# RMP-RESP-005 Scheduled breathing rate and oxygen saturation (SpO2) checks: reminder, preparation checklist, readings as displayed and a breathing rate counted by the CMO # 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 11 review: 10 required corrections, R1 to R10; 9 optional suggestions not applied in this version); all required corrections that apply to this protocol are applied in this version (see Corrections). No named human clinician has reviewed it. Not for clinical use. fixed_rules: flight_surgeon_is_medical_authority: true cmo_acts_under_delegated_care: true human_starts_and_restarts_robot: true robot_never_diagnoses: true no_drug_or_fluid_advice_by_robot: true safe_state_on_fault_or_no_response: true lost_link_pause_then_cmo_decides: true robot_lockouts: diagnosis: true drug_or_fluid_advice: true starting_stopping_or_adjusting_oxygen_or_any_medicine: true self_start_or_self_restart: true changing_own_protocol_thresholds_or_limits: true handing_over_a_mismatched_item_as_verified: true id: RMP-RESP-005 slug: rmp-resp-005 title: >- Scheduled breathing rate and oxygen saturation (SpO2) checks: reminder, preparation checklist, readings as displayed and a breathing rate counted by the CMO category: resp tier: 3 rung_note: >- Max rung 2 for the scheduled prompt, a checked kit fetch, showing the oximeter preparation checklist, recording oxygen saturation (SpO2) and heart rate as displayed, and recording the breathing rate the CMO counts and states. The crewmember places the oximeter; the robot never counts breaths from video and never touches anyone. result_language: use: - reading as displayed - saturation not obtained - breathing rate as counted by the CMO - logged, not interpreted - sent to flight surgeon never: - normal - no problem found - all clear - negative - any diagnosis or cause - high - low - in range - out of range - good - healthy - stable - better - worse - reading is reassuring - probe error - safe - mild - minor scope: summary: >- At the times the flight surgeon schedules, the robot prompts the crewmember that a breathing check is due; the check starts only when the crewmember or the CMO accepts. The robot brings the oximeter by a checked kit fetch and shows the preparation checklist; the crewmember places the pulse oximeter. The robot records oxygen saturation (SpO2, the percentage of oxygen-carrying blood) and heart rate as displayed once the reading has stopped changing, and the breathing rate the CMO counts over one full minute on their own timer and states. A failed oximeter reading is URGENT. why: >- A raised breathing rate is "a powerful sign of acute illness and distress", and an extreme value in a single measure needs urgent review (NEWS2, 2017), so the breathing rate is counted by a human over a full minute and recorded as stated; the alert values are the clinical lead's (design judgment). A pulse oximeter reads best with a warm, relaxed hand below heart level, no nail polish, the person still, and a reading taken once it stops changing; circulation, skin pigmentation, thickness and temperature can affect it (FDA 2025). A failed reading is never reassuring: it can mean poor circulation, so it is URGENT, as in the other protocols that use the oximeter. 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. covers: - Scheduled breathing rate and SpO2 checks on the flight surgeon's schedule - 'Breathing trouble: RMP-RESP-001; cabin air alarms: the commander''s procedure' - 'Heart rate and blood pressure checks: RMP-CARD-005' 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) - Placing or removing the oximeter, or touching anyone - Counting breaths from video or sound, or estimating a breathing rate - Saying whether a reading is normal, high, low or changed - Changing the schedule or the alert values related: - RMP-RESP-001 - RMP-RESP-004 - RMP-CARD-005 - RMP-PREV-002 - RMP-INF-001 - RMP-EVA-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 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' robot_may: - Prompt the crewmember at the scheduled time - Bring the oximeter by a checked kit fetch (or an emergency fetch) - Show the preparation checklist - Record SpO2 and heart rate as displayed and the breathing rate as the CMO states it - Send the record to the flight surgeon robot_may_not: - Place the oximeter or touch anyone - Count breaths itself or estimate a rate - Say what a reading means - Start a scheduled check without a human accepting the prompt 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 check 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. check: human_start == true refs: - V2 10174 - id: PRE-2 text: Robot self-test passed; kit stowage locations known. refs: - V2 10161 - V2 7059 - id: PRE-3 text: Robot and supplies restrained when not moving. refs: - V2 7046 - id: PRE-4 text: Link status known. The crew never wait for the robot before acting. check: link_state in [live, delayed, down] consent: standard: The crewmember agrees to the check and to readings being recorded and sent to the flight surgeon. emergency: >- If the crewmember cannot agree, this is not a scheduled check: the robot sends an URGENT alert and a crewmember checks in person (X7). withdrawal: The crewmember can stop at any time; a stopped check is logged as "stopped", never as a value. inputs: - id: IN-1 name: >- The flight surgeon's schedule and the clinical lead's alert values (SpO2 uses the shared parameter SPO2_ALERT_PCT) source: Flight surgeon / clinical lead required: true if_missing: The robot shows "schedule not loaded" and runs only on a human command. - id: IN-2 name: SpO2 and heart rate as displayed by the crew-placed pulse oximeter, after the reading stops changing source: Crew-placed pulse oximeter required: true if_missing: Log "saturation not obtained" (never a value); RF2 applies. - id: IN-3 name: Breathing rate as counted by the CMO over one full minute and stated source: CMO required: true if_missing: Log "breathing rate not stated" (never a value); the CMO is told. - id: IN-4 name: Air or supplemental oxygen in use (flow and device), as stated by the CMO, with the clock time source: CMO (as stated) required: true if_missing: Log "oxygen in use not stated"; never a value. The robot never starts, stops or adjusts oxygen. - id: IN-5 name: Symptoms in the crewmember's words (breathlessness, cough, chest pain, feeling faint, fever) source: Crewmember required: false if_missing: Log "no response"; D3 applies. - id: IN-6 name: Link status and delay source: Communications system required: true if_missing: Treat as link down; the record is queued. steps: - id: S1 actor: robot rung: 2 action: >- At the scheduled time, show the crewmember an on-screen prompt that a breathing check is due, and tell the CMO (URGENT if any red flag is stated). The check 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 seconds is repeated and sent to the next named crewmember. success: Prompt accepted, or "not accepted" logged. refs: - V2 10174 - V1 3003 - V1 3006 - id: S2 actor: robot rung: 2 action: >- On the CMO's command, run a checked kit fetch of the vital-signs kit (pulse oximeter): 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". success: Kit within reach after a matched ID and seal, or quarantined, or emergency fetch logged. limit: refs: - V2 7046 - V2 7059 - id: S3 actor: robot rung: 2 action: >- Show the oximeter preparation checklist: hand warm and relaxed, held below heart level and restrained; no nail polish on that finger; sit still and quiet for the rest time the flight surgeon sets; take the reading once it stops changing. Then show the symptom prompt and log answers word for word. 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". success: Checklist shown; answers logged. refs: - V1 3003 - id: S4 actor: crew action: >- The crewmember places the pulse oximeter. The CMO counts the breaths for one full minute on their own timer, without telling the crewmember when the count starts, and states the rate. success: Oximeter placed; rate counted and stated, or not obtained. refs: - V1 3003 - id: S5 actor: robot rung: 2 action: >- Record SpO2 and heart rate as displayed once the reading has stopped changing, and the breathing rate as the CMO states it, and whether the crewmember is on air or supplemental oxygen (flow and device) as the CMO states it, each with the clock time and marked "as displayed", "as counted by the CMO" or "as stated by the CMO"; a missing value is logged as "not obtained", never a value. The robot never counts breaths from video or sound. After the validated attempts (L5) with no oximeter reading, log "saturation not obtained". The robot never starts, stops or adjusts oxygen and never comments on it. success: Readings logged, or "not obtained". refs: - V1 7001 - 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) reviews the readings and decides on follow-up and the next check. success: Decision logged. refs: - V1 3003 - id: S8 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: S9 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: S10 actor: robot rung: 2 action: >- Send the flight surgeon one package: readings as displayed or as counted with times, answers as stated, alerts and decisions. success: Package delivered or queued. refs: - V1 6003 - V1 7001 decisions: - id: D1 after: S2 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: S5 decided_by: robot question: >- Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag? branches: - if: 'Yes' then: >- Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember. - if: 'No' then: Continue. - id: D3 after: S3 decided_by: robot question: Did the crewmember answer the symptom prompt, or say they want to skip it? branches: - if: 'Yes' then: Continue. - if: Declined explicitly (the crewmember says no to a question) then: Log "declined" for that question only; the alert already sent stands. - if: No response, or the answer does not make sense then: >- URGENT: log "no response" (never "declined"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once. - id: D4 after: S7 decided_by: ground question: What follow-up and next check apply? 