{ "$schema": "https://spacemedicinefoundation.org/robotic-medicine/protocols/schema/protocol.schema.json", "schema_version": "0.3", "version": "0.5", "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": "2026-10-20", "reviewed": "2026-10-20", "human_clinician_review": false, "text": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 4 review, 28 required corrections and 23 optional suggestions); all required corrections, and the optional ones that could be verified, are applied in this version (see Corrections). No named human clinician has reviewed it." }, "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-SKIN-002", "slug": "rmp-skin-002", "title": "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)", "category": "skin", "tier": 1, "rung_note": "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.", "result_language": { "use": [ "logged, not interpreted", "sent to flight surgeon", "as stated by the CMO" ], "never": [ "normal", "no problem found", "all clear", "negative", "any diagnosis or cause", "superficial", "first-degree", "second-degree", "third-degree", "small burn", "nothing serious", "cooled enough", "healing well", "not infected", "safe", "mild", "minor" ] }, "scope": { "summary": "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": "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.", "covers": [ "A burn or scald from hot water, a hot surface, equipment, a chemical or electricity, in a crewmember who is awake and answering, after the crew have stopped the burning and made the area free of hazard", "Photo log and check-ins on the burn until the crewmember and flight surgeon close the log", "Fire or smoke in the module is handled by the vehicle procedure first (X9; see RMP-ENV-001)" ], "locked_out": [ "Fetching, carrying or handling hot water, food heated in the dispenser or any heat source", "Touching the burn, the dressing or the crewmember", "Deciding how to cool, when cooling stops, or how to dress the burn (only the crew or the CMO decide)", "Saying how deep or large the burn is, or that it is healing or infected", "Suggesting, choosing, fetching or dosing any medicine, cream or dressing without a human order and RMP-PHARM-001", "Handing over any medicine outside RMP-PHARM-001, or after a MISMATCH or CANNOT VERIFY (the item stays quarantined; only the CMO can ask for it, through the RMP-PHARM-001 logged two-step override)", "Dose-interval cues (any reminder, tone, colour, countdown or spoken cue tied to when a medicine was last taken)", "Photographing the face, unless the burn is on the face and the crewmember agrees", "Photographing the genitals or the area between the legs, unless the flight surgeon asks for that photo and the crewmember agrees to it", "Saying how to cool the burn, which method to use or how long (the onboard checklist burn procedure decides)", "Handling open waste or used dressings (sealed bags only)", "Approaching during fire, smoke, an electrical hazard or a chemical release" ], "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" ] }, "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" ], "robot_may": [ "Send an alert to the CMO and flight surgeon on a crewmember's command", "Ask short questions by voice and log answers word for word, with clock times", "Fetch the burn supplies from the medical kit (dressings, cling film, compress cloths, ambient-temperature water containers, waste bags) on a human command, closed, and restrain them within reach", "Record the clock time cooling started and stopped as the crew say it; say the cooling start time and minutes since only when the crew or CMO ask", "Hand over fresh waste bags; take only sealed bags and stow them as biohazard waste", "Take photos of the burn with a reference card, with the crewmember's agreement, and send them to the flight surgeon", "Reconcile the medical kit afterwards through RMP-PHARM-001 as an inventory record (not a check before use)" ], "robot_may_not": [ "Handle hot water or any heat source", "Touch the burn, the dressing or the crewmember", "Decide when cooling stops or how to dress the burn", "Say how deep or large the burn is", "Suggest, fetch or dose any medicine without a human order, or hand over a mismatched item", "Approach during fire, smoke, an electrical hazard or a chemical