{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.2", "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 10 review: 10 required corrections, R1 to R10, of which R10 applies to RMP-CARD-004, RMP-EGR-002, RMP-EGR-003 and RMP-NEURO-005; 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-EVA-002", "slug": "rmp-eva-002", "title": "Prebreathe event log: clock times as called by the EVA crew, breaks in prebreathe flagged at once (the procedure timer stays primary)", "category": "eva", "tier": 2, "rung_note": "Max rung 2 for showing the EVA plan's prebreathe timeline, logging each event clock time as the EVA crew or EVA lead calls it, and flagging a stated break in prebreathe at once. The robot stays outside the airlock and every hatch route, never operates the suit, mask, oxygen or pressure, and never says prebreathe is complete or that anyone is ready.", "result_language": { "use": [ "time as called by ", "elapsed since the start called, on request", "break in prebreathe as stated", "logged, not interpreted", "sent to flight surgeon" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "time reached", "done", "passed", "failed", "complete", "ready", "go", "prebreathe done", "no break", "enough time", "on time", "cleared", "DCS unlikely", "safe", "mild", "minor" ] }, "scope": { "summary": "Off by default where the EVA procedure already timestamps events (for example on the ISS); it runs only when the EVA plan asks for a second record (for example a small surface crew, or no real-time ground support). During an EVA prebreathe (for example in-suit, campout, exercise or in-suit light exercise, as the EVA plan names), the robot shows the plan's prebreathe timeline as written and logs the clock time of each event as the EVA crew or the EVA lead calls it (start of 100% oxygen, mask or suit changes, start of depressurization, any break). Any break in prebreathe that a crewmember states is flagged at once to the EVA lead, the CMO and the flight surgeon. Elapsed time is shown only on request. The procedure timer and the EVA lead stay primary; the robot never says prebreathe is complete or that anyone is ready.", "why": "Prebreathe works by breathing 100% oxygen to wash nitrogen out of the body before the pressure drop to suit pressure; any mask leak, seal breach or suit configuration issue that lets the crewmember breathe cabin air is a break in prebreathe, which rapidly reintroduces nitrogen and can need extra prebreathe time or a full restart (OCHMO-TB-037). NASA has used in-suit, campout, exercise and in-suit light exercise protocols; for example, the in-suit light exercise protocol spends 40 minutes on 100% oxygen by mask, followed by a 20-minute depressurization to 10.2 psia (OCHMO-TB-037). NASA policy requires immediate reporting of any DCS symptom (HRP DCS and hypoxia evidence report). Every crewmember is medically cleared for each EVA by ground medical support (V1 6006); the robot never clears anyone. A second, independent clock-time record that never replaces the procedure timer, and flagging stated breaks at once, are design judgment.", "covers": [ "Prebreathe for an EVA or a suited test, as the EVA plan names it", "Clock times of events as the EVA crew or EVA lead call them; stated breaks in prebreathe", "Any DCS symptom: RMP-EVA-001; after the EVA, the hand and skin check: RMP-EVA-003" ], "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)", "Operating the suit, mask, oxygen, pressure, airlock or any EVA hardware", "Saying prebreathe is complete, that the time is enough, or that anyone is ready or cleared for the EVA", "Deciding added prebreathe time or a restart after a break", "Entering the airlock or stopping in a hatch route", "Replacing or overriding the procedure timer", "Entering a campout or exploration atmosphere volume (for example 10.2 psia with 26.5% oxygen) unless the robot is certified for that oxygen concentration; otherwise it holds outside that volume" ], "related": [ "RMP-EVA-001", "RMP-EVA-003", "RMP-RAD-002", "RMP-RESP-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": [ "EVA lead: the crewmember or ground EVA officer who runs the prebreathe procedure and its timer", "Second trained CMO: receives every alert and takes over if the CMO is the patient", "Vehicle commander: leads any cabin emergency procedure" ], "robot_may": [ "Show the EVA plan's prebreathe timeline as written", "Log event clock times as called", "Flag a stated break in prebreathe at once", "Show elapsed time since the called start, on request only", "Send the log to the flight surgeon and EVA lead" ], "robot_may_not": [ "Operate the suit, mask, oxygen or pressure", "Say prebreathe is complete or anyone is ready", "Decide added time or a restart", "Enter the airlock or stop in a hatch route", "Start without a human command" ], "commercial": "On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.)" }, "preconditions": [ { "id": "PRE-1", "text": "Off by default where the