# RMP-INF-003 Isolating a sick crewmember: supply deliveries and check-ins to reduce contact (the flight surgeon decides on isolation) # Version 0.2 (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: '0.2' 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 8 review, 17 required corrections and 16 optional suggestions); all required corrections 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-INF-003 slug: rmp-inf-003 title: >- Isolating a sick crewmember: supply deliveries and check-ins to reduce contact (the flight surgeon decides on isolation) category: infection tier: 2 rung_note: >- Max rung 2 for supervised deliveries to a hand-over point outside the isolation area, carrying out sealed waste, and on-screen check-ins the crewmember accepts. The robot never decides on isolation, never enforces it, and never waits or pauses inside the isolation area. result_language: use: - as stated by the crewmember - temperature as measured by the crewmember - reading not obtained - sent to flight surgeon - no response never: - normal - no problem found - all clear - negative - any diagnosis or cause - contagious - not contagious - infectious - cured - safe to leave - just a cold - flu - COVID - reading is reassuring - safe - mild - minor scope: summary: >- When the flight surgeon or the CMO decides that a sick crewmember should stay apart from the others, the robot delivers supplies, food and water to a hand-over point outside the isolation area, carries out only sealed waste, runs on-screen check-ins the crewmember accepts, and alerts on red flags. The robot is cleaned under RMP-INF-002 after each delivery. why: >- Infection spreads easily in a confined spacecraft: microbe-carrying aerosol particles persist in weightlessness and crew immunity changes in flight (Mermel 2013). On Earth, the CDC isolation guideline (2007) recommends a single room for patients who pose a transmission risk, hand hygiene, dedicated patient-care equipment or cleaning before use on another patient, frequent cleaning of touched surfaces, more than 3 feet of separation for droplet spread, a mask when the patient leaves the room, ending precautions when symptoms resolve or as pathogen guidance states, and placement decided case by case, weighing infection risk against the potential adverse psychological impact on the isolated patient. How these apply to a vehicle (which module, air flow, how long) is the flight surgeon's decision with the commander; using the robot to deliver supplies so fewer crewmembers have close contact is design judgment. NASA-STD-3001 requires a means to isolate released biological contaminants (V2 6063) and private psychological communication (V1 6011). A robot that enters the isolation area counts as patient-dedicated equipment until it is cleaned under RMP-INF-002 (CDC V.B.5.b and IV.F.5), so it delivers to the hand-over point by default and enters only for a listed delivery the CMO sends it on. Airborne precautions depend on the vehicle's air flow, which the flight surgeon and commander decide. covers: - Supplies, food, water and personal items delivered to a hand-over point - Sealed waste carried out - Check-ins the crewmember accepts; temperature as the crewmember measures it - Private calls to the flight surgeon or behavioral health team on request - 'Fever and sepsis signs: RMP-INF-001; cleaning: RMP-INF-002' 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) - Deciding to start or end isolation, or who may enter - >- Restraining, blocking or locking in a crewmember (isolation is by agreement; the commander and flight surgeon lead) - Entering, waiting or pausing inside the isolation area - Opening a sealed waste bag - Saying the crewmember is or is not infectious - >- Watching, tracking or reporting the isolated crewmember's movements, including whether they stay in the area (isolation is by agreement; only the crewmember's own check-in answers are logged) related: - RMP-INF-001 - RMP-INF-002 - RMP-RESP-001 - RMP-GI-002 - RMP-BEH-002 - RMP-BEH-001 - 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: - 'Vehicle commander: decides on the isolation area and crew movement with the flight surgeon' - 'Second trained CMO: receives every alert and takes over if the CMO is the patient' - 'Behavioral health team (ground): available for private calls' - 'Other crew: help as the CMO or commander directs' robot_may: - Deliver supplies to the hand-over point - Carry out sealed waste - Run check-ins the crewmember accepts - Connect a private call on request - Alert the flight surgeon and the CMO robot_may_not: - Decide on or enforce isolation - Touch the crewmember - Wait or pause inside the isolation area - Say whether anyone is infectious - 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: >- The flight surgeon or the CMO decided on isolation, the commander named the isolation area and the hand-over point, and the crewmember agreed. 