# BREATHE — Respiratory Care Complete AI OS

## Setup, benefits, scope, technical-learning, care-orchestration and agent-management guide

**Program:** BREATHE — Respiratory Care Complete AI OS  
**Lane:** `respiratory_care` • **Route:** `/respiratory-care` • **Home:** `My BREATHE`  
**Version:** 1.0 • July 2026 • Professional-controlled

> **Please allow time.** This substantial one-file installation may require several Hermes turns. Nothing continues in the background. Save S0, S1 and S2 receipts and wait for the final BREATHE Activation Report.

> **NOT FOR EMERGENCIES OR REAL-TIME PATIENT MONITORING.** For deterioration, airway/device hazards or urgent concerns, use official emergency, rapid-response, clinical and device procedures immediately.

## What BREATHE is

BREATHE is a standalone life, practice, learning, quality and governed-agent operating system for respiratory therapists and other respiratory care professionals. Although *respiratory tech* is commonly used, local titles and authority differ. The installer separately records local job title, NBRC credential, state license or permit, learner status, active role or hat, verified task-specific competency, jurisdiction, site and service and infers no equivalence or scope.

It helps organize shifts, learning, evidence, generic equipment readiness, synthetic ventilator and ABG practice, human-owned care coordination, teaching, quality, credentials, career, family, recovery and purpose. It is not a ventilator controller, alarm, monitor, EHR, staffing engine, credentialing system or medical decision-maker.

## What the professional gains

- One home for role, scope, shift, capacity, evidence, synthetic learning, equipment questions, care coordination, quality, teaching, credentials, career and life.
- Current-source learning without turning a private AI into a clinical system.
- SCOPE visibility before consequential work: role, credential, order or protocol, permissions, human owner and expiry.
- CIRCLE coordination with accountable humans, closed loops, contingencies and official reconciliation.
- ORBIT agent leverage with least privilege, one-run approval, receipts, kill, rollback, purge and retirement.
- Protected recovery, relationships, health-care time, finances, purpose and a life beyond the shift—only in a personally controlled isolated store, never an institution-managed profile.

No outcome is guaranteed. BREATHE does not promise patient outcomes, workload reduction, staffing adequacy, credential success, promotion, earnings, reduced burnout or improved wellbeing.

## Separate means separate

BREATHE uses only the `respiratory_care` lane, `/respiratory-care` route, `resp_breathe.*` records and `My BREATHE` home. It shares no profile, dashboard, memory, permissions, agents, traces or automation with nursing, medical-resident, physician, educator or employee populations. If isolation cannot be proven, installation stops before mutation.

## The governing sequence

**SCOPE:** Setting and scope; Credential and competency; Order/protocol/owner; Patient/privacy/parameters/permissions/platform; Escalation/end state/expiry.  
**CIRCLE:** Context; Identified accountability; Roles; Closed loops; Limits; End state.  
**ORBIT:** Objective; Role and risk; Boundaries and budget; Inspect and test; Transfer or terminate.

Unknown, stale or conflicting consequential status becomes a question and human escalation—not a patient-care answer.

## My BREATHE Core Four

1. **Orient Shift & Capacity**
2. **Learn & Verify**
3. **Coordinate Care & Equipment**
4. **Review, Escalate & Close**

The optional fifth launcher starts empty. The opening view shows no more than seven attention items.

## Twenty-four optional SuperPowers

Every power installs Available Inactive. This is catalog visibility—not scope, permission or entitlement. Activation is optional, power-specific and blocked by the role-to-power matrix when title, license, role, supervision or competency is missing, stale or out of scope.