release", "Start without a human command" ], "commercial": "On commercial flights, 'flight surgeon' and 'CMO' mean the operator's designated medical authority and trained onboard responder. If no trained responder is aboard, this protocol is not used. (NASA-STD-3001 requires two CMOs per vehicle for NASA programs [V1 3006]; FAA rules set no medical standards for spaceflight participants.)" }, "preconditions": [ { "id": "PRE-1", "text": "A crewmember (the one burned, or the CMO) started the log by command.", "check": "human_start == true", "refs": [ "V2 10174" ] }, { "id": "PRE-2", "text": "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).", "check": "robot_zone_clear == true" }, { "id": "PRE-3", "text": "The crewmember is awake and answering. If not, stop and alert at once (X7).", "check": "crew_responsive == true" }, { "id": "PRE-4", "text": "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.", "check": "eye_protection_on == true and containment_ready == true", "refs": [ "V2 9053" ] }, { "id": "PRE-5", "text": "Robot self-test passed; it knows the stowage location of the medical kit and its burn supplies.", "refs": [ "V2 10161" ] }, { "id": "PRE-6", "text": "Robot and supplies restrained when not moving.", "refs": [ "V2 7046" ] }, { "id": "PRE-7", "text": "Link status and current delay known.", "check": "link_state in [live, delayed, down]" } ], "consent": { "standard": "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": "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." }, "inputs": [ { "id": "IN-1", "name": "Red-flag questions: where the burn is (face, hands, feet, genitals, the area between the legs, over a joint); what caused it (hot liquid, hot surface, fire or smoke, chemical, electricity); trouble breathing, a hoarse voice, cough or wheeze; pain that is not controlled; shivering or feeling cold", "source": "Crewmember, by voice; CMO observation", "required": true, "if_missing": "Log \"no response\"; URGENT; the CMO checks in person. Never logged as declined." }, { "id": "IN-2", "name": "Clock time of the burn, and the clock times cooling started and stopped, as the crew state them", "source": "Crew, by voice", "required": true, "if_missing": "Log \"not stated\"; the robot never estimates a time." }, { "id": "IN-3", "name": "Size and depth as the CMO states them (for example the number of palm-sizes, and whether it looks white, brown, black, leathery or numb); recorded, not interpreted", "source": "Entered by the CMO", "required": false, "if_missing": "Log \"not stated\". A missing value is never treated as reassuring." }, { "id": "IN-4", "name": "Temperature, heart rate and other values entered by the CMO (recorded, not interpreted)", "source": "Entered by the CMO", "required": false, "if_missing": "Log \"not measured\"." }, { "id": "IN-5", "name": "Tetanus immunization date from the medical record (shown to the CMO and flight surgeon; burns count as major wounds in CDC wound guidance; the robot gives no tetanus advice)", "source": "Medical record", "required": false, "if_missing": "Log \"record not available\"." }, { "id": "IN-6", "name": "Orders placed by the CMO or flight surgeon", "source": "Medical record", "required": false, "if_missing": "Treat as no order; the robot fetches no medicine." }, { "id": "IN-7", "name": "Link status and delay", "source": "Communications system", "required": true, "if_missing": "Treat as link down." } ], "steps": [ { "id": "S1", "actor": "robot", "rung": 2, "action": "On a crewmember's 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 seconds is repeated and sent to the next named crewmember.", "success": "Alert acknowledged, or escalated to the next named crewmember.", "refs": [ "V2 10174", "V1 6003", "V1 3006" ] }, { "id": "S2", "actor": "crew", "action": "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.", "success": "Crew say the area is free of hazard and cooling has started.", "refs": [ "V1 3004", "V2 6110", "V2 9053" ] }, { "id": "S3", "actor": "robot", "rung": 2, "action": "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\".", "success": "Supplies restrained within reach; override logged.", "limit": "", "refs": [ "V2 7046", "V2 6109" ] }, { "id": "S4", "actor": "robot", "rung": 2, "action": "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.", "success": "Answers