RMP-SKIN-002 Burns and scalds: cooling and dressing supplies, cooling start time on request, photo log, urgent relay to the flight surgeon (the crew lead all first aid)

1 · Identity and scope

When a crewmember is burned or scalded (for example by hot water from the drink dispenser, a hot surface or equipment), the robot sends an alert to the CMO and the flight surgeon at once, keeps clear while the crew stop the burning and make the area free of hazard, asks short questions (red flags first), fetches the burn supplies from the medical kit on a human command, records the clock time cooling started, gives the cooling start time and minutes since when the crew ask, hands over fresh waste bags and collects only sealed ones, and takes photos of the burn with the crewmember's agreement for the flight surgeon. The crew do all first aid: cooling, removing jewellery, dressing, keeping the crewmember warm. Any medicine is fetched only after a human order, through RMP-PHARM-001.

Why this protocol was chosen. Burns have occurred in spaceflight (the NASA evidence report lists burns among the non-emergency conditions seen). On the ISS the drink dispenser's hot water averages about 82 °C (range about 65-93 °C), well above the 48.9 °C that building codes treat as the tissue damage limit (NASA-STD-3001 Vol 2, rationale for [V2 6110]), and water for medical use, including wound irrigation, is part of the required water supply [V2 6109]. First-aid guidance on Earth is to stop the burning, remove jewellery and clothing near the burn unless stuck, cool the burn with cool running water for 20 minutes within 3 hours, use a cool wet compress changed often over 20 minutes if the water supply is limited, cover the burn with cling film and cool it at the first opportunity within 3 hours if no water is available, never use ice, and cool the burn but warm the patient, because cooling can cause hypothermia (British Burn Association, reaffirmed 2026; WHO: "Do not apply ice" and "Avoid prolonged cooling with water"). There is no pre-hospital evidence for hydrogel burn dressings (Goodwin 2016). Running water does not flow in weightlessness, and free-floating water is a hazard: to the eyes, near equipment (an electrical hazard; design judgment), and as microbial growth on wet surfaces [V2 6058 rationale]. So the crew cool the burn by the onboard medical checklist burn procedure (owner: flight surgeon), which states the method and keeps the water contained, using the BBA water-limited method as the closest Earth guidance; no public spaceflight burn-cooling procedure was found (not verified). The robot never says which method or how long. For chemical burns the BBA advises brushing off powders, then irrigating with saline or room-temperature water for at least 20 minutes, without trying to neutralise; in flight that is contained irrigation under the vehicle procedures (RMP-ENV-005), and eye involvement goes to RMP-EYE-001, where irrigation is not delayed; the robot says none of this aloud. The American Burn Association advises immediate consultation for all high-voltage (1,000 V or more) electrical injuries, and consultation and follow-up to screen for heart rhythm problems after low-voltage injuries. Deep burns of the face, hands, feet, genitals, the area between the legs or over a joint (even small burns of these areas may need specialist evaluation), other deep burns, larger burns (10% of the body surface or more for partial-thickness burns; the crewmember's palm is about 1%), burns with breathing in smoke or hot gas, chemical and electrical burns, and poorly controlled pain need immediate specialist advice (American Burn Association 2022). The 20 minutes is shown only as context, and only the crew or the CMO decide when cooling stops. Open question for review: the in-flight cooling method is the onboard checklist's (owner: flight surgeon); this draft assumes one exists and names the BBA water-limited method only as Earth guidance.

Autonomy: Max rung raised from 1 to 2 for supervised fetching, timing on request and photos, as in batch 3. Tier 1 as in the library contents. The robot fetches supplies, records clock times and photos and collects sealed waste; it never touches the burn, never handles hot water or any heat source, and never decides when cooling stops.