EVA procedure already timestamps events (for example on the ISS); it runs only when the EVA plan asks for a second record (for example a small surface crew, or no real-time ground support). The EVA lead or an EVA crewmember then starts the log by command at the start of prebreathe.", "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 EVA crew agree to the log and to its being sent to the flight surgeon and the EVA lead.", "emergency": "During any emergency the log is not a priority; the robot clears every route and the crew act under their procedures.", "withdrawal": "The EVA lead can stop the log at any time; the procedure timer and the crew's own record are unaffected." }, "inputs": [ { "id": "IN-1", "name": "The EVA plan's prebreathe protocol and timeline, as written", "source": "EVA plan / EVA lead", "required": true, "if_missing": "The robot shows \"plan not loaded\" and logs called times only." }, { "id": "IN-2", "name": "Each event and its clock time, as the EVA crew or EVA lead calls it", "source": "EVA crew / EVA lead", "required": true, "if_missing": "Log \"not called\"; never fill a blank." }, { "id": "IN-3", "name": "Any break in prebreathe, as stated (mask off, leak, a breath of cabin air)", "source": "EVA crew / EVA lead", "required": false, "if_missing": "Nothing is assumed; the procedure decides." }, { "id": "IN-4", "name": "Symptoms in the crewmember's words (joint pain, itching, skin mottling, numbness, tingling, headache, breathlessness)", "source": "EVA crew", "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; the log is queued." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "Tell the flight surgeon, the CMO and the EVA lead that the prebreathe log has started, with the protocol the EVA plan names (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 seconds is repeated and sent to the next named crewmember.", "success": "Notice acknowledged.", "refs": [ "V1 6006", "V1 3006" ] }, { "id": "S2", "actor": "robot", "rung": 2, "action": "Hold outside the airlock and every hatch route, where the EVA lead can see the screen, and show the EVA plan's prebreathe timeline as written; the robot does not change it.", "success": "Timeline in view; robot clear of every hatch route.", "limit": "", "refs": [ "V2 10172" ] }, { "id": "S3", "actor": "crew", "action": "The EVA crew and EVA lead run prebreathe under the EVA procedure and its timer, and call out each event (start of 100% oxygen, mask or suit changes, start of depressurization, any break).", "success": "Events called, or not called.", "refs": [ "V1 6006" ] }, { "id": "S4", "actor": "robot", "rung": 2, "action": "Log each event with the clock time as called, marked \"time as called by \", word for word. On request only, show the time elapsed since the start the EVA lead called, as a clock-time entry; the robot never announces a time and never says \"complete\", \"ready\", \"go\", \"time reached\" or \"done\". If the robot's log and the procedure timer differ, the procedure timer is used.", "success": "Events logged as called.", "refs": [ "V1 7001" ] }, { "id": "S5", "actor": "robot", "rung": 2, "action": "When a crewmember states a break in prebreathe, flag it at once to the EVA lead, the CMO and the flight surgeon with the clock time as called; the EVA lead and flight surgeon decide on added time or a restart. Show an on-screen symptom prompt the EVA crew can accept, and log answers word for word.", "success": "Break flagged; answers logged.", "refs": [ "V1 6006" ] }, { "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 and the EVA team (or the CMO and EVA lead under the onboard checklist when there is no link) decide on any added prebreathe time, a restart, and whether the EVA goes ahead.", "success": "Decision logged.", "refs": [ "V1 6006" ] }, { "id": "S8", "actor": "robot", "rung": 2, "action": "Send the flight surgeon and the EVA lead one package: the protocol named, events and times as called, breaks, answers, alerts and decisions.", "success": "Package delivered or queued.", "refs": [ "V1 6003", "V1 7003" ] } ], "decisions": [ { "id": "D1", "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": "D2", "after": "S5", "decided_by": "robot", "question": "Has a crewmember stated a break in prebreathe?", "branches": [ { "if": "Yes", "then": "Flag at once to the EVA lead, the CMO and the flight surgeon with the time as called; log it; the humans decide." }, { "if": "No", "then": "Continue logging; the robot never says \"no break\"." } ] }, { "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": "Added prebreathe time, restart, or go ahead?", "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." } ] } ], "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 the airlock, a hatch route or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: prebreathe and all crew care continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether the robot continues offline under the pre-approved onboard checklist; it resumes only on the CMO's confirmation.