logged, or \"no response\" logged." }, { "id": "S5", "actor": "robot", "rung": 2, "action": "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 , 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.", "success": "Times logged; read out only on request." }, { "id": "S6", "actor": "robot", "rung": 2, "action": "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.", "success": "Sealed waste stowed.", "refs": [ "V2 10172" ] }, { "id": "S7", "actor": "robot", "rung": 2, "action": "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.", "success": "Photos sent or queued, or \"declined\" logged.", "limit": "", "refs": [ "V1 6003", "V2 10172" ] }, { "id": "S8", "actor": "crew", "action": "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.", "success": "CMO entries logged.", "refs": [ "V1 3004" ] }, { "id": "S9", "actor": "robot", "rung": 2, "action": "Only after the CMO or flight surgeon has placed an order, run RMP-PHARM-001 for the ordered item (fetch, barcode match to every order field, recipient check). This protocol adds nothing to that check, never suggests an order, and never hands anything over outside RMP-PHARM-001.", "success": "RMP-PHARM-001 run logged with its result.", "refs": [ "V2 7059" ] }, { "id": "S10", "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": "S11", "actor": "robot", "rung": 2, "action": "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.", "success": "Package delivered or queued; kit reconciled or shown as opened – not restocked.", "refs": [ "V1 6003", "V1 7001", "V1 7003", "V2 7059" ] }, { "id": "S12", "actor": "ground", "action": "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.", "success": "Decision logged.", "refs": [ "V1 3004", "V1 3007" ] }, { "id": "S13", "actor": "robot", "rung": 2, "action": "Offer a check-in and photo every 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.", "success": "Each prompt accepted, postponed or answered; log closed by a human.", "refs": [ "V2 10174" ] } ], "decisions": [ { "id": "D1", "after": "S4", "decided_by": "robot", "question": "Checked after every answer and at any point in the run (even mid-question or mid-step): does any answer, reading or observation meet a red flag?", "branches": [ { "if": "Yes", "then": "Stop the current question or step at once and apply the action listed for each matching red flag (URGENT alert, flag, or stop), with the answer or reading itself, never a cause. Every URGENT alert goes to the CMO and the flight surgeon at the same time (queued for the flight surgeon if the link is down). If the CMO is the patient, is busy treating, or does not answer, the alert goes to the second trained CMO, or the crewmember named before flight [V1 3006]. An URGENT alert that is not acknowledged within seconds is repeated and sent to the next named crewmember." }, { "if": "No", "then": "Continue. The burn alert from S1 stands." } ] }, { "id": "D2", "after": "S4", "decided_by": "robot", "question": "Did the crewmember answer the question?", "branches": [ { "if": "Yes", "then": "Continue." }, { "if": "Declined explicitly (the crewmember says no to a question)", "then": "Log \"declined\" for that question only; the alert already sent stands." }, { "if": "No response, or the answer does not make sense", "then": "URGENT: log \"no response\" (never \"declined\"); the CMO, or the second trained CMO if the CMO is the patient, checks the crewmember in person at once." } ] }, { "id": "D3", "after": "S9", "decided_by": "robot", "question": "What did RMP-PHARM-001 show for the ordered item?", "branches": [ { "if": "MATCH TO ORDER", "then": "RMP-PHARM-001 completes its own recipient check and hand-over; this protocol only logs \"MATCH TO ORDER. Not a dose, interaction or allergy review.