Related: RMP-SKIN-001 · RMP-SKIN-003 · RMP-ENV-001 · RMP-ENV-005 · RMP-EYE-001 · RMP-CARD-003 · RMP-INF-001 · RMP-INF-002 · RMP-PHARM-001 · RMP-PHARM-003

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

• Burned crewmember: answers questions and can stop questions or photos at any time
• Other crew: stop the burning, make the area free of hazard, cool the burn and keep the crewmember warm, as the CMO directs
• Second trained CMO: receives alerts if the CMO is the patient

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.) [14]

3 · Preconditions and consent

• PRE-1 A crewmember (the one burned, or the CMO) started the log by command.human_start == trueV2 10174
• PRE-2 The crew have stopped the burning and say the area is free of hazard (no fire, smoke, live electrical source or chemical release). If not, the robot only sends the alert and keeps clear (X9).robot_zone_clear == true
• PRE-3 The crewmember is awake and answering. If not, stop and alert at once (X7).crew_responsive == true
• PRE-4 Patient, CMO and helpers wear eye protection; absorbent containment is in place before any wet cooling or irrigation. If cooling has already started, the crew put containment and eye protection in place as soon as they can; the robot never delays cooling.eye_protection_on == true and containment_ready == trueV2 9053
• PRE-5 Robot self-test passed; it knows the stowage location of the medical kit and its burn supplies.V2 10161
• PRE-6 Robot and supplies restrained when not moving.V2 7046
• PRE-7 Link status and current delay known.link_state in [live, delayed, down]

Consent

The crewmember agrees to questions by voice and to photos. Photos show the burn and a reference card only; the face only if the burn is on the face and the crewmember agrees; the genitals or the area between the legs only if the flight surgeon asks for that photo and the crewmember agrees to it. The crewmember can ask for any photo to be deleted before it is sent. Any question can be declined; an explicit "no" is logged as declined for that question only.

Emergency consent

If the crewmember cannot answer, the robot asks no more questions; it sends an URGENT alert and a crewmember checks in person (X7). No photos are taken without agreement.

Withdrawal

The crewmember can stop questions or photos at any time; an alert already sent is not withdrawn.

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 a crewmember's command, open the log and send a "burn or scald" alert to the CMO and the flight surgeon at once (queued for the flight surgeon if the link is down), with the clock time. 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: Alert acknowledged, or escalated to the next named crewmember.

   V2 10174V1 6003V1 3006

2. S2Crew

   The crew stop the burning and make the area free of hazard (switch off or isolate the source, follow the vehicle fire, electrical or chemical procedure), then remove jewellery and clothing near the burn unless stuck. The crew cool the burn by the onboard medical checklist burn procedure (owner: flight surgeon). That procedure states the method (for example cool wet compresses changed often, or contained irrigation), uses ambient water the crew fill (never the hot port), and keeps the water contained. No ice. If no water is available, the burn is covered (loose strips of cling film, not wrapped round a limb and not on the face) and cooled as soon as possible, within 3 hours. A hydrogel dressing is used only if the checklist names it.

   Done when: Crew say the area is free of hazard and cooling has started.

   V1 3004V2 6110V2 9053

3. S3RobotRung 2

   On a human command, fetch the burn supplies from the medical kit, closed, and restrain them within reach outside the crew's work area. Any water container it brings is ambient temperature, filled by the crew. It never opens the kit. This is an emergency fetch on a human command (CMO or crewmember): 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 or crewmember 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: Supplies restrained within reach; override logged.

   Limit: <set by validation>

   V2 7046V2 6109

4. S4RobotRung 2

   Ask the red-flag questions first, then how and when the burn happened. Log answers word for word with clock times. D1 is checked after every answer.

   Done when: Answers logged, or "no response" logged.

   D1DecisionRobot 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. The burn alert from S1 stands.
   D2DecisionRobot decides

   Did the crewmember answer the question?

   • 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.
5. S5RobotRung 2

   Record the clock time cooling started and stopped, as the crew say it. When the crew or the CMO ask, say aloud "cooling started at <clock time>, <n> minutes ago", in the same words each time. Only the crew or the CMO decide when cooling stops; the robot never decides when to stop and never says it is enough.

   Done when: Times logged; read out only on request.

6. S6RobotRung 2

   Hand over fresh waste bags on request; take only bags the crew have sealed (used compress cloths, wipes and dressings), then label and stow them as biohazard waste.

   Done when: Sealed waste stowed.