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: S8 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 or a crewmember's route (it never pauses in one), and tells the CMO. This pauses robot movement only: crew oxygen, breathing care and every check already under way 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: A cabin air alarm (for example ammonia, smoke or carbon dioxide) sounds action: >- Robot stops the check at once and holds clear of every route; the crew follow the commander's emergency procedure and never wait for the robot. level: stop refs: - V2 10172 - id: X10 trigger: Someone needs the space or route the robot is in action: Robot moves clear at once without contact and holds; it never pauses in a hatch route. level: safe-state refs: - V2 10172 red_flags: - id: RF1 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: RF2 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: RF3 sign: >- Breathing rate as counted by the CMO below or above the clinical lead's alert values (design judgment; NEWS2 hospital context) threshold: below or above breaths per minute action: URGENT alert; see RMP-RESP-001 source: news2 - id: RF4 sign: Displayed heart rate low or high (design judgment; same values as RMP-CARD-002 RF2) threshold: below or above beats per minute action: URGENT alert; see RMP-CARD-003 - id: RF5 sign: >- Breathlessness getting worse, or the crewmember cannot speak in full sentences, as stated (design judgment) threshold: any action: URGENT alert; see RMP-RESP-001 - id: RF6 sign: Chest pain, pressure or tightness, as stated threshold: any action: URGENT alert; see RMP-CARD-002 source: gulati - id: RF7 sign: Breathing symptoms during or after a cabin air alarm (for example ammonia) threshold: any action: URGENT alert; the commander's procedure leads; see RMP-ENV-002 source: atsdrnh3 - id: RF8 sign: Breathlessness, cough or chest pain after an EVA or a pressure change, as stated threshold: any action: URGENT alert; see RMP-EVA-001 source: tb037 - id: RF9 sign: Fever or shaking chills 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: URGENT alert; see RMP-INF-001 source: ng253 - id: RF10 sign: New confusion or drowsiness, as stated or seen by the crew threshold: any action: URGENT alert; a crewmember checks in person now source: ng253 - id: RF11 sign: Unresponsive, or not breathing normally threshold: any action: URGENT alert; start RMP-CARD-001 now source: aha2025bls 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: Counting or estimating a breathing rate by the robot (from video, sound or any sensor) value: not allowed enforced: No such function is loaded - id: L3 name: Robot speed near the crewmember value: enforced: Hard limit in the controller refs: - V2 10172 - id: L4 name: Placing, adjusting or removing the oximeter by the robot value: not allowed enforced: No such task is loaded - 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: >- Prompt and acceptance; checklist shown; each reading as displayed or as counted by the CMO with the clock time; readings not obtained; answers as stated. - 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 - 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 - id: LOG-9 text: >- 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. refs: - V2 7059 requirements: - id: V1 3003 use: In-mission preventive health care and monitoring; the flight surgeon schedules every check. - 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 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: >- 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 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 checks with an unaccepted prompt, a failed oximeter reading, a breathing rate past an alert value, a cabin alarm, CMO as patient, lost link. pass: Every failed reading URGENT; zero robot-counted rates; zero contact. - stage: training model what: Check drill with a crew-placed oximeter. pass: Every reading logged as displayed after it stops changing. - stage: parabolic or station demonstration what: Checklist display and kit fetch in weightlessness. pass: Keep-out held. - stage: flight use under flight surgeon supervision what: First scheduled check. 