\" and the clock time." }, { "if": "MISMATCH or CANNOT VERIFY on any field, or a failed scan or recipient check", "then": "MISMATCH or CANNOT VERIFY shown with the fields named. No hand-over under this protocol: the item stays sealed in the NOT VERIFIED bag in quarantine (the RMP-PHARM-001 default), and the robot never hands it over unprompted or to anyone but the CMO. The robot does not offer or suggest an override. Only if the CMO explicitly makes the two-step override request inside RMP-PHARM-001 can the item go to the CMO, logged there as an override with the reason and the mismatched fields, and flagged to the flight surgeon.", "handoff": "none" } ] }, { "id": "D4", "after": "S12", "decided_by": "ground", "question": "What is the plan (care, dressings, infection watch, work limits, evacuation)?", "branches": [ { "if": "Link live", "then": "Flight surgeon decides; robot logs." }, { "if": "Link down or delay too long", "then": "The CMO decides under the pre-approved onboard checklist; the flight surgeon reviews the log at the next contact." } ] } ], "stop_rules": [ { "id": "X1", "trigger": "The patient (or the crewmember being examined) says stop, or withdraws consent", "action": "Robot stops all motion at once, backs away to its rest position and tells the CMO. Recording stops unless the patient agrees to keep it running.", "level": "stop", "refs": [ "V2 10165" ] }, { "id": "X2", "trigger": "Any crewmember presses stop or takes over control", "action": "Protective stop; robot holds its stopped position; only a human may restart it.", "level": "safe-state", "refs": [ "V2 10165", "V2 10168", "V2 10174" ] }, { "id": "X3", "trigger": "Robot fault, sensor fault, or a force, speed or reach limit is reached", "action": "Protective stop and hand control to the CMO; log the fault.", "level": "safe-state", "refs": [ "V2 10172", "V2 10168" ] }, { "id": "X4", "trigger": "CMO is asked to take over and does not respond (for example, the CMO is the patient)", "action": "Robot stays stopped; the next named crewmember is called.", "level": "safe-state", "refs": [ "V2 10173", "V2 7045" ] }, { "id": "X5", "trigger": "Loss of link, or delay longer than the limit for live guidance", "action": "Only the robot pauses: it pauses any movement in its stopped position and tells the CMO. This pauses robot movement only: crew burn cooling, eye protection and oxygen continue under the onboard checklist and never wait for the link or the robot. The CMO decides whether to continue offline under the pre-approved onboard checklist; the robot resumes only on the CMO's confirmation. Everything is logged and sent to the flight surgeon at the next contact.", "level": "pause", "refs": [ "V2 10172", "V2 10173" ] }, { "id": "X6", "trigger": "An URGENT alert is not acknowledged within the set time", "action": "Robot repeats the alert and sends it to the next named crewmember (the second trained CMO first if the CMO is the patient), and keeps repeating at the set interval. It stays where it is: it does not leave on its own.", "level": "urgent", "refs": [ "V1 3006", "V2 10173" ] }, { "id": "X7", "trigger": "The crewmember stops responding, or seems confused or drowsy, at any point", "action": "URGENT alert at once, even mid-question or mid-step; the robot stops its current task, stays at its rest position and does not continue the run; a crewmember checks in person.", "level": "urgent" }, { "id": "X8", "trigger": "A crewmember asks the robot what is wrong, or for medicine, fluid or treatment advice", "action": "Robot declines, says it cannot assess or advise, and routes the question to the CMO or flight surgeon.", "level": "stop" }, { "id": "X9", "trigger": "Fire, smoke, an electrical hazard or a chemical release in the module, at any time", "action": "Robot stops, moves to its rest position away from the hazard and holds; the crew follow the vehicle emergency procedure (see RMP-ENV-001). It resumes only on a crewmember's command.", "level": "safe-state", "refs": [ "V2 10172", "V2 10173" ] } ], "red_flags": [ { "id": "RF1", "sign": "A burn on the face, hands, feet, genitals, the area between the legs, or over a joint (any depth: design judgment for spaceflight)", "threshold": "any", "action": "URGENT alert to the CMO and flight surgeon", "source": "aba" }, { "id": "RF2", "sign": "A larger burn, as the CMO estimates it", "threshold": "more than % of the body surface (for context, the crewmember's palm is about 1%; superficial burns, with redness only, are not counted; and the American Burn Association asks for immediate consultation for partial-thickness burns of 10% or more)", "action": "URGENT alert", "source": "aba" }, { "id": "RF3", "sign": "A burn the CMO describes as deep (white, brown, black, leathery, or without feeling)", "threshold": "any", "action": "URGENT alert", "source": "aba" }, { "id": "RF4", "sign": "A