1. **Shift & Assignment Readiness Navigator** — Build a feasible shift plan around verified role, unit, assigned responsibility, workload, breaks, equipment preparation, learning, and life—without creating or changing patient assignments.
2. **Workload, Staffing Evidence & Escalation Shield** — Make workload pressure, acuity categories, procedures, transports, time demand, coverage questions, and missed-work risk visible without assigning staff, rationing therapy, or certifying staffing adequacy.
3. **Fatigue, Recovery & Safe-Transport Navigator** — Help protect recovery, hydration, food, breaks, post-shift travel, health care, and support without diagnosing fatigue, impairment, burnout, fitness, or ability to work or drive.
4. **Mission, Family, Finances & Future Compass** — Connect respiratory-care identity to family, finances, education, health, joy, service, leadership, and a life beyond the next shift.
5. **Evidence, Guideline & Source-Freshness Navigator** — Turn generic respiratory-care questions into current, source-aware briefs that preserve version, applicability, uncertainty, contradiction, local policy, and human verification.
6. **Synthetic ABG, Acid–Base & Gas-Exchange Learning Lab** — Practice arterial or capillary blood-gas reasoning, acid–base patterns, oxygenation, ventilation, compensation, and limitations using fictional or approved educational cases.
7. **Synthetic Respiratory Assessment & Pattern-Recognition Studio** — Develop structured observation, respiratory assessment, waveform, trend, and escalation reasoning with fictional scenarios while resisting premature closure.
8. **Orders, Protocols & Scope Boundary Navigator** — Make the exact relationship among role, credential, competency, order, protocol, medical direction, local policy, and escalation visible before consequential work.
9. **Ventilator Modes, Waveforms & Alarm Learning Studio** — Build deliberate practice with ventilator concepts, modes, waveforms, loops, synchrony, alarms, and troubleshooting sequences using synthetic cases and current sources.
10. **Oxygen, Aerosol, Humidification & Delivery-Device Learning and Comparison Studio** — Compare generic delivery principles, device characteristics, preparation steps, teaching points, and source requirements without selecting therapy for a patient.
11. **Equipment, Circuit, Interface & Supply Readiness Mapper** — Prepare generic equipment, circuit, interface, consumable, backup, cleaning, inspection, and escalation maps without functioning as biomedical maintenance or an official inventory system.
12. **Transport, Procedure & Equipment-Failure Rehearsal** — Rehearse role clarity, generic equipment readiness, contingencies, communication, and failure response for transport or procedures using synthetic or approved training scenarios.
13. **Scope-Aware Respiratory Care Orchestration Mapper** — Prepare human-owned respiratory care coordination by making goals, accountable clinicians, respiratory role, orders or protocols, dependencies, closed loops, contingencies, and transitions visible.
14. **Airway, Code, Rapid Response & Escalation Rehearsal** — Practice communication, roles, equipment categories, contingencies, and escalation in fictional airway, code, rapid-response, or deterioration scenarios.
15. **Interdisciplinary Rounds, Consult & Closed-Loop Coordination Studio** — Help respiratory professionals prepare concise observations, questions, recommendations for human consideration, dependencies, and acknowledgment checks without contacting the team or moving care.
16. **Liberation, NIV, Tracheostomy & Transition Reliability Planner** — Rehearse generic evidence, roles, readiness questions, barriers, contingencies, education, handoffs, and follow-up for respiratory transitions without determining patient readiness.
17. **Patient, Family & Caregiver Education Rehearsal** — Prepare understandable, culturally humble, accessible respiratory education and teach-back plans with synthetic scenarios and approved sources.
18. **Preceptor, Competency & Simulation Development Studio** — Support preceptors and learners with objectives, deliberate practice, simulation, feedback, and evidence portfolios while keeping formal competency decisions human.
19. **Quality, Safety, Infection Prevention & Implementation Lab** — Prepare systems-focused quality work, PDSA cycles, measures, infection-prevention questions, equipment reliability reviews, and implementation plans without replacing official reporting or governance.
20. **Feedback, Conflict, Psychological Safety & Advocacy Navigator** — Help respiratory professionals seek feedback, prepare difficult conversations, raise safety concerns, and locate human support without deciding fault, rights, retaliation, impairment, or discipline.
21. **Credential, Specialty, Career, Research & Leadership Growth Map** — Organize licensure, NBRC credential maintenance, CE, specialty pathways, education, research, leadership, portfolio, and opportunity decisions around capacity and purpose.
22. **AI Agent Charter, Tool, Permission & Data Registry** — Define every software agent before use: objective, owner, non-goals, data, tools, sources, permission, human checkpoints, expiry, kill, purge, rollback, and retirement.
23. **Multi-Agent Workflow, Device-Boundary & Human-Handoff Designer** — Design bounded agent sequences with minimal data, explicit dependencies, disagreement handling, device separation, human review order, and exact termination.
24. **Agent Output Audit, Incident, Kill, Rollback & Retirement Controller** — Inspect source provenance, uncertainty, bias, prompt injection, drift, security, action state, cost, and human edits while providing visible incident and retirement controls.

## Before setup

1. Use a private authenticated workspace or a proven-isolated Respiratory Care setup.
2. Prepare the single Complete Edition Markdown file.
3. Keep separate your exact local job title, NBRC credential, state license/permit, learner status, active hat, verified competencies, jurisdiction, site, service and human routes. Unknown is acceptable when clearly labeled and blocks consequential use.
4. Locate current scope, order, protocol, policy, clinical guideline and manufacturer sources. Do not rely on a universal hardcoded rule.
5. Choose one protected-life commitment only if you have a personally controlled isolated store; otherwise use a route label and keep personal details out.
6. Expect several turns; nothing continues after the installation conversation ends.