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: >- Scheduled by the flight surgeon and accepted by the crewmember or CMO, or started by command. The CMO counts the breathing rate; the flight surgeon judges every reading. 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 the readings when the link allows.' loss_of_signal: - >- Only the robot pauses non-essential motion, at a position clear of hatch routes and crew routes, and tells the CMO; it resumes offline only on the CMO's confirmation. - >- Crew oxygen, breathing care and every check already under way continue under the onboard checklist and never wait for the link or the robot. - Checks continue offline; the record is queued; any red flag goes to the CMO at once. mars_delay: - 'Mars: the alert values are set before flight and the CMO decides.' sources: - key: news2 text: >- Royal College of Physicians. National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS (2017). url: https://www.rcp.ac.uk/improving-care/resources/national-early-warning-score-news-2/ supports: >- A respiration rate of 12 to 20 breaths per minute scores 0; 8 or fewer, or 25 or more, scores 3; a single red score (3 in one parameter, an extreme value) should prompt an urgent review; "an elevated respiration rate is a powerful sign of acute illness and distress". Hospital context for the clinical lead's alert values only. Read Oct 21, 2026 (saved copy in src/b11). - key: fdaspo2 text: US Food and Drug Administration. Pulse Oximeter Basics (consumer update, 2025). url: https://www.fda.gov/consumers/consumer-updates/pulse-oximeter-basics supports: >- For an accurate reading: the hand warm, relaxed and held below the level of the heart; remove fingernail polish; sit still; wait until the reading stops changing and settles on one number. Poor circulation, skin pigmentation, skin thickness, skin temperature, tobacco use and fingernail polish can affect accuracy. Content current as of March 26, 2025; read Oct 21, 2026 (saved copy in src/b11). - 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: 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: gulati text: >- 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. url: https://doi.org/10.1161/CIR.0000000000001029 doi: 10.1161/CIR.0000000000001029 pmid: '34709879' 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. - key: atsdrnh3 text: >- Agency for Toxic Substances and Disease Registry (CDC). Medical Management Guidelines for Ammonia (NH3). Fetched Oct 21, 2026. url: https://wwwn.cdc.gov/TSP/MMG/MMGDetails.aspx?mmgid=7&toxid=2 supports: >- NIOSH IDLH (immediately dangerous to life or health) 300 ppm. Ammonia is corrosive to eyes, skin and airways; upper airway swelling and pulmonary edema may lead to airway obstruction; after severe exposure, injury to the eyes, lungs and skin may continue to develop for 18 to 24 hours. Eye exposure: irrigate with plain water or saline for at least 15 minutes. Rescuers should be trained and appropriately attired before entering the contaminated (hot) zone. No antidote; treatment is supportive (humidified oxygen is given by clinicians). - 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: aha2025bls text: >- Kleinman ME, Buick JE, Huber N, et al. Part 7: Adult Basic Life Support: 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(16_suppl_2):S448-S478. url: https://doi.org/10.1161/CIR.0000000000001369 doi: 10.1161/CIR.0000000000001369 pmid: '41122888' supports: >- Adult basic life support: initial recognition of cardiac arrest, activation of the emergency response, high-quality CPR and use of an automated external defibrillator; also respiratory arrest and foreign-body airway obstruction. Earth guidance; the onboard checklist leads. Abstract read via PubMed Oct 21, 2026; full text not read. - key: v1 text: 'NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).' url: https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf supports: 'NASA-STD-3001 Vol 1 Rev C: V1 3003, V1 3006, V1 6003, V1 7001.' - 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: Batch 11 AI-assisted clinical review (Medical Research Assistant), Oct 21, 2026 items: - >- R7: the oxygen in use is recorded: "air or supplemental oxygen, flow and device, as stated by the CMO", with the clock time (new input and S5). The never-words and lockouts are unchanged: the robot never starts, stops or adjusts oxygen and never comments on it (NEWS2 2017, recommendation 24: document oxygen flow and device). - >- Batch 11 protocols now record the review as AI-assisted (Medical Research Assistant, Oct 21, 2026); no named human clinician.