RMP-INF-001 Fever or feeling feverish: temperature and vital-sign recording support, early escalation to the flight surgeon

1 · Identity and scope

When a crewmember feels feverish, has chills or shaking, or feels very unwell, the robot alerts the CMO and the flight surgeon at the start, brings the thermometer, vital-signs monitor and infection-control kit, and records temperature, heart rate, breathing rate, blood pressure, oxygen saturation and alertness as the crew measure them. It asks structured questions (chills or shaking, urine in the past 18 hours, rash, wounds, local symptoms), sends everything to the flight surgeon, and repeats the recordings on the flight surgeon's schedule. It never names a cause and gives no drug, fluid or oxygen advice.

Why this protocol was chosen. Infection can become serious quickly, and NICE advises not to rely on fever alone, since people with sepsis may not have a high temperature. Among 46 long-duration station crew, upper respiratory symptoms (0.97 per flight year) and other infections were among the most reported immune-related events. Body temperature also behaves differently in space: resting core temperature rose by about 1 °C over 2.5 months of flight and rose higher and faster during exercise, so alert levels are set against each crewmember's in-flight baseline and the time since exercise is recorded. The red flags are modeled on the NICE sepsis guideline's risk table for community settings (NG253 Table 1), not the hospital NEWS2 score; the robot does not calculate any score. In someone with a fever, not answering can be new confusion, and an oximeter that cannot get a reading can be a sign of poor circulation, so both are escalated. A robot that fetches and records lets the CMO stay with the patient.

Related: RMP-INF-002 · RMP-INF-003 · RMP-RENAL-001 · RMP-SKIN-001 · RMP-ENT-004 · RMP-EGR-001 · RMP-PHARM-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

• Patient: answers questions and can stop the robot at any time
• Second crewmember: helps if the CMO is busy

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.) [12]

3 · Preconditions and consent

• PRE-1 Patient is responsive and breathing normally. If not, the CMO starts emergency care (cardiac arrest: RMP-CARD-001) and this protocol stops.patient_responsive == true and breathing_normal == true
• PRE-2 A crewmember started the run by command; the CMO is present and able to take over.human_start == true and cmo_present == trueV2 10174V2 10168
• PRE-3 Patient, caregiver and kits restrained.V2 7046
• PRE-4 Thermometer and monitor self-tests passed; robot self-test passed.V2 10161
• PRE-5 Robot and kits cleaned before use (RMP-INF-002). The CMO decides masks, gloves and distancing at the start (S1), before others approach.
• PRE-6 Link status and current delay known.

Consent

The patient agrees by voice or touch; logged.

Emergency consent

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

Withdrawal

The patient can stop the robot at any time; it backs away.

4 · Required sensor inputs

5–6 · Steps and decision points

Each step names who acts. Decision points sit after the step they follow and say who decides: Robot Crew Ground. Any stop rule in section 7 can interrupt any step.

1. S1RobotRung 2

   On a crew command such as "fever", alert the CMO and, if the link is up, send an immediate "fever event started" alert to the flight surgeon; start the event clock; prompt the CMO: "Decide masks, gloves and distancing now, before others approach." Recordings follow as they are made.

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

   V2 10174V1 6003

   D1DecisionCrew decides

   Is the patient unresponsive, not breathing normally, or newly confused?

   • Yes → The CMO starts emergency care; URGENT call to the flight surgeon; cardiac arrest goes to RMP-CARD-001.
   • No → Continue.
2. S2RobotRung 2

   Bring the infection-control kit (masks first), then the thermometer, vital-signs monitor and pulse oximeter; restrain them by the patient.

   Done when: Kits restrained at the patient.

   Limit: <set by validation>

   V2 7046

3. S3Crew

   The patient or CMO takes the temperature; the CMO attaches the blood pressure cuff and oximeter, counts the breathing rate, checks alertness and checks the skin.

   Done when: Readings taken, or marked "not measured".