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: >- Isolation is by agreement; the crewmember chooses whether to answer each check-in and can ask for a private call at any time. emergency: >- In an emergency the commander's procedure overrides isolation; the robot follows the matching protocol on a human command. withdrawal: >- The crewmember can decline any check-in; an explicit "no" is logged as declined, and silence as "no response". inputs: - id: IN-1 name: Isolation decision, area and hand-over point, as stated source: Flight surgeon / CMO / commander required: true if_missing: The robot does not start; it asks the CMO. - id: IN-2 name: Check-in answers, word for word source: Crewmember required: false if_missing: Log "no response" (never "declined"); D3 applies. - id: IN-3 name: Temperature as measured by the crewmember with their own thermometer source: Crewmember required: false if_missing: Log "reading not obtained". - id: IN-4 name: Oxygen saturation as displayed, if the crewmember uses their own oximeter source: Pulse oximeter (patient-dedicated) required: false if_missing: Log "reading not obtained". - id: IN-5 name: Requests for supplies, food, water or a private call source: Crewmember required: false if_missing: None. - id: IN-6 name: Link status and delay source: Communications system required: true if_missing: Treat as link down; the CMO leads under the onboard checklist. steps: - id: S1 actor: robot rung: 2 action: >- Tell the flight surgeon, the CMO and the commander that isolation support has started, with the area and hand-over point as stated (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 3006 - V2 10174 - id: S2 actor: crew action: >- The CMO and commander set up the isolation area under the onboard checklist (module, air flow, hand-over point, the crewmember's own thermometer and oximeter); the crewmember wears a mask outside the area. success: Area set up as stated. refs: - V2 6063 - id: S3 actor: robot rung: 2 action: >- On the CMO's command, run a checked kit fetch of the isolation medical kit (masks, gloves, tissues, thermometer and sealable waste bags, 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". The robot brings it to the hand-over point outside the isolation area. success: Kit at the hand-over point after a matched ID and seal, or quarantined, or emergency fetch logged. limit: refs: - V2 7046 - V2 7059 - id: S4 actor: robot rung: 2 action: >- On request, bring food, water and personal items to the hand-over point, place them, and move back beyond the keep-out distance before the crewmember collects them. It never enters the isolation area unless the CMO sends it for a listed delivery, and then it leaves at once; it never waits or pauses inside. success: Delivery placed; robot outside the area. limit: refs: - V2 10172 - id: S5 actor: robot rung: 2 action: >- Carry only sealed waste bags the crewmember has closed from the hand-over point to the waste stowage the commander names, never opening them. success: Sealed bags stowed. refs: - V2 6063 - V2 7064 - id: S6 actor: robot rung: 2 action: >- At the times the flight surgeon sets, show an on-screen check-in the crewmember can accept: temperature as they measure it, saturation as their own oximeter displays it, and symptoms and how they are coping in their own words. Log answers word for word. If the crewmember asks, connect a private call to the flight surgeon or the behavioral health team; never log the content of a private call. success: Answers logged, or "no response"; calls connected on request. refs: - V1 6003 - V1 6011 - id: S7 actor: robot rung: 2 action: >- After every delivery or waste run, hold at the cleaning point the commander names until the crew have cleaned it under RMP-INF-002; until then it enters no other module. success: Robot cleaned before its next task. refs: - V2 7082 - V2 7083 - id: S8 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: S9 actor: ground action: >- The flight surgeon (or the CMO under the onboard checklist when there is no link) decides on testing, treatment and when isolation ends; the commander announces it. success: Decision logged. refs: - V1 3004 - id: S10 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: S11 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: S12 actor: robot rung: 2 action: >- Send the flight surgeon one private package: deliveries, check-in answers, readings as stated, alerts and decisions. success: Package delivered or queued. refs: - V1 6003 - V1 7003 decisions: - id: D1 after: S3 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: S6 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: S6 decided_by: robot question: Did the isolated crewmember answer the check-in, 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: S9 decided_by: ground question: What testing or treatment is needed, and when does isolation end? 