RMP-PREV-002 Periodic health exam support: reminder, checked kit fetch, vital signs as displayed, consented photos and a secure record (the CMO examines)

1 · Identity and scope

At the times the flight surgeon schedules, the robot prompts the crewmember that a periodic health exam is due; the exam starts only when the crewmember (or the CMO) accepts. The robot brings the exam kit by a checked kit fetch, shows the flight surgeon's exam checklist and the RMP-CARD-005 preparation checklist for blood pressure, records vital signs as displayed and the CMO's findings word for word, takes consented photos of only the areas the checklist lists, and sends one secure package to the flight surgeon. A default checklist (design judgment) covers vital signs including temperature and body mass, a symptom review, skin, hands and feet, mouth and throat, eyes (imaging under RMP-EYE-003) and musculoskeletal complaints; the flight surgeon owns and changes it. Behavioral health stays in the private RMP-BEH-002 and RMP-BEH-003, never in this exam log.

Why this protocol was chosen. Programs must provide in-mission capabilities to monitor physiological and psychosocial well-being and deliver preventive health care (V1 3003), and medical records must be kept in a retrievable form for trends (V1 7001) and handled securely (V1 7003). Accurate blood pressure needs a standard technique, including no caffeine, exercise or smoking in the 30 minutes before, quiet rest, an arm supported at heart level and the right cuff size (Muntner 2019); RMP-CARD-005's checklist is reused. Photos follow the RMP-SKIN-003 rules (IMI 2019: standard views, an establishing view with surrounding skin, consent). What the exam covers, how often, and the alert values are set by the flight surgeon; the robot's role (prompt, fetch, checklist, record only) is design judgment. The shared value SPO2_ALERT_PCT only raises an alert; it never gates a crew action (the crew act without waiting for a reading), and the clinical lead sets it per mission with the flight surgeon, because the cabin atmosphere can differ by mission.

Autonomy: Max rung 2 for the scheduled prompt, a checked kit fetch, showing the flight surgeon's exam checklist, recording vital signs as displayed and the CMO's findings as stated, and consented photos of listed areas only. The crewmember or CMO places every device; the robot never touches anyone and never judges a finding.

Related: RMP-CARD-005 · RMP-SKIN-003 · RMP-PREV-001 · RMP-EYE-003 · RMP-CARD-002 · RMP-PHARM-001 · RMP-CARD-004

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

• Second trained CMO: receives every alert and takes over if the CMO is the patient
• Vehicle commander: leads any cabin emergency procedure
• Other crew: help as the CMO or commander directs

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 The exam starts only when the crewmember (or the CMO) accepts the on-screen prompt; a loaded schedule alone never starts it. An unaccepted prompt is logged "not accepted" and the CMO is told. A crewmember or the CMO can also start it by command.human_start == trueV2 10174
• PRE-2 Robot self-test passed; kit stowage locations known.V2 10161V2 7059
• PRE-3 Robot and supplies restrained when not moving.V2 7046
• PRE-4 Link status known. The crew never wait for the robot before acting.link_state in [live, delayed, down]

Consent

The crewmember agrees to the exam, to readings and findings being recorded and sent to the flight surgeon, and, before the camera moves, to each photo session. For the genital, breast or buttock area, the robot camera is used only if the crewmember chooses it; otherwise the CMO takes the photos with a handheld camera and adds them to the log.

Emergency consent

If the crewmember cannot agree, this is not a scheduled exam: the robot sends an URGENT alert and a crewmember checks in person (X7).

Withdrawal

The crewmember can skip any part or stop at any time; withdrawal stops future photos, and the flight surgeon decides on photos already taken.

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

   At the scheduled time, show the crewmember an on-screen prompt that a periodic health exam is due, and tell the flight surgeon and the CMO (URGENT if any red flag is stated). The exam starts only when the crewmember or the CMO accepts the prompt; an unaccepted prompt is logged "not accepted" and the CMO is told. 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 <set by validation> seconds is repeated and sent to the next named crewmember.

   Done when: Prompt accepted, or "not accepted" logged and sent.

   V2 10174V1 3003V1 3006

2. S2RobotRung 2

   On the CMO's command, run a checked kit fetch of the periodic exam medical kit (vital-signs devices and the exam items 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".

   Done when: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged.

   Limit: <set by validation>

   V2 7046V2 7059

   D1DecisionRobot decides

   Which kit fetch was it, and what did the checked kit fetch show?

