RMP-SKIN-001 Wound cleaning and dressing: hold and pass supplies, photo documentation (crew leads)

1 · Identity and scope

For a minor wound (cut, scrape or skin tear), the CMO cleans and dresses it while the robot brings the kit, holds a containment pad or bag, passes items on request, holds the limb steady if asked, and takes standard photos with a scale and color reference before and after dressing and at each dressing change.

Why this protocol was chosen. In weightlessness, fluid and debris containment must be planned for: blood tends to dome at the wound, but droplets can break free. Standard, repeatable photos let the flight surgeon follow a wound across days. (Skin rashes, a different problem, were the most reported clinical event in one study of 46 long-duration crew; rashes are covered by RMP-SKIN-004; RMP-SKIN-003 is the wound photo log.)

Autonomy: Raised from rung 1 in the outline for fetching, passing supplies and photo positioning. Holding a limb is rung 1 and is its own step (S5), so the build checks it: the CMO places the limb and the robot only holds it still while the CMO keeps a hold command active.

Related: RMP-SKIN-002 · RMP-SKIN-003 · RMP-MSK-001 · RMP-INF-002

2 · Roles

Medical authority

Flight surgeon (ground). Holds medical authority for every run.

Onboard lead

Crew medical officer (CMO), acting under delegated care; uses the pre-approved onboard checklist when there is no link.

Others

• Patient: can stop the robot at any time
• Second crewmember if available (wears eye protection)

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.) [10]

3 · Preconditions and consent

• PRE-1 The CMO judged the wound minor and started the run.V2 10174
• PRE-2 Patient, CMO and supplies restrained.V2 7046
• PRE-3 Robot self-test passed; gripper surfaces cleaned.V2 10161
• PRE-4 Bleeding controlled with pressure before the robot comes close.
• PRE-5 Link status and delay known.
• PRE-6 Patient, CMO and helper wear eye protection; absorbent containment in place before any irrigation.eye_protection_on == true and containment_ready == true

Consent

Patient agrees by voice or touch, including to photos; logged. Photos frame the wound and reference card only.

Emergency consent

If the patient cannot agree, the robot only fetches and passes supplies on the CMO's decision; photos wait for consent unless the flight surgeon decides otherwise.

Withdrawal

Patient can stop photos or robot help at any time.

4 · Required sensor inputs

5–6 · Steps and decision points

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

1. S1RobotRung 2

   On request, bring the wound kit, eye protection, containment supplies and camera; restrain them by the patient. Show the CMO the tetanus immunization date from the medical record (shown only; the robot gives no advice).

   Done when: Kit restrained at the patient; tetanus record shown.

   V2 7046

   D1DecisionCrew decides

   Is the wound beyond minor or dirty: deep, gaping, heavy bleeding, affecting the eye, face, a joint or hand function, or a puncture, crush injury, bite, embedded foreign material or a contaminated wound?

   • Yes → Stop this protocol; CMO starts trauma care and calls the flight surgeon (RMP-MSK-001). Tetanus status and wound type go to the flight surgeon.
   • No → Continue.
2. S2RobotRung 2

   Hold an absorbent pad or containment bag under the wound area.

   Done when: Pad in place; CMO confirms.

3. S3RobotRung 2

   Take a "before" photo with the scale and color card; label it. Frame the wound and reference card only; exclude the face unless the wound is on the face and the patient agrees.

   Done when: Photo passes the focus and framing check.

   V1 6003

   D2DecisionRobot decides

   Did the photo pass the quality check?

   • Yes → Continue.
   • No after <set by validation> tries → Hand the camera to the CMO.
4. S4Crew

   If a limb needs holding, the CMO places it and starts a hold command.

   Done when: Limb placed; hold command active, or no hold needed.

   V2 10164

5. S5RobotRung 1

   Hold the limb still only while the CMO keeps the hold command active, within force limits; release at once on X6 or when the command ends.

   Done when: Limb held steady, or released on command.

   Limit: <set by validation>

   V2 10165V2 10172

6. S6RobotRung 2

   Pass items on request during cleaning and dressing (never sharps).

   Done when: Each requested item handed over.

7. S7Crew

   CMO cleans the wound.