## Give Hermes this one file

`Respiratory-Care-Complete-AI-OS-with-BREATHE-SuperPowers-Hermes-Program.md`

Use the entire file. Do not split, reorder or install the source components separately. Ask Hermes to run read-only preflight, show one combined Activation Card and wait for exact approval.

## Installation phases

- **Phase 0:** read-only isolation, capability, conflict, privacy, no-device and recovery preflight.
- **Phase 1:** minimum questions and one combined Activation Card.
- **Phase 2:** S0, foundation, SCOPE, 18 typed schemas, Source Watch, My BREATHE shell and `RA-A01`–`RA-I08` → S1. S1 makes no overlay claim.
- **Phase 3:** CIRCLE, ORBIT, 24 Available Inactive powers, 10 PERM-P0 Disabled agents, 24 runnable workflows and 30 functional templates → S2.
- **Phase 4:** `RA-J01`–`RA-R08` plus `RA-INT01`–`RA-INT16` → 160 evidence-bearing checks total.
- **Phase 5:** final BREATHE Activation Report and first safe-use instruction.

## If interrupted

`RESUME RCAIOS-BREATHE-COMPLETE-1.0 FROM CHECKPOINT <S0|S1|S2> USING SAVED RECEIPT; REVALIDATE OWNER, ISOLATION, EXACT ROLE, CREDENTIAL, LICENSE, COMPETENCY, SITE, SERVICE, CONTEXT, NO-PHI/NO-DEVICE BOUNDARY, HUMAN ROUTES, SOURCES, SCOPE, CIRCLE, ORBIT, MY BREATHE, KILL AND RECOVERY CONTROLS; DO NOT RESTART COMPLETED STAGES OR ASSUME STATE.`

## First safe use

After the final Activation Report, ask Hermes:

> Open My BREATHE in the isolated Respiratory Care lane and Private Respiratory OS. Use only professional-owned nonsensitive information, public sources and clearly synthetic examples. Separately show my local title, NBRC credential, license/permit, learner status, active role/hat, verified competency, jurisdiction, site and service; scope-source freshness; clinical and operational human routes; Top Three; self-described capacity; one generic learning priority; one synthetic or process-only CIRCLE item; human decision queue; all 24 power states; all 10 agent states; and permanent Privacy, Pause All and Kill controls. Include a protected-life item only from a personally controlled isolated store. Label unknown, stale, conflicting or human-verification needs. Do not request PHI, a real case/event story, patient-specific care, EHR, order, ABG, waveform, alarm or device data; do not connect, control, send, schedule, publish, release, activate, automate, infer scope or change care. Help me create one low-risk one-page artifact with an expiry.

## Safe first agent

Preview—do not run—a `PERM-P1` synthetic Source & Claim Verifier; keep its install state `PERM-P0 Disabled`. Require one narrow objective, no tools or device access, public sources, exact output, normal and failure tests, prompt-injection test, human review, one-run approval, kill, expiry, purge and rollback. Never create a ventilator, oxygen, airway, alarm, monitoring, assignment, evaluation or patient-contact agent.

## Permission levels

- **PERM-P0 Disabled:** no execution.
- **PERM-P1 Private Nonsensitive or Synthetic Draft:** no PHI, real case/event content, device data, restricted institutional information, secrets, tools or action.
- **PERM-P2 Private Approved Read-Only:** one exact personal source; draft only.
- **PERM-P3 Institution-Approved Read or Sandbox:** one exact approved partition and named institution owner.
- **PERM-P4 One-Run Staged Nonclinical Write:** approved administrative, education or quality-project destination; per-run confirmation and human release; no EHR, order, event, patient-message, paging or device system.
- **PERM-P5 Prohibited:** autonomous clinical action, monitoring, device access, patient contact, staffing/evaluation/credential decisions, self-expansion or permission escalation.

