayed with time and position. - stage: parabolic or station demonstration what: Checklist display and logging in weightlessness. pass: Keep-out held. - stage: flight use under flight surgeon supervision what: First use for scheduled checks. pass: No safety 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: >- Scheduled by the flight surgeon, or started by a crewmember or the CMO. The crewmember or CMO places the cuff. 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 readings when the link allows.' loss_of_signal: - >- Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation. - >- Readings already under way and all crew care continue under the onboard checklist and never wait for the link or the robot. - The schedule continues offline; readings are queued and alerts go to the CMO. mars_delay: - >- Mars: no real-time guidance; the schedule and alert values are set before flight and the CMO decides. sources: - key: muntner2019 text: >- Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73(5):e35-e66. url: https://doi.org/10.1161/HYP.0000000000000087 doi: 10.1161/HYP.0000000000000087 pmid: '30827125' supports: >- Table 5 (best practices): an empty bladder; rest quietly for at least 5 minutes; no talking or texting; back supported, feet flat, legs not crossed; cuff on a bare arm, sized to the arm; arm supported at heart level; avoid caffeine, exercise and smoking for at least 30 minutes before; the patient should not hold up their own arm, because that muscle effort affects the reading; the middle of the cuff at the level of the right atrium (mid-sternum); separate repeated readings by 1-2 minutes. A cuff that is too small gives an artificially high reading, and one that is too large an artificially low reading. Earth seated-position context; the in-flight position is set by the flight surgeon's checklist. Full text read Oct 21, 2026. - key: tb019 text: NASA OCHMO. Orthostatic Intolerance. Technical Brief OCHMO-TB-019 Rev B. url: https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-019-orthostatic-intolerance.pdf supports: >- Spaceflight reduces intravascular fluid volume by around 15%; fluid loading before reentry is an important countermeasure to decrease orthostatic intolerance, and current protocols include 24-48 oz of salt-water solution before deorbit, depending on body weight. - key: gulati text: >- 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. url: https://doi.org/10.1161/CIR.0000000000001029 doi: 10.1161/CIR.0000000000001029 pmid: '34709879' 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. - key: aha2025bls text: >- 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. url: https://doi.org/10.1161/CIR.0000000000001369 doi: 10.1161/CIR.0000000000001369 pmid: '41122888' 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. - 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: btso2 text: >- British Thoracic Society. Guideline for oxygen use in healthcare and emergency settings (emergency oxygen guideline page). Fetched Oct 21, 2026. url: https://www.brit-thoracic.org.uk/quality-improvement/guidelines/emergency-oxygen/ 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. - 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 (medical monitoring), V1 7001, 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: - >- PRE-1 and S1: a scheduled check starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts it, and an unaccepted prompt is logged "not accepted" and the CMO is told (R1) [V2 10174]. - >- RF1 and RF2 (displayed blood pressure or heart rate past the alert values) now route to RMP-CARD-003, and to RMP-CARD-004 for low blood pressure with light-headedness or after landing; RF5 routes to RMP-CARD-003 and, for shortness of breath, RMP-RESP-001 (R2). - >- S3 preparation checklist adds three items from the American Heart Association statement (Muntner 2019, Table 5): no exercise, caffeine or nicotine in the last 30 minutes (logged as stated if there was; the reading is still taken); the arm held at heart level by a strap or restraint, not by the crewmember's own effort; the middle of the cuff at mid-chest level (R3, Q1). - >- 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 10 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026 items: - >- Link-loss wording (X5 and comms) fixed: the stray word "crew" before the list of what continues is removed, so the sentence reads, for example, "the exam already under way and all crew care continue under the onboard checklist" (R6; batch 10 review, editorial).