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: S10 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, a crewmember's route or the isolation area (it never pauses in one), and tells the CMO. This pauses robot movement only: crew care of the isolated crewmember and the CMO's sepsis checklist 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 isolation area door or hatch opens while the robot is within the keep-out distance action: Robot stops and backs away to beyond the keep-out distance without contact, then holds. level: safe-state refs: - V2 10172 - id: X10 trigger: Body fluid on the robot, or the robot entered the isolation area action: Robot holds at the cleaning point and enters no other module until it is cleaned under RMP-INF-002. level: safe-state refs: - V2 7082 - V2 7083 - trigger: Any cabin alarm or emergency protocol action: >- The robot first clears the isolation-area exit and every hatch route, by the shortest path and without contact, then holds; it never waits at the hand-over point if that point is on an exit route; it moves again only on the commander's command. level: urgent refs: - V2 10173 - V2 7055 id: X11 red_flags: - id: RF1 sign: Breathlessness, or breathing faster than before threshold: any action: URGENT alert; see RMP-RESP-001 source: ng253 - id: RF2 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: RF3 sign: >- The oximeter cannot get a reading after the validated attempts (L5), 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: RF4 sign: Confusion, drowsiness, a rash that does not fade, or feeling very unwell threshold: any action: URGENT alert; see RMP-INF-001 source: ng253 - id: RF5 sign: Temperature as measured by the crewmember threshold: >- degrees (shared parameter FEVER_ALERT_C: body temperature in degrees Celsius, the same value in RMP-GI-003, RMP-ENT-002, RMP-SKIN-002 and RMP-RENAL-004) or higher, or any shaking chills action: Flag to the flight surgeon; see RMP-INF-001 - id: RF6 sign: Vomiting, diarrhoea or unable to drink (design judgment) threshold: any action: Flag to the flight surgeon; see RMP-GI-002 - id: RF7 sign: Another crewmember reports symptoms (design judgment) threshold: any action: Flag to the flight surgeon and the CMO; the flight surgeon decides on any change to isolation - id: RF8 sign: Distress, low mood, or saying they cannot cope with isolation threshold: any action: >- Flag privately to the flight surgeon; offer a private call; see RMP-BEH-002 (the robot's action: design judgment) source: cdciso - id: RF9 sign: Any mention of self-harm or suicide threshold: any action: URGENT alert; see RMP-BEH-001 source: ng225 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: Distance from the isolated crewmember value: enforced: 'Hard limit in the controller (CDC context: more than 3 feet for droplet spread)' refs: - V2 10172 - id: L3 name: Robot waiting or pausing inside the isolation area value: not allowed enforced: >- Keep-out map in the robot controller; entry only for a listed delivery on the CMO's command, leaving at once - id: L4 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L5 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: >- Deliveries and waste runs with times; check-in answers word for word; readings as stated; cleaning holds; private calls connected (never their content). - 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 6011 use: Private calls and check-in answers are private communication. - id: V1 7001 use: Records kept so the flight surgeon can see trends. - id: V1 7003 use: Secure handling of medical records. - id: V2 6063 use: >- Released biological contaminants are isolated: the robot stays outside the isolation area and carries sealed waste only. - 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 7055 use: Mission-critical and frequently used items are the easiest to reach. - 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 7064 use: Sealed waste goes to the waste stowage the commander names. - id: V2 7082 use: The robot is cleaned after every delivery or waste run. - id: V2 7083 use: Cleaning uses the program-approved products and procedure (RMP-INF-002). - 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 isolation with deliveries, worsening breathing, a failed oximeter reading, a second sick crewmember, distress, CMO as patient, lost link. pass: Zero pauses inside the area; zero contact; every red flag raised. - stage: training model what: Isolation drill in a mock module. pass: Deliveries and sealed-waste runs completed outside the keep-out distance. - stage: parabolic or station demonstration what: Deliveries in weightlessness. pass: No loose items at the hand-over point. - stage: flight use under flight surgeon supervision what: First use for a minor illness. 