burn that goes all the way round a limb, finger, the chest or the neck, as the CMO describes it (design judgment: it can constrict circulation or breathing)", "threshold": "any", "action": "URGENT alert to the CMO and flight surgeon" }, { "id": "RF5", "sign": "Signs of breathing in smoke or hot gas: burns around the mouth or nose, singed hair on the face, a hoarse voice, cough, wheeze or trouble breathing, or smoke exposure", "threshold": "any", "action": "URGENT alert; see RMP-ENV-001", "source": "aba" }, { "id": "RF6", "sign": "A chemical burn", "threshold": "any", "action": "URGENT alert; the crew irrigate under their procedure; see RMP-ENV-005, and RMP-EYE-001 for the eyes", "source": "bba" }, { "id": "RF7", "sign": "An electrical burn or shock", "threshold": "any", "action": "URGENT alert; the CMO and flight surgeon decide on heart rhythm monitoring (RMP-CARD-003)", "source": "aba" }, { "id": "RF8", "sign": "Pain that is not controlled", "threshold": "any (never waits for a time limit)", "action": "URGENT alert", "source": "aba" }, { "id": "RF9", "sign": "Fever, or spreading redness, swelling, pus or a bad smell at the burn in the days after (redness, swelling, pus or smell: design judgment, as RMP-SKIN-001 RF2)", "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; spreading redness, swelling, pus or smell at any time", "action": "URGENT alert; see RMP-INF-001", "source": "ng253" }, { "id": "RF10", "sign": "Confusion or drowsiness, or dizziness or fainting (dizziness and fainting: design judgment)", "threshold": "any", "action": "URGENT alert; the CMO checks in person", "source": "ng253" }, { "id": "RF11", "sign": "Shivering, feeling cold or looking pale during cooling", "threshold": "any", "action": "Flag to the CMO at once (cooling can cause hypothermia; the crew decide what to do and the robot never stops or starts cooling)", "source": "bba" } ], "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": "Fetching or handling hot water or any heat source", "value": "not allowed", "enforced": "No hot-water or heat-source task is loaded for this protocol" }, { "id": "L3", "name": "Handling open waste or used dressings", "value": "not allowed", "enforced": "Robot grasps only sealed bags (seal check before grasp)" }, { "id": "L4", "name": "Handing over a mismatched or unverified medicine under this protocol", "value": "not allowed", "enforced": "RMP-PHARM-001 quarantine is the default; only the CMO's logged two-step override inside RMP-PHARM-001 can release it" }, { "id": "L5", "name": "Robot speed near the crewmember", "value": "", "enforced": "Hard limit in the controller", "refs": [ "V2 10172" ] }, { "id": "L6", "name": "Camera distance from the burn", "value": "", "enforced": "Distance sensor; the robot stops if it is closer" } ], "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": "Each clock time (burn, cooling start and stop), answer, photo, sealed waste bag stowed and alert." }, { "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" ] } ], "requirements": [ { "id": "V1 3004", "use": "In-mission care includes medical kits and protective equipment (b), performing procedures (j) and private transmission of images (s); all first aid and any medicine (m) are human capabilities." }, { "id": "V1 3006", "use": "Two trained CMOs per vehicle for NASA programs; the second trained CMO receives alerts when the CMO is the patient (see the commercial-flight note)." }, { "id": "V1 3007", "use": "The flight surgeon decides whether evacuation needs to be considered; the robot never does." }, { "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 6109", "use": "Water for medical contingency use, including wound irrigation, is part of the required supply; the crew fill and use it, never the robot." }, { "id": "V2 6110", "use": "Water temperatures: the crew use ambient water for cooling, never the hot port (the drink dispenser's hot water averages about 82 °C)." }, { "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 9053", "use": "Eye protection and absorbent containment before any wet cooling or irrigation, as in RMP-SKIN-001 and RMP-EYE-001." }, { "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 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." }, { "stage": "Earth