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "An URGENT alert is not acknowledged within the set time", "action": "Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own.", "level": "urgent", "refs": [ "V1 3006", "V2 10173" ] }, { "id": "X7", "trigger": "The crewmember stops responding, or seems confused or drowsy, at any point", "action": "URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person.", "level": "urgent" }, { "id": "X8", "trigger": "A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice", "action": "Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.", "level": "stop" }, { "id": "X9", "trigger": "The EVA crew need the space or route the robot is in, or the airlock hatch is to be opened or closed", "action": "Robot moves clear at once without contact and holds outside every hatch route.", "level": "safe-state", "refs": [ "V2 10172" ] }, { "id": "X10", "trigger": "Any cabin alarm or emergency procedure", "action": "The log stops; the robot clears every route and hatch and holds; the commander leads.", "level": "urgent", "refs": [ "V2 10173" ] } ], "red_flags": [ { "id": "RF1", "sign": "Any DCS symptom during or after prebreathe or depressurization (joint pain, itching, skin mottling, numbness, tingling, weakness, headache, breathlessness, chest pain, confusion, vision change), as stated", "threshold": "any", "action": "URGENT alert; start RMP-EVA-001", "source": "hypdcs" }, { "id": "RF2", "sign": "A break in prebreathe, as stated (mask off, leak, a breath of cabin air)", "threshold": "any", "action": "Flag at once to the EVA lead, the CMO and the flight surgeon; the humans decide on added time or a restart; URGENT if any RF1 or RF3 symptom is also stated", "source": "tb037" }, { "id": "RF3", "sign": "Breathlessness, chest pain or feeling faint while on oxygen, as stated (design judgment)", "threshold": "any", "action": "URGENT alert; see RMP-EVA-001 and RMP-RESP-001" }, { "id": "RF4", "sign": "Unresponsive, or not breathing normally", "threshold": "any", "action": "URGENT alert; start RMP-CARD-001 now", "source": "aha2025bls" }, { "id": "RF5", "sign": "The robot's log and the procedure timer differ (design judgment)", "threshold": "any", "action": "Flag to the EVA lead; the procedure timer is used" } ], "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": "Operating the suit, mask, oxygen, pressure or airlock", "value": "not allowed", "enforced": "No such task or interface is loaded" }, { "id": "L3", "name": "Robot in the airlock or a hatch route", "value": "not allowed", "enforced": "Keep-out map in the robot controller", "refs": [ "V2 10172" ] }, { "name": "Robot inside a campout or exploration atmosphere volume without certification for its oxygen concentration (design judgment; OCHMO-TB-037 campout: 10.2 psia, 26.5% oxygen)", "value": "not allowed", "enforced": "Keep-out map in the robot controller; holds outside that volume", "id": "L4" }, { "id": "L5", "name": "Robot speed near the crewmember", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] } ], "logs": [ { "id": "LOG-1", "text": "Every input, robot action, decision (with who made it) and hand-off, time-stamped to the second.", "refs": [ "V2 10163", "V2 10164" ] }, { "id": "LOG-2", "text": "Mode changes and safety-limit events are announced to the operator as they happen and logged.", "refs": [ "V2 10162", "V2 10172" ] }, { "id": "LOG-3", "text": "Records are stored and sent as private medical data, encrypted, with access limited to the medical team.", "refs": [ "V1 6003", "V1 7003" ] }, { "id": "LOG-4", "text": "Results are kept in a permanent, retrievable format so the flight surgeon can see trends.", "refs": [ "V1 7001" ] }, { "id": "LOG-5", "text": "The protocol named; each event with the time as called and by whom; breaks as stated and when they were flagged; elapsed-time requests; answers as stated; decisions." }, { "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" ] } ], "requirements": [ { "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 6006", "use": "Every crewmember is medically cleared for each EVA by ground medical support; the robot only logs." }, { "id": "V1 7001", "use": "Records kept so the flight surgeon can see trends." }, { "id": "V1 7003", "use": "Secure handling of medical records." }, { "id": "V2 6009", "use": "Decompression sickness treatment capability; any DCS symptom routes to RMP-EVA-001." }, { "id": "V2 7045", "use": "Usable by non-physician crew, including when the CMO is the patient." }, { "id": "V2 7046", "use": "Patient, caregiver and supplies restrained." }, { "id": "V2 7059", "use": "Kit inventory and seal status are tracked." }, { "id": "V2 10161", "use": "Robot shows its status and health." }, { "id": "V2 10162", "use": "Mode changes are announced to the operator." }, { "id": "V2 10163", "use": "Robot records and shares its data." }, { "id": "V2 10164", "use": "Shows