4. S4RobotRung 2

   Record each reading with the time, method, patient ID and time since the patient last exercised, and the oximeter probe site and device (pulse oximeters can overestimate oxygen saturation; overestimation has been reported in people with dark skin).

   Done when: Readings recorded.

   D2DecisionRobot decides

   Is any reading missing, did a device fail, or did the patient not answer?

   • The oximeter cannot get a reading → URGENT alert to the CMO and flight surgeon (this can indicate poor circulation because of shock), and ask the CMO to check the patient now; record the probe site and device. Never treated as only a device fault.
   • The patient does not answer a question (rather than declining) → URGENT: ask the CMO to check alertness now; treated as possible new confusion (RF3). Never treated as reassuring.
   • Another reading is missing, or another device failed → Ask the CMO to measure by hand and enter it; log "not measured". Never treated as reassuring.
   • No → Continue.
5. S5RobotRung 2

   Ask the structured questions and log the answers word for word. If the patient stops answering, ask the CMO to check alertness now (RF3); do not carry on with the questions.

   Done when: Answers logged, or "no answer" escalated to the CMO.

6. S6RobotRung 2

   Send the readings and answers to the flight surgeon at once, or queue them and show the CMO the onboard checklist page. Compare each value with the red-flag list and apply the action listed for each match.

   Done when: Delivered or queued; alerts sent.

   V1 6003V1 7003

   D3DecisionRobot decides

   Does any value or answer meet a red flag?

   • Yes → Apply the action listed for each matching red flag (all are URGENT in this protocol): alert the CMO and flight surgeon; the robot names the value, not its meaning.
   • No → Continue the repeat schedule. Values below the alert level do not rule out a serious infection.
7. S7RobotRung 2

   Prompt the CMO on screen when a repeat recording is due (every <set by flight surgeon> minutes, and at once if the patient feels worse); the robot approaches only when the CMO accepts, then records and sends each repeat. A prompt never starts the robot.

   Done when: Each repeat recorded and sent.

   V2 10174

   D4DecisionGround decides

   What happens next (tests, treatment, isolation, evacuation planning)?

   • 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 at the next contact.
8. S8Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) decides tests, treatment, isolation and any evacuation planning; the robot logs the decisions.

   Done when: Decision logged.

   V1 3007

9. S9RobotRung 2

   Clean and disinfect the thermometer, monitor, kits and its own surfaces per RMP-INF-002; update inventory.

   Done when: Cleaning and inventory logged.

   V2 7059

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 Event start, first flight surgeon alert, each reading with time since exercise, and each repeat, so delays can be audited.

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [8] and Volume 2 Revision F [9]. 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 fever scenarios, including sepsis-like cases with a temperature below the alert level, missing readings and device failures, at station, Moon and Mars delays. Pass: Flight surgeon alert at time zero in every case with a link; every red flag alerts; zero cases where a missing value is reported as reassuring; zero cause statements.
2. Training model. Manikin or standardized-patient drills; crew take readings while the robot fetches and records. Pass: Time from command to first transmitted readings at or below <set by validation>.
3. Earth analog. Analog crews with remote flight surgeons. Pass: Pass criteria set in advance by the clinical lead and safety board.
4. Flight use under flight surgeon supervision. First use for scheduled temperature checks on healthy crew, to build in-flight baselines. Pass: No safety events; readings usable.

No stage has been run. Pass and fail criteria must be fixed in advance by the clinical lead and safety board.

12 · Human sign-off

Before any use

• Clinical lead for the specialty (sets every clinical threshold marked <set by clinical lead>)
• Flight surgeon, as medical authority
• Robotics and medical-device safety board
• Program approval for the mission

Each run

Started by any crewmember. The flight surgeon is alerted at the start when the link allows; otherwise the CMO follows the onboard checklist, with flight surgeon review at the next contact.

Restart after a stop

Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.

None of these sign-offs has happened. This is a Draft v0.4.