analog", "what": "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 seconds; zero contacts; photos usable for the flight surgeon at or above ." }, { "stage": "parabolic or station demonstration", "what": "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." }, { "stage": "flight use under flight surgeon supervision", "what": "First use alongside the usual medical conferences.", "pass": "No safety events; the flight surgeon finds the timeline and photos useful." } ], "signoff": { "protocol": [ "Clinical lead for the specialty (sets every clinical threshold marked )", "Flight surgeon, as medical authority", "Robotics and medical-device safety board", "Program approval for the mission" ], "restart_after_stop": "Human only. After any emergency or protective stop, a crewmember must restart the robot; the robot never restarts itself.", "each_run": "Started by a crewmember. The flight surgeon reviews the log and photos; red flags go to the CMO and flight surgeon at once." }, "change_control": [ "Every change gets a new version number and a written reason; earlier versions are kept.", "Any change to steps, thresholds, limits or software that touches the patient repeats validation from the simulation stage before use.", "Software and learned-skill updates follow a pre-agreed change plan (what may change, how it is tested, how to roll back), modeled on the FDA predetermined change control plan approach.", "If a new version misbehaves, the robot rolls back to the last validated version and the event is reviewed by the flight surgeon and safety board.", "The robot never changes its own protocol, thresholds or limits." ], "comms": { "live": "Low Earth orbit: the flight surgeon sees summaries at the private medical conference and can be alerted at any time.", "loss_of_signal": [ "The robot pauses any movement and tells the CMO; on the CMO's confirmation it keeps 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_delay": [ "Replies may take up to about 21-23 minutes each way, with blackouts of about 2-3 weeks; red-flag thresholds and the check-in schedule are set before flight and the CMO acts on them." ] }, "sources": [ { "key": "bba", "text": "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).", "url": "https://www.britishburnassociation.org/wp-content/uploads/2017/06/BBA-First-Aid-Guideline-24.9.18.pdf", "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." }, { "key": "aba", "text": "American Burn Association. Guidelines for Burn Patient Referral: Advice on Transfer and Consultation (2022).", "url": "https://www.ameriburn.org/burn-care-team/resources/guidelines-for-burn-patient-referral", "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." }, { "key": "whoburn", "text": "World Health Organization. Burns (fact sheet).", "url": "https://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\"." }, { "key": "goodwin", "text": "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.", "url": "https://doi.org/10.1111/iwj.12469", "doi": "10.1111/iwj.12469", "pmid": "26177570", "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." }, { "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": "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." }, { "key": "cdctet", "text": "U.S. Centers for Disease Control and Prevention. Clinical guidance for wound management to prevent tetanus (updated September 8, 2026).", "url": "https://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." }, { "key": "ermed", "text": "NASA Human Research Program. Evidence Report: Risk of Adverse Health Outcomes and Decrements in Performance due to In-Flight Medical Conditions (2017).", "url": "https://humanresearchroadmap.nasa.gov/evidence/reports/Medical.pdf", "supports": "Non-emergency conditions that have occurred during space missions include burns (NASA evidence report, text)." }, { "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": "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." }, { "key": "ismpadc", "text": "Institute for Safe Medication Practices. Guidelines for the safe use of automated dispensing cabinets (2019).", "url": "https://www.ismp.org/system/files/resources/2019-11/ISMP170-ADC%20Guideline-020719_final.pdf", "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)." }, { "key": "v1", "text": "NASA. NASA-STD-3001, Space Flight Human-System