# RMP-NEURO-003 Seizure: clear the space, time and record, alert crew and ground # 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 5 review, 25 required corrections and 18 optional suggestions); all required corrections, and the low-risk editorial suggestions, 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-NEURO-003 slug: rmp-neuro-003 title: 'Seizure: clear the space, time and record, alert crew and ground' category: neuro tier: 1 rung_note: >- Max rung raised from 1 to 2 for supervised scene clearing, timing and video. The robot never restrains the crewmember, never puts anything in the mouth, and never gives medicine. result_language: use: - logged, not interpreted - sent to flight surgeon - seizure start and stop as stated - elapsed time on request never: - normal - no problem found - all clear - negative - any diagnosis or cause - epilepsy - status epilepticus - safe to wake - post-ictal - just a seizure - safe - mild - minor scope: summary: >- When a crewmember has a seizure (fit), the robot sends an URGENT alert at once, clears loose items from the area, starts a clock, records start and stop times as the CMO states them, streams video when the link allows, and after the event offers prompt-only check-ins. The crew protect the person under the onboard checklist. The robot never holds the person down, never puts anything in the mouth, and never gives a benzodiazepine or any medicine (those are CMO decisions under NICE NG217 and the checklist). why: >- NICE NG217 treats convulsive seizures lasting 5 minutes or more as status epilepticus and directs community first-line benzodiazepine treatment when an individualised plan is not available, with a call for emergency help if the first dose fails. In flight the "emergency services" role is the CMO and the flight surgeon. Head injury can cause seizures (NICE NG232); decompression sickness can too (RMP-EVA-001). NG217 also lists low blood glucose among underlying causes of status epilepticus. Timing the event without interfering is the robot's job. For clinicians only, NG217 names community first-line benzodiazepine routes; the exact onboard medicine and route stay on the checklist, and the robot never names one aloud. covers: - A witnessed or suspected seizure in flight, including during another protocol - Prompt-only check-ins after the seizure until the flight surgeon closes the log locked_out: - Restraining or holding the crewmember - Putting anything in the mouth - Choosing or giving any medicine - Naming any first-line seizure medicine aloud - >- 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) - >- Dose-interval cues (any reminder, tone, colour, countdown or spoken cue tied to when a medicine was last taken) - Saying the seizure is over enough to return to work related: - RMP-NEURO-001 - RMP-NEURO-002 - RMP-NEURO-006 - RMP-ENV-004 - RMP-RESP-001 - RMP-CARD-001 - RMP-EVA-001 - RMP-PHARM-001 - RMP-PHARM-003 - RMP-BEH-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 alerts if the CMO is the patient' - 'Other crew: help clear the area as the CMO directs' robot_may: - Send an URGENT alert at once - Clear loose items and hold clear of the person - Time the seizure; give elapsed minutes only when the CMO asks, in the same words each time - Stream video when the link allows - Run RMP-PHARM-001 only after a human order robot_may_not: - Touch or restrain the person - Put anything in the mouth - Suggest or give medicine - Say when it is safe to wake or return to duty - 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: >- A crewmember or the CMO started the protocol by command, or another protocol handed off on a seizure. check: human_start == true refs: - V2 10174 - id: PRE-2 text: Robot self-test passed. refs: - V2 10161 - id: PRE-3 text: Link status known. check: link_state in [live, delayed, down] consent: standard: Emergency recording; questions after the person can answer, with agreement. emergency: During the seizure the robot asks nothing of the patient; the CMO leads. withdrawal: Video can be stopped by the CMO; the alert and times are kept. inputs: - id: IN-1 name: Time seizure was first noticed, and time movements stopped, as stated by the CMO source: CMO required: true if_missing: Log "not stated"; keep timing from the robot clock if the CMO asked it to start. - id: IN-2 name: Injury during the seizure, first seizure vs known epilepsy plan, after head injury or EVA, as stated source: CMO or crewmember after recovery required: false if_missing: Log "not reported". - id: IN-3 name: Medicines given and times, as stated by the CMO source: CMO required: false if_missing: Log "not stated". - id: IN-4 name: Blood glucose as measured by the CMO, when measurable (recorded, not interpreted) source: Entered by the CMO required: false if_missing: Log "not measured". - id: IN-5 name: Sleep medicine logged in RMP-NEURO-006, or a sleep medicine recently stopped, as stated source: Crewmember, CMO or log required: false if_missing: Log "not stated". - id: IN-6 name: Link status and delay source: Communications system required: true if_missing: Treat as link down. steps: - id: S1 actor: robot rung: 2 action: >- On a crewmember's or the CMO's word, send an URGENT "seizure" alert to the flight surgeon and the CMO at once. 