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: Started after the flight surgeon's or the CMO's isolation decision. The commander names the area. 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 check-ins when the link allows and can take private calls. 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 care of the isolated crewmember and the CMO's sepsis checklist continue under the onboard checklist and never wait for the link or the robot. - >- Check-ins continue offline on the CMO's confirmation; answers are stored encrypted for the flight surgeon. mars_delay: - The isolation plan, check-in times and alert values are set before flight; the CMO decides. sources: - key: cdciso text: >- U.S. Centers for Disease Control and Prevention. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, summary of recommendations (2007). url: https://www.cdc.gov/infection-control/hcp/isolation-precautions/summary-recommendations.html supports: >- Quotes as checked by the AI-assisted batch 8 reviewer (WebFetch, Oct 21, 2026). IV.A.3 hand hygiene; IV.D.1 a single room for patients who pose a risk of transmission; V.B.2.b "make decisions regarding patient placement on a case-by-case basis, balancing infection risks… and the potential adverse psychological impact on the infected or colonized patient" (category II); V.B.5.b "use disposable noncritical patient-care equipment… or implement patient-dedicated use of such equipment. If common use of equipment for multiple patients is unavoidable, clean and disinfect such equipment before use on another patient" (IB); IV.F.5 cleaning policies include "multi-use electronic equipment… and mobile devices that are moved in and out of patient rooms frequently" (IB); V.B.6 clean frequently touched surfaces often; V.C.2.a.iv spatial separation of more than 3 feet for droplet precautions; V.C.4.b the patient wears a mask when moved outside the room; V.B.7 discontinue precautions after signs and symptoms resolve or as pathogen-specific guidance states. Earth hospital context; the vehicle layout and the flight surgeon decide what applies on board. - key: mermel2013 text: >- Mermel LA. Infection prevention and control during prolonged human space travel. Clin Infect Dis. 2013;56(1):123-130. url: https://doi.org/10.1093/cid/cis861 doi: 10.1093/cid/cis861 pmid: '23051761' supports: >- Abstract: the confined spacecraft environment, the persistence of microbe-containing aerosol particles in weightlessness, and changes in crew immunity raise the importance of infection prevention and control on long missions. - key: crucian text: >- 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. url: https://doi.org/10.2147/IJGM.S114188 doi: 10.2147/IJGM.S114188 pmid: '27843335' supports: >- Among 46 long-duration ISS crewmembers, skin rashes were the most reported clinical event in the categories studied (infections, allergies, rashes and hypersensitivities), at 1.12 per flight year. Wounds were not studied. - 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: ng225 text: >- National Institute for Health and Care Excellence. Self-harm: assessment, management and preventing recurrence. NICE guideline NG225 (2022). url: https://www.nice.org.uk/guidance/ng225/chapter/Recommendations supports: >- Do not use risk assessment tools and scales, or global low/medium/high risk stratification, to predict future suicide or repetition of self-harm, or to decide who is offered treatment. - 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, V1 6011, 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 6063 (remove or isolate released contaminants), V2 7064, V2 7082, V2 7083, V2 7059, 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: >- AI-assisted clinical and source review by the Medical Research Assistant, Oct 21, 2026 (batch 8 review) items: - >- Source cdciso: V.B.2.b is now quoted as written (case-by-case placement balancing infection risk and the potential adverse psychological impact), with V.B.5.b and IV.F.5 added; RF7 is labelled design judgment and RF8's robot action design judgment (fix 13). - 'Lockout: no watching, tracking or reporting of the isolated crewmember''s movements (fix 14).' - >- New stop rule X11: on any cabin alarm or emergency protocol the robot clears the isolation-area exit and every hatch route, then holds, and moves only on the commander's command (fix 15). - >- Why: the robot counts as patient-dedicated equipment until cleaned (CDC V.B.5.b, IV.F.5); hand-over point by default; airborne precautions depend on vehicle air flow; the open question is removed (Q6, suggestion 26). - >- Batch 8 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.