   V2 10172

7. S7RobotRung 2

   When the CMO asks and the crewmember agrees, take photos of the burn with a reference card from the set distance, outside the keep-out zone, and send them to the flight surgeon (queued if the link is down). The face only if the burn is on the face and the crewmember agrees. Burns of the genitals or the area between the legs: no photo unless the flight surgeon asks for one and the crewmember agrees to that photo; only the CMO is present; the images go to the flight surgeon only, are never shown on a shared screen, and are stored with restricted access. The crewmember can ask for any photo to be deleted before it is sent.

   Done when: Photos sent or queued, or "declined" logged.

   Limit: <set by validation>

   V1 6003V2 10172

8. S8Crew

   The CMO assesses and dresses the burn under the onboard checklist, keeps the crewmember warm, and enters size, depth and values. Any medicine is ordered by the CMO or flight surgeon.

   Done when: CMO entries logged.

   V1 3004

9. S9RobotRung 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.

   V2 7059

   D3DecisionRobot 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
10. S10RobotRung 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

11. S11RobotRung 2

    Send the flight surgeon one package: clock times (burn, cooling start and stop), answers, CMO entries, photos, the tetanus date, RMP-PHARM-001 results and alerts. Clean its own surfaces (RMP-INF-002). 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: Package delivered or queued; kit reconciled or shown as opened – not restocked.

    V1 6003V1 7001V1 7003V2 7059

12. S12Ground

    The flight surgeon (or the CMO under the onboard checklist when there is no link) decides care, dressing changes, infection watch, work limits and whether evacuation needs to be considered [V1 3007]. The robot logs the decisions.

    Done when: Decision logged.

    V1 3004V1 3007

    D4DecisionGround decides

    What is the plan (care, dressings, infection watch, work limits, evacuation)?

    • 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.
13. S13RobotRung 2

    Offer a check-in and photo every <set by flight surgeon> hours, or at each dressing change the CMO sets, until the crewmember and flight surgeon close the log (RMP-SKIN-003 covers longer photo tracking). 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.

    Done when: Each prompt accepted, postponed or answered; log closed by a human.

    V2 10174

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 clock time (burn, cooling start and stop), answer, photo, sealed waste bag stowed and alert.
• 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

10 · Links to NASA-STD-3001

IDs as published in Volume 1 Revision C [10] 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 runs covering every red flag, no response, a fire or electrical hazard during the run, a burn of the genitals, a CMO who is the patient, an RMP-PHARM-001 MISMATCH, and lost link. Pass: Every red flag acts as listed; zero photos of the genitals or the area between the legs without a flight-surgeon request and the crewmember's agreement; zero hot-water handling; zero statements on depth, size or when to stop cooling; the cooling time read out only on request, in the same words; zero hand-overs after a MISMATCH.
2. Earth analog. Trained crew practise burn first aid on a manikin with the robot fetching supplies, timing on request and taking photos. Pass: Supplies within reach within <set by validation> seconds; zero contacts; photos usable for the flight surgeon at or above <set by validation>.
3. Parabolic or station demonstration. Supply fetch, sealed-waste collection with wet cloths and photos in weightlessness, without a patient. Pass: Zero escapes of free water from sealed bags; zero contacts.
4. Flight use under flight surgeon supervision. First use alongside the usual medical conferences. Pass: No safety events; the flight surgeon finds the timeline and photos useful.

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 a crewmember. The flight surgeon reviews the log and photos; red flags go to the CMO and flight surgeon at once.

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 v0.5.

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 [13].

Loss of signal and Mars delay

Live link

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 recording times and logging offline.
• Crew burn cooling, eye protection and oxygen 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-class 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.