13 · Change control for learning

• Every change gets a new version number and a written reason; earlier versions are kept.
• Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.
• Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.
• If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.
• The robot never changes its own protocol, thresholds or limits.

Change-plan model: FDA guidance [11].

Loss of signal and Mars delay

Live link

Low Earth orbit: the flight surgeon is alerted at the start and sees readings in near real time.

Loss of signal

• The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps recording on schedule and queues everything.
• The CMO's sepsis checklist and crew oxygen continue under the onboard checklist and never wait for the link or the robot.
• The CMO decides under the pre-approved onboard checklist; the robot never waits for the ground before urgent onboard care.
• At the next contact the robot sends one package: readings, answers, alerts and decisions.

Mars-class delay

• With up to about 21-23 minutes one way, and blackouts of about 2-3 weeks, the CMO acts on red flags onboard.
• Alert levels (set against each crewmember's in-flight baseline), the repeat schedule and the onboard treatment plan must be set before flight.

[10]

Delay limit for live guidance

<set by validation>

Sources

1. 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: Red flags are modeled on NG253 Table 1 (community settings), not the hospital NEWS2 score; the robot calculates no score. Do not rely on fever or hypothermia alone (1.4.1); a rise in temperature can be a physiological response (1.4.3); heart rate is lower in fit adults and a new arrhythmia can be a response to infection; interpret blood pressure against previous values (Table 1: systolic more than 40 mmHg below normal); changes in mental state are significant and may be subtle (1.4.6-1.4.7); if oxygen saturation is difficult to measure, this may indicate poor peripheral circulation because of shock (1.4.10), and pulse oximeters may overestimate saturation, which has been reported in people with dark skin; trauma, surgery or invasive procedures in the last 6 weeks is a risk factor; ask how often urine was passed in the past 18 hours and about rigors (1.3.5), and about previous presentations (1.3.6). Numbers from the guideline are not used as thresholds here.
2. Stahn AC, Werner A, Opatz O, et al. Increased core body temperature in astronauts during long-duration space missions. Sci Rep. 2017;7(1):16180. PMID 29170507. doi:10.1038/s41598-017-15560-w Supports: During exercise, core body temperature rose higher and faster in space than on Earth; resting core temperature rose by about 1 °C, developing gradually over 2.5 months of flight.
3. Crucian B, Babiak-Vazquez A, Johnston S, et al. Incidence of clinical symptoms during long-duration orbital spaceflight. Int J Gen Med. 2016;9:383-391. PMID 27843335. doi:10.2147/IJGM.S114188 Supports: Among 46 long-duration ISS crewmembers, upper respiratory symptoms (0.97 per flight year) and various other infections were among the most reported events in the categories studied (infections, allergies, rashes and hypersensitivities).
4. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Table 2: 33 respiratory infections, 13 skin infections and 9 urinary tract infections among US astronauts (Shuttle, Mir and ISS through 2006).
5. European Association of Urology. EAU Guidelines on Urolithiasis. uroweb.org/guidelines/urolithiasis Supports: Section 3.4.2: the obstructed kidney with all signs of urinary tract infection and/or anuria is a urological emergency; urgent decompression is often necessary, with antibiotics.
6. National Institute for Health and Care Excellence. Headaches in over 12s: diagnosis and management. Clinical guideline CG150. www.nice.org.uk/guidance/cg150/chapter/Recommendations Supports: Headache features that need further investigation or referral include worsening headache with fever, sudden-onset headache reaching maximum intensity within 5 minutes, new-onset neurological deficit, and impaired level of consciousness.
7. 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.
8. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: Requirement IDs beginning V1.
9. NASA. NASA-STD-3001, Volume 2: Human Factors, Habitability, and Environmental Health (Rev F, 2026), including Section 10.6 Automated and Robotic Systems. standards.nasa.gov/standard/NASA/NASA-STD-3001_VOL_2 Supports: Requirement IDs beginning V2.
10. 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.
11. 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.
12. 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.