   Done when: CMO reports cleaning complete.

   V2 7046

8. S8Crew

   CMO chooses and applies the dressing.

   Done when: Dressing applied.

9. S9RobotRung 2

   Take an "after" photo with the same framing; log supplies used.

   Done when: Photo stored; inventory updated.

   V2 7059

10. S10RobotRung 2

    Bag waste per the biohazard procedure; clean robot surfaces per the cleaning protocol.

    Done when: Cleaning logged.

11. S11RobotRung 2

    Send photos and the log to the flight surgeon as private medical data, or queue them; set up follow-up photo sessions at each dressing change as the flight surgeon directs.

    Done when: Delivery confirmed or queued; schedule logged.

    V1 6003V1 7001V1 7003

    D3DecisionGround decides

    What is the dressing and follow-up plan?

    • Link live → Flight surgeon decides; robot logs.
    • Link down → CMO follows the onboard checklist; flight surgeon reviews photos later.

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

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [6] and Volume 2 Revision F [7]. 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. Robot passing, holding and photo tasks in simulation, including fluid release. Pass: Zero force-limit violations; photos framed consistently.
2. Training model. Wound-care trainer limbs with simulated fluid. Pass: Containment success at or above <set by validation>; photo sets judged usable by clinicians.
3. Earth analog. Analog crews; photos reviewed remotely. Pass: Pass criteria set in advance.
4. Parabolic or station demonstration. Containment pad and passing tasks in weightlessness, without a patient. Pass: Fluid containment and hand-over work as specified.

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

12 · Human sign-off

Before any use

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

Each run

Started by the CMO. Flight surgeon review of photos when the link allows; otherwise at the next contact.

Restart after a stop

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

None of these sign-offs has happened. This is a Draft v0.7.

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 [9].

Loss of signal and Mars delay

Live link

Low Earth orbit: photos and video go to the flight surgeon live.

Loss of signal

• Only the robot pauses; crew care never waits for the link or the robot.
• The robot pauses any movement and tells the CMO; on the CMO's confirmation it continues under the onboard checklist; photos and logs are queued.
• Follow-up photo sessions continue on the last agreed schedule.

Mars-class delay

• No live review; the flight surgeon follows the wound through photo packages.
• Escalation signs and the photo schedule are agreed before flight.

[8]

Sources

1. Khanna R, Li Y, Cook M, et al. Surgery for interplanetary space missions. Br J Surg. 2026;113(3):znag005. PMID 41823369. doi:10.1093/bjs/znag005 Supports: Means of fluid and debris containment must be planned for in space surgery; the review also notes that fluid management may be less difficult than expected, because blood tends to stay at the wound (surface tension makes it dome), though arterial bleeding can form a stream of droplets.
2. U.S. Centers for Disease Control and Prevention. Clinical guidance for wound management to prevent tetanus (updated September 8, 2026). www.cdc.gov/tetanus/hcp/clinical-guidance/index.html Supports: Dirty or major wounds include penetrating or puncture wounds, wounds containing dirt, soil, feces or saliva (for example bites), and wounds with devitalized tissue such as crush injuries and burns; the need for tetanus vaccination or immune globulin depends on the wound type and vaccination history.
3. Crucian B, Babiak-Vazquez A, Johnston S, et al. Incidence of clinical symptoms during long-duration orbital spaceflight. Int J Gen Med. 2016;9:383-391. PMID 27843335. doi:10.2147/IJGM.S114188 Supports: Among 46 long-duration ISS crewmembers, skin rashes were the most reported clinical event in the categories studied (infections, allergies, rashes and hypersensitivities), at 1.12 per flight year. Wounds were not studied.
4. NASA OCHMO. Spaceflight Experience and Medical Care. Technical Brief OCHMO-TB-033 (2023). www.nasa.gov/wp-content/uploads/2023/12/ochmo-tb-033-spacefl… Supports: Headaches are more common in spaceflight, with elevated CO2, fluid shifts and pressure changes among contributing factors; pre-mission exams include ECG, eye exams and photo documentation of skin.
5. 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.
6. NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023). www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-… Supports: Requirement IDs beginning V1.
7. 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.
8. 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.
9. 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.
10. 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.