[12]

Sources

1. British Burn Association. First Aid Clinical Practice Guidelines (Sept 24, 2018); and British Burn Association and National Burns Network First Aid Statement (Aug 7, 2026). www.britishburnassociation.org/wp-content/uploads/2017/06/BB… Supports: Stop the burning process; remove burned, damp or constricting clothing and jewellery near the burn, leaving molten or stuck clothing; do not delay cooling: cool the burn with cool running tap water for 20 minutes, within 3 hours of injury; if the water supply is limited, apply a cool water compress with a clean wetted lint-free cloth, changed frequently over 20 minutes; if no water is available, cover with cling film and cool at the first opportunity within 3 hours; do not use ice or iced water; cool the burn but warm the patient (further cooling may cause hypothermia, especially with large burns); chemical burns: wear protective equipment, brush off dry powders and irrigate for at least 20 minutes without delaying irrigation for detailed assessment; electrical burns: manage life-threatening conditions first and cool after the electrical source is controlled. The 2026 statement continues to support 20 minutes of cool running water as the gold standard, ideally within 3 hours.
2. American Burn Association. Guidelines for Burn Patient Referral: Advice on Transfer and Consultation (2022). www.ameriburn.org/burn-care-team/resources/guidelines-for-bu… Supports: Immediate consultation with consideration for transfer: full-thickness burns; partial-thickness burns of 10% or more of total body surface area; any deep partial or full-thickness burns involving the face, hands, genitalia, feet, perineum, or over any joints; burns with other illnesses or injuries; poorly controlled pain; all suspected inhalation injury; all chemical injuries; all high-voltage (1,000 V or more) electrical injuries. Consultation: partial-thickness burns under 10%; all potentially deep burns of any size; signs of potential inhalation such as facial flash burns, singed facial hair or smoke exposure; low-voltage (under 1,000 V) electrical injuries, with follow-up to screen for heart rhythm problems. Even small burns involving critical areas (face, hands, feet, genitalia) may require specialized evaluation regardless of TBSA. Superficial burns (redness only) are NOT counted in calculations of total burn surface area; the palm of the patient's hand is about 1%; full-thickness burns are dry and leathery, white, brown or black, with loss of pin-prick sensation.
3. World Health Organization. Burns (fact sheet). www.who.int/news-room/fact-sheets/detail/burns Supports: Fact sheet dated 13 October 2023. Cited only for two first-aid points: "Do not apply ice because it deepens the injury" and "Avoid prolonged cooling with water because it will lead to hypothermia".
4. Goodwin NS, Spinks A, Wasiak J. The efficacy of hydrogel dressings as a first aid measure for burn wound management in the pre-hospital setting: a systematic review of the literature. Int Wound J. 2016;13(4):519-525. PMID 26177570. doi:10.1111/iwj.12469 Supports: Of 129 studies considered, no pre-hospital studies of hydrogel burn dressings were identified; current pre-hospital use appears to be driven by sources that do not reflect the paramedic setting. Only the abstract was 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: In the NICE sepsis guideline's risk table for community settings (Table 1), not passing urine in the previous 18 hours and objective evidence of a new altered mental state are high-risk criteria; the guideline asks about fever or shaking chills but says not to rely on fever alone. Used as context for the no-urine, fever and confusion red flags; the hours and the temperature stay placeholders.
6. 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 burns; the need for tetanus vaccination or immune globulin depends on the wound type and vaccination history. Cited for the tetanus date shown to the CMO; the robot gives no advice.
7. NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017). humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf Supports: Non-emergency conditions that have occurred during space missions include burns (NASA evidence report, text).
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: NASA-STD-3001 Vol 2 Rev F: V2 6109 rationale (water for medical contingency use, including wound irrigation); V2 6110 rationale (the ISS drink dispenser's hot water averages about 82 °C, range about 65-93 °C; 48.9 °C is the building-code tissue damage limit for shower water); V2 6058 rationale (the presence of free water can promote the growth of microbial organisms); V2 9053 (protective equipment shall be provided to protect the crew from expected hazards). Section 10.6 covers automated and robotic systems.
9. Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019). www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Gu… Supports: Override is limited to medicines needed in emergent circumstances where waiting could harm the patient (3.3b); limit what is available on override (3.4b); require documentation of the override rationale (3.4d); routinely analyze override reports (3.6). Used for the emergency-fetch pattern by analogy (a robot fetching a sealed kit is not a dispensing cabinet).
10. 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 3004 items b (medical kits and protective equipment), j (procedures), m (medicines) and s (private transmission of medical data); V1 3007 (medical evacuation).
11. 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.
12. 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.
13. 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.
14. 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.