   • EMERGENCY FETCH (an URGENT red flag had fired, or a crewmember or the CMO stated an emergency) → Hand-over already done as an emergency fetch, logged as an override; reconciled afterwards (not a check before use).
   • KIT ID AND SEAL MATCH → Hand the kit over closed; log "KIT ID AND SEAL MATCH. Not a check of the contents." and the clock time.
   • MISMATCH, seal not intact or CANNOT VERIFY → 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.No hand-over
3. S3RobotRung 2

   Show the flight surgeon's exam checklist and, for blood pressure, the RMP-CARD-005 preparation checklist (the same restrained position each time; an empty bladder; quiet rest with no talking; no exercise, caffeine or nicotine in the last 30 minutes; a bare arm held at heart level by a strap or restraint; the middle of the cuff at mid-chest level; the cuff size the kit chart gives). On request only, the robot shows the time elapsed since the start the CMO called, as a clock-time entry; it never announces a time, and never says "time reached", "done", "passed" or "failed".

   Done when: Checklists shown; the crewmember says when they are ready.

   V1 3003

4. S4Crew

   The crewmember or the CMO places each device and takes each reading; the CMO examines as the checklist states.

   Done when: Readings taken and findings stated, or not obtained.

   V1 3003

5. S5RobotRung 2

   Record each reading as displayed, with the clock time and position, and the CMO's findings word for word, marked "as stated by the CMO"; a missing reading is logged as "reading not obtained", never a value. Show an on-screen prompt for symptoms or concerns the crewmember can accept, and log answers word for word.

   Done when: Readings, findings and answers logged.

   V1 3003V1 7001

   D2DecisionRobot decides

   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?

   • Yes → 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 <set by validation> seconds is repeated and sent to the next named crewmember.
   • No → Continue.
   D3DecisionRobot decides

   Did the crewmember answer the prompt, or say they want to skip it?

   • Yes → Continue.
   • Declined explicitly (the crewmember says no to a question) → Log "declined" for that question only; the alert already sent stands.
   • No response, or the answer does not make sense → 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.
6. S6Crew

   For each area on the photo list, the CMO sets the standard view and the area to frame (with a margin of surrounding skin) and places the scale the flight surgeon chose. For the genital, breast or buttock area, the robot camera is used only if the crewmember chooses it; otherwise the CMO takes the photos with a handheld camera and adds them to the log.

   Done when: View and area set.

   V1 3004

   D4DecisionRobot decides

   Before the camera moves: did the crewmember agree to this session's photos (each view is named on screen before it is taken)?

   • Yes → Continue to S7; the crewmember can say stop before or during any view.
   • No, or no answer → The camera does not move and no photo is taken; log "photo not taken – no consent" and tell the CMO.
7. S7RobotRung 2

   Only after the crewmember agrees (D4), move the camera to the view the CMO set, no closer than the set camera distance, and take the standard set (an establishing view with surrounding skin, a close-up with the scale, and the same close-up without it). Label each with the area, view, date and clock time and mark it "for human review". A photo with anything outside the area the CMO set in frame is held unsent and flagged to the flight surgeon, who decides whether to keep it.

   Done when: Photos taken and labelled, or "photo not obtained".

   Limit: <set by validation>

   V1 7001

8. S8RobotRung 2

   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.

   Done when: Robot at rest in the module until a human releases it; alert acknowledged or escalated.

   V2 10173V1 3006

9. S9Ground

   The flight surgeon (or the CMO under the onboard checklist when there is no link) reviews the exam and decides on follow-up, care and the next exam.

   Done when: Decision logged.

   V1 3003

   D5DecisionGround decides

   What follow-up, care and next exam apply?

   • 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 the log at the next contact.
10. S10RobotRung 2

    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.

    Done when: RMP-PHARM-001 run logged with its result, or none ordered.

    V2 7059

    D6DecisionRobot decides

    What did RMP-PHARM-001 show for the ordered item?

    • MATCH TO ORDER → 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.
    • MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check → 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.No hand-over
11. S11RobotRung 2

    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.

    Done when: Kit reconciled or shown as "opened – not restocked".