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. Start the event clock. success: Alert acknowledged, or escalated; clock started. refs: - V2 10174 - V1 6003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- Clear loose items from around the person and hold a position clear of them. Do not touch, restrain or approach the head. Stream video when the link allows unless the CMO stops it. success: Area clear; robot outside keep-out. refs: - V2 10172 - id: S3 actor: crew action: >- The CMO protects the person under the onboard checklist (do not hold the limbs down or stop the movements; nothing in the mouth; recovery position, or the restrained position the onboard checklist states for weightlessness, and the robot never positions the crewmember; medicines only as the checklist and flight surgeon direct). success: Human-led care; robot logs what is stated. refs: - V1 3004 - id: S4 actor: robot rung: 2 action: >- Log seizure start and stop as the CMO states them. Give elapsed time only when the CMO asks ("how many minutes?"), in the same words each time, with no tone or countdown. For context only, NG217 treats 5 minutes or more as status epilepticus; the threshold the CMO uses stays on the checklist. success: Times logged; elapsed time on request only. - id: S5 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. refs: - V2 7059 - 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) decides medicines, work limits, head-injury or EVA paths and any evacuation [V1 3007]. success: Decision logged. refs: - V1 3007 - id: S8 actor: robot rung: 2 action: >- After the person can answer, offer a prompt-only check-in every hours until the flight surgeon closes the log. At each scheduled time the robot prompts the crewmember on their own screen; it approaches only when the crewmember (or the CMO) accepts, and a prompt never starts the robot. success: Each prompt accepted, postponed or answered. refs: - V2 10174 - id: S9 actor: robot rung: 2 action: >- Send the flight surgeon one package: times, stated injuries, medicines as stated, video pointer, alerts and decisions. success: Package delivered or queued. refs: - V1 6003 - V1 7001 - V1 7003 decisions: - id: D1 after: S4 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: S8 decided_by: robot question: Did the crewmember answer the check-in? 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: D3 after: S5 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 - id: D4 after: S7 decided_by: ground question: What is the plan (medicine, observation, evacuation)? 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: >- Robot pauses its own movement in its stopped position and tells the CMO and the commander. This pauses robot movement only: crew protecting the person, oxygen and the CMO's 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; the robot resumes only on the CMO's confirmation. Everything is logged and sent to the flight surgeon at the next contact. 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 crewmember becomes unresponsive and not breathing normally after the seizure action: URGENT; start RMP-CARD-001. level: urgent - id: X10 trigger: The CMO needs the robot's space action: Robot moves to its rest position at once and holds. level: safe-state refs: - V2 10172 red_flags: - id: RF1 sign: Seizure ongoing threshold: >- at or beyond minutes (for context, NG217: 5 minutes or more is treated as status epilepticus) action: >- URGENT alert; the CMO follows the onboard status-epilepticus plan; the robot only reports elapsed time when asked source: ng217 - id: RF2 sign: Repeat seizure without full recovery between, or a cluster of seizures, as the CMO states threshold: any action: URGENT alert source: ng217 - id: RF3 sign: Seizure after a head injury threshold: any action: URGENT alert; see RMP-NEURO-001 source: ng232 - id: RF4 sign: Seizure after a spacewalk or pressure change threshold: any action: URGENT alert; see RMP-EVA-001 source: tb037 - id: RF5 sign: Injury, tongue bite with heavy bleeding, or difficulty breathing after the seizure threshold: any action: URGENT alert; the CMO checks in person source: ng217 - id: RF6 sign: First known seizure, as stated threshold: any action: >- Flag to the flight surgeon; still URGENT from S1; the flight surgeon decides return to duty and the robot never clears the crewmember for work source: ng217 - id: RF7 sign: Low blood glucose as the CMO measures, or suspected low oxygen or high cabin CO2 with the seizure threshold: glucose below as measured; or any suspected low oxygen or high CO2 action: >- URGENT alert; the CMO treats under the checklist; see RMP-ENV-004 for CO2 and RMP-RESP-001 for oxygen; the robot does not advise source: ng217 - id: RF8 sign: >- Seizure while a sleep medicine is logged, or after a sleep medicine was stopped, as stated (design judgment, extrapolated from NG217) threshold: any action: >- Flag to the flight surgeon; see RMP-NEURO-006; still URGENT from S1; the robot never names withdrawal source: ng217 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: Restraining the crewmember or contacting the mouth value: not allowed enforced: No grasp or mouth task is loaded - id: L3 name: Handing over a mismatched or unverified medicine under this protocol value: not allowed enforced: >- RMP-PHARM-001 quarantine is the default; only the CMO's logged two-step override inside RMP-PHARM-001 can release it - id: L4 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L5 name: Closest approach during the seizure value: enforced: Distance sensing; clear-only tasks inside the zone 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: >- Alert time, seizure start/stop as stated, elapsed-time readouts on request, medicines via RMP-PHARM-001. - 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-8 text: >- Each RMP-PHARM-001 run started from this protocol: order ID, result (MATCH TO ORDER, MISMATCH or CANNOT VERIFY with the fields), quarantine, and any CMO override logged by RMP-PHARM-001 (reason and mismatched fields), at clock time. No running counter of doses. refs: - V2 7059 requirements: - id: V1 3004 use: Emergency care and recording; medicines are human decisions. - 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 3007 use: Evacuation decisions stay with the flight surgeon. - 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: >- Medicines are fetched and inventory is tracked only through RMP-PHARM-001; a mismatched item is quarantined and this protocol never hands it over. - 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 short and prolonged seizures, clusters, post-head-injury, post-EVA, low glucose, high CO2, transition to CARD-001, CMO as patient, lost link. pass: >- Zero restraint or mouth contact; elapsed time only on request; the robot never treats 5 minutes as its own threshold and never sounds a 5-minute alarm; no medicine suggestions. - stage: Earth analog what: Crew drills with a manikin. pass: Timing accuracy at or above . - stage: flight use under flight surgeon supervision what: First use in drills. 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 by a crewmember or the CMO. Alerts go to the CMO and flight surgeon at once. 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 sees summaries at the private medical conference and can be alerted at any time. loss_of_signal: - >- The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps timing the seizure and logging offline. - >- Crew protecting the person, oxygen and the CMO's checklist continue under the onboard checklist and never wait for the link or the robot. - >- Red flags go to the CMO (or the second trained CMO) at once; the CMO decides under the pre-approved onboard checklist. - 'At the next contact the robot sends one package: the log, alerts and decisions.' mars_delay: - >- Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; red-flag thresholds and the check-in schedule are set before flight and the CMO acts on them. sources: - key: ng217 text: >- National Institute for Health and Care Excellence. Epilepsies in children, young people and adults. NICE guideline NG217 (published 27 April 2022; last updated 5 August 2026). url: >- https://www.nice.org.uk/guidance/ng217/chapter/7-Treating-status-epilepticus-repeated-or-cluster-seizures-and-prolonged-seizures supports: >- 7.1.1 Treat as status epilepticus seizures lasting 5 minutes or more. 7.1.2 Follow an individualised emergency management plan if immediately available. Give a benzodiazepine as first-line treatment in the community when no plan is available; if the first dose does not work, call emergency services (7.1.7-7.1.8). The robot never chooses or gives a medicine; this is context for the CMO and the onboard checklist. - key: ng232 text: >- National Institute for Health and Care Excellence. Head injury: assessment and early management. NICE guideline NG232 (May 18, 2023). url: https://www.nice.org.uk/guidance/ng232/chapter/Recommendations supports: >- Recommendation 1.2.4: community services should refer to an emergency department anyone with a head injury and any of: a Glasgow Coma Scale score below 15 on initial assessment; any loss of consciousness; any focal neurological deficit; suspected complex skull fracture or penetrating head injury; amnesia for events before or after the injury; persistent headache; any vomiting since the injury; any seizure; previous brain surgery; a high-energy head injury; a bleeding or clotting disorder; current anticoagulant or antiplatelet treatment (except aspirin alone); intoxication; or continuing concern about the diagnosis. Signs of basal skull fracture include blood behind the eardrum, "panda" eyes, cerebrospinal fluid leaking from the ear or nose and Battle's sign (1.5.8). With a suspected neck injury, paraesthesia in the arms or legs or a focal peripheral deficit is a high-risk factor (1.6.2). CT is the primary investigation, and people who need CT where none is available are transferred (1.5.1, 1.5.5). CT within 1 hour for a GCS score of 12 or less on initial assessment, below 15 at 2 hours after the injury, a suspected open or depressed skull fracture, any sign of basal skull fracture, a post-traumatic seizure, a focal neurological deficit, or more than 1 episode of vomiting (1.5.8); CT within 8 hours after loss of consciousness or amnesia with a bleeding or clotting disorder or a dangerous mechanism (1.5.9); consider CT for anticoagulant or antiplatelet treatment other than aspirin alone (1.5.13). Only assume a depressed conscious level is due to intoxication after an important brain injury has been excluded (1.4.2). Consider referral for irritability or altered behaviour (1.2.5). Signs of deterioration include agitation or abnormal behaviour, a drop in GCS, severe or increasing headache, persistent vomiting, and new neurological signs (1.9.13); a second competent person confirms deterioration if possible, otherwise the supervising doctor is contacted without waiting (1.9.14). With a suspected neck injury, an axial load to the head is a high-risk factor (1.6.2). - 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: 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 3007.' - 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 5 review) items: - >- RF1 keeps the NG217 5-minute figure as context only; validation now checks that the robot never treats 5 minutes as its own threshold and never sounds a 5-minute alarm (item 12). - >- New lockout: naming any first-line seizure medicine aloud; the "why" keeps the NG217 classes for clinicians only (item 13). - >- S3 reworded: "recovery or restrained position as the onboard checklist states for weightlessness, and the robot never positions the crewmember" (removes "when safe") (item 14). - >- New RF7: low blood glucose as the CMO measures, or suspected low oxygen or high cabin CO2 → URGENT; see RMP-ENV-004 and RMP-RESP-001. Glucose added to inputs (item 15). - >- New RF8 (Flag, design judgment extrapolated from NG217): seizure while a sleep medicine is logged or after one was stopped → see RMP-NEURO-006; the robot never names withdrawal. RMP-NEURO-006, RMP-PHARM-003, RMP-ENV-004 and RMP-RESP-001 added to related (item 16). - >- RF6: the flight surgeon decides return to duty; the robot never clears the crewmember for work (suggestion 37). - >- Batch 5 drafts 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 7 editorial (AI-assisted), Oct 21, 2026 items: - >- Citation labels changed to the site's year-only convention: "(approved for public release )" now reads "(YYYY)", and NASA-STD-3001 Volume 2 "Revision F (approved July 14, 2026)" now reads "(Rev F, 2026)" (sources: v2). Editorial; no change to steps, thresholds or limits. - >- X5 and the comms loss-of-signal branch now say only the robot pauses: crew protecting the person, oxygen and the CMO's checklist never wait for the link or the robot (batch 6 review item 24 / suggestion 40). Editorial; robot behaviour unchanged. - >- S3 now reads "do not hold the limbs down or stop the movements; nothing in the mouth; recovery position, or the restrained position the onboard checklist states for weightlessness" (batch 6 review item 26). Editorial; crew-led step, robot behaviour unchanged.