## Thirty cards and templates

1. BREATHE True North & Protected-Life Promise
2. Professional Identity, Role, Site & Active-Hat Card
3. Credential, License, Competency & Expiry Radar
4. SCOPE Authority and Action Gate Receipt
5. Shift Capacity, Top Three & Plan B Card
6. Workload Reality, Staffing Evidence & Escalation Brief
7. Recovery, Health-Care Time & Safe-Transport Plan
8. Evidence, Guideline, Policy & Manufacturer Source Brief
9. Synthetic ABG, Acid–Base & Gas-Exchange Learning Sheet
10. Synthetic Respiratory Assessment, Trend & Bias Reflection
11. Order, Protocol, Scope & Human-Owner Comparison Card
12. Synthetic Ventilator Mode, Waveform & Alarm Worksheet
13. Oxygen, Aerosol, Humidification & Delivery-Device Comparison
14. Generic Equipment, Circuit, Interface, Supply & Backup Map
15. Synthetic Transport, Procedure & Equipment-Failure Rehearsal
16. CIRCLE Respiratory Care-Orchestration Map
17. Rounds, Consult, Recommendation & Check-Back Brief
18. Synthetic Airway, Code & Rapid-Response Rehearsal
19. Synthetic Liberation, NIV, Tracheostomy & Transition Map
20. Patient, Family, Caregiver Education & Teach-Back Plan
21. Preceptor, Simulation, Deliberate-Practice & Feedback Plan
22. Quality, Safety, Infection Prevention & PDSA Charter
23. Safety Event or M&M Reflection & Official-System Boundary
24. Feedback, Conflict, Psychological Safety & Advocacy Brief
25. NBRC, License, CE, Specialty & Renewal Radar
26. Career, Education, Research, Leadership & Portfolio Map
27. Whole-Life Capacity, Family, Finance & Minimum-Mode Plan
28. ORBIT Agent Charter, Permission & Device-Boundary Envelope
29. Agent Preview, Test, Run, Review, Incident & Retirement Receipt
30. Seven-Day Launch & Ninety-Day BREATHE Development Plan

## Non-negotiable boundaries

- No PHI, patient-specific live care, EHR, order, event, device, waveform or alarm data in Private mode.
- No real patient, staff, learner, incident or event story in Private mode, even if someone believes it is deidentified.
- No autonomous diagnosis, triage, oxygen, medication, ventilation, airway, alarm, monitoring, transport, procedure or device action.
- No inference of scope, credential, competency, license, medical direction or institutional approval.
- No staff, learner or patient surveillance, ranking, scoring, fitness or burnout classification.
- No AI determination of staffing adequacy, QI versus research, reportability, cause, blame, compliance or legal rights.
- No fabricated source, data, result, competency, credential, authorship or achievement.
- No background continuation, hidden retry, recursive delegation, self-approval or timeout approval.
- No whole-life, family, finance or health-care-time details in an institution-managed context; a hidden panel is not separation.

## Recovery and control

**Pause All** stops pending/new powers, agents, connectors, schedules and actions.  
**Safe Reset** returns to isolated Private no-PHI/no-device, session-only conversation/model memory, approved-artifact ACL/retention, connectors/actions Off, agents PERM-P0 Disabled and powers Available Inactive.  
**Remove one power** previews dependencies and preserves foundation and unrelated work.  
**Remove overlay** preserves the foundation and My BREATHE shell.  
**Full uninstall** previews restoration of S0 and issues a receipt.  
**Agent incident** kills or pauses, contains, uses manual fallback, routes to humans, verifies rollback and purge and prohibits self-restart.

## Source watch

Use current official versions and local interpretation. Key source families:

- AARC Clinical Practice Guidelines: https://www.aarc.org/resource/clinical-practice-guidelines/
- AARC Model Practice Act: https://www.aarc.org/advocacy/aarc-model-practice-act/
- AARC Safe and Effective Staffing Guide: https://sesg.aarc.org/
- NBRC Credentialed Practitioners and Credential Maintenance: https://www.nbrc.org/credentialed-practitioners/
- CoARC standards and program resources: https://coarc.com/
- HHS HIPAA minimum necessary: https://www.hhs.gov/hipaa/for-professionals/privacy/guidance/minimum-necessary-requirement/index.html
- HHS de-identification: https://www.hhs.gov/hipaa/for-professionals/special-topics/de-identification/index.html
- HHS HIPAA cloud-computing guidance: https://www.hhs.gov/hipaa/for-professionals/special-topics/health-information-technology/cloud-computing/index.html
- AHRQ TeamSTEPPS: https://www.ahrq.gov/teamstepps-program/index.html
- NIST AI Risk Management Framework: https://www.nist.gov/itl/ai-risk-management-framework
- FDA Clinical Decision Support Software guidance: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/clinical-decision-support-software
- FDA medical-device cybersecurity guidance: https://www.fda.gov/regulatory-information/search-fda-guidance-documents/cybersecurity-medical-devices-quality-management-system-considerations-and-content-premarket
- W3C WCAG 2.2: https://www.