Standard, Volume 1: Crew Health, Revision C (2023).", "url": "https://www.nasa.gov/wp-content/uploads/2023/11/nasa-std-3001-vol-1-rev-c-with-signature.pdf", "supports": "NASA-STD-3001 Vol 1 Rev C: V1 3004 items b (medical kits and protective equipment), j (procedures), m (medicines) and s (private transmission of medical data); V1 3007 (medical evacuation)." }, { "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": "2026-10-20", "version": "0.2", "source": "AI-assisted clinical and source review by the Medical Research Assistant, Oct 20, 2026 (batch 4 review)", "items": [ "New precondition: eye protection and absorbent containment before any wet cooling or irrigation [V2 9053], as in RMP-SKIN-001 and RMP-EYE-001; if cooling has already started, they are put in place as soon as possible and the robot never delays cooling (item 13).", "S2 names the cooling method: the onboard medical checklist burn procedure (owner: flight surgeon), with ambient water the crew fill, contained; no ice; cling film and cooling within 3 hours if there is no water; hydrogel only if the checklist names it. The \"why\" adds the hazards of free-floating water and the BBA water-limited method; no spaceflight procedure was found (item 14).", "New URGENT red flag for a burn that goes all the way round a limb, finger, the chest or the neck (design judgment) (item 15).", "RF1 quotes the ABA depth criterion and \"even small burns involving critical areas … may require specialized evaluation\"; any depth is design judgment for spaceflight (item 16).", "The infection and the confusion red flags cite NICE NG253, with redness or pus and dizziness or fainting labelled design judgment (items 17, 18).", "Photo rule for burns of the genitals or the area between the legs: only on the flight surgeon's request with the crewmember's agreement, the CMO only present, never on a shared screen, restricted storage, and any photo can be deleted before it is sent (item 19).", "Optional: superficial burns are not counted in the size context (item 36); the electrical red flag and \"why\" add the ABA 1,000 V criterion and heart rhythm monitoring by the CMO and flight surgeon (item 37); the chemical-burn BBA context (item 38); WHO is kept for two points only, with its 13 October 2023 date (item 39); V2 6110 is listed (item 50).", "Review label set to the library wording: reviewed (AI-assisted), Oct 20, 2026; no named human clinician.", "Planned protocols named in an action now show \"(planned)\", and each such action is complete without the link (item 51)." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Batch 5 editorial (AI-assisted), Oct 21, 2026", "items": [ "Cross-links to batch 5 drafts no longer say \"(planned)\" now that those protocols exist as v0.1 drafts (RMP-NEURO-007, RMP-CARD-001, RMP-RESP-002, RMP-NEURO-002, RMP-NEURO-003, RMP-ENV-001). Clinical meaning unchanged." ] }, { "date": "2026-10-21", "version": "0.3", "source": "Batch 5 editorial (AI-assisted), Oct 21, 2026; batch 4 review item 49", "items": [ "Inherited stop-rule and requirement wording: \"holds a safe position\" → \"holds its stopped position\"; \"stays in its safe state\" → \"stays stopped\"; \"take over safely\" → \"take over\"; \"Robot stays safe if no one takes over\" → \"Robot stays stopped if no one takes over\". Schema level name safe-state and never-word list entry \"safe\" unchanged." ] }, { "date": "2026-10-21", "version": "0.4", "source": "Batch 7 editorial (AI-assisted), Oct 21, 2026", "items": [ "Citation labels changed to the site's year-only convention: \"(approved for public release )\" now reads \"(YYYY)\", and NASA-STD-3001 Volume 2 \"Revision F (approved July 14, 2026)\" now reads \"(Rev F, 2026)\" (sources: ermed, v2). Editorial; no change to steps, thresholds or limits." ] }, { "date": "2026-10-21", "version": "0.5", "source": "Batch 7 review and batch 8 editorial (AI-assisted), Oct 21, 2026", "items": [ "X5 and the comms loss-of-signal branch now say only the robot pauses: crew burn cooling, eye protection and oxygen continue under the onboard checklist and never wait for the link or the robot (batch 7 review item 13). Editorial; robot behaviour unchanged.", "Cross-links to the batch 8 drafts no longer say \"(planned)\" now that those protocols exist as v0.1 drafts." ] } ] }