whether the human or the robot is expected to act." }, { "id": "V2 10165", "use": "Human can override and shut down the robot." }, { "id": "V2 10168", "use": "Human can take over." }, { "id": "V2 10172", "use": "Protective stop when a limit is exceeded." }, { "id": "V2 10173", "use": "Robot stays stopped if no one takes over." }, { "id": "V2 10174", "use": "Only a human starts or restarts the robot." } ], "validation": [ { "stage": "simulation", "what": "Scripted prebreathe with a stated break, a DCS symptom, a log and timer difference, a hatch-route conflict, CMO as patient, lost link.", "pass": "Zero \"complete\" or \"ready\" wording; every break flagged at once; zero entries into the airlock." }, { "stage": "training model", "what": "Prebreathe drill with the EVA lead calling times.", "pass": "Every event logged with the time as called." }, { "stage": "parabolic or station demonstration", "what": "Holding outside the airlock in weightlessness.", "pass": "Hatch-route keep-out held." }, { "stage": "flight use under flight surgeon supervision", "what": "First use alongside the procedure timer and crew record.", "pass": "Agreement with the procedure record; 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": "Started by the EVA lead or an EVA crewmember. The EVA lead and the procedure timer stay primary; the flight surgeon and EVA team decide." }, "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 and the ground EVA team follow prebreathe live 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.", "Prebreathe and all crew care continue under the onboard checklist and never wait for the link or the robot.", "The EVA lead runs prebreathe under the procedure; the log is queued." ], "mars_delay": [ "Mars: no real-time ground support; the prebreathe protocol and break rules are set before flight and the EVA lead and CMO decide." ] }, "sources": [ { "key": "tb037", "text": "NASA OCHMO. Decompression Sickness (DCS) Risk Mitigation. Technical Brief OCHMO-TB-037 Rev D (Oct 5, 2026).", "url": "https://www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-037-decompression-sickness.pdf", "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." }, { "key": "hypdcs", "text": "NASA Human Research Program. Evidence Report: Risk of Reduced Crew Health and Performance due to Decompression Sickness and Hypoxia (2023).", "url": "https://humanresearchroadmap.nasa.gov/evidence/reports/Evidence%20Report%20Hypoxia%20and%20DCS_FINAL_1-8-2024.pdf", "supports": "No reported cases of DCS in astronauts or cosmonauts working in suits pressurized to 3.7-5.8 psia during EVAs, while research subjects testing prebreathe protocols in altitude chambers report about 20% DCS; mild symptoms may be under-reported in an operational setting, and NASA policy requires immediate reporting of the onset of any DCS symptoms; Type II symptoms (central nervous system, cardiopulmonary \"chokes\", circulatory collapse, shock) require immediate termination of an EVA; on the ISS, treatment keeps the crewmember in the suit (more than 95% oxygen) with stacked habitat and suit pressure, adding the Bends Treatment Apparatus if symptoms do not resolve; ending an EVA can take up to 30 minutes. The stacked habitat (14.7 psia) and suit (4.3 psid) pressure totals 19.0 psia; at an 8.2 psia exploration habitat the modeled probability of symptom resolution is only 48-67%, so it may not be enough to resolve symptoms at once. A diver's DCS happens on return to the surface, an astronaut's during their tasks. Many astronauts take aspirin before an EVA, so mild aches and pains are managed in advance; suit aches are comparable to pain-only DCS, many potentially mild cases are not reported, and it is possible that the first report of DCS during an EVA will be a serious case of DCS." }, { "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": "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 3006, V1 6003, V1 6006 (medical clearance before each EVA), 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": "NASA-STD-3001 Vol 2 Rev F: V2 6009 (decompression sickness treatment capability), and Section 10.6 automated and robotic systems." }, { "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": "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).", "Off by default where the EVA procedure already timestamps events (ISS); used only when the EVA plan asks for a second record, because a second clock near the airlock adds a distraction and a discrepancy flag (PRE-1, summary) (S10).", "RF2 (a stated break in prebreathe) stays a Flag and becomes URGENT when any RF1 or RF3 symptom is also stated (S11).", "New lockout and limit: the robot enters a campout or exploration atmosphere volume (for example 10.2 psia with 26.5% oxygen, OCHMO-TB-037) only if certified for that oxygen concentration; otherwise it holds outside it (design judgment) (S12).", "Batch 10 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician." ] } ] }