    V2 7059

12. S12RobotRung 2

    Send the flight surgeon one secure package: readings as displayed with times, findings as stated, answers, labelled photos, alerts and decisions. Photos are stored only in the crewmember's medical record, encrypted in storage and in transit as the program requires; access is limited to the CMO, the flight surgeon and people the flight surgeon names. They are never shown on a shared display and never used for robot or AI training, research or outreach without separate written consent.

    Done when: Package delivered or queued.

    V1 6003V1 7001V1 7003

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 Each reading as displayed with time and position; readings not obtained; findings as stated by the CMO; answers as stated; consent before each photo session; each photo with area, view and time; photos held unsent and the flight surgeon's decision; who viewed the record.
• LOG-6 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.V2 10163
• LOG-7 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".V2 7059
• LOG-8 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.V2 7059
• LOG-9 Each checked kit fetch: time, who asked, kit ID, seal status and result (KIT ID AND SEAL MATCH, MISMATCH, seal not intact or CANNOT VERIFY), and any quarantine.V2 7059

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [7] and Volume 2 Revision F [8]. 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 exams with an unaccepted prompt, a kit seal mismatch, a reading past an alert value, a failed oximeter reading, a missed photo consent, CMO as patient, lost link. Pass: Zero contact; zero interpretation; zero photos without consent; every red flag raised.
2. Training model. Exam drill with crew-placed devices and photos on a model. Pass: Every reading logged as displayed; photos comparable and labelled.
3. Parabolic or station demonstration. Checklist display, kit fetch and camera positioning in weightlessness. Pass: Keep-out and camera distance held.
4. Flight use under flight surgeon supervision. First use for a scheduled exam. Pass: No safety or privacy events.

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

Scheduled by the flight surgeon and accepted by the crewmember or CMO, or started by command. The CMO examines; the flight surgeon judges every finding.

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 v0.2.

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 receives the package when the link allows and can join by private call.

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.
• The exam already under way and all crew care continue under the onboard checklist and never wait for the link or the robot.
• The exam continues offline under the checklist; the package is queued.

Mars-class delay

• Mars: no real-time guidance; the checklist, schedule and alert values are set before flight and the CMO decides.

[10]

Sources

1. Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association. Hypertension. 2019;73(5):e35-e66. PMID 30827125. doi:10.1161/HYP.0000000000000087 Supports: Table 5 (best practices): an empty bladder; rest quietly for at least 5 minutes; no talking or texting; back supported, feet flat, legs not crossed; cuff on a bare arm, sized to the arm; arm supported at heart level; avoid caffeine, exercise and smoking for at least 30 minutes before; separate repeated readings by 1-2 minutes. A cuff that is too small gives an artificially high reading, and one that is too large an artificially low reading. Earth seated-position context; the in-flight position is set by the flight surgeon's checklist. Full text read Oct 21, 2026.
2. Institute of Medical Illustrators. IMI National Guidelines: Wound Management Photography (2019). www.imi.org.uk/wp-content/uploads/2019/04/2019_Apr_IMINatGui… Supports: Standardise equipment, lighting, background, viewpoint and magnification so serial photographs can be compared; use the same light source each time where possible; hold a measurement scale on the same plane as the wound and photograph from 90 degrees; acute wounds are photographed at each dressing change, and any significant change is photographed; written guidance on consent for clinical photography. Earth hospital context. Saved copy read Oct 21, 2026 (a 2025 version 2.0 exists).
3. Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. Circulation. 2021;144(22):e368-e454. PMID 34709879. doi:10.1161/CIR.0000000000001029 Supports: On Earth, a 12-lead ECG should be acquired and interpreted within 10 minutes of arrival; an initial normal ECG does not exclude acute coronary syndrome, so ECGs are repeated while symptoms continue; chest pain includes pressure, tightness or discomfort in the chest, shoulders, arms, neck, back, upper abdomen or jaw; sudden ripping pain radiating to the back is suspicious of an acute aortic syndrome.
4. 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. PMID 41122888. doi:10.1161/CIR.0000000000001369 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.
5. 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: 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.
6. British Thoracic Society. Guideline for oxygen use in healthcare and emergency settings (emergency oxygen guideline page). Fetched Oct 21, 2026. www.brit-thoracic.org.uk/quality-improvement/guidelines/emer… 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.
7. 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: NASA-STD-3001 Vol 1 Rev C: V1 3003 (in-mission preventive health care), V1 3004, V1 3006, V1 6003, V1 7001, V1 7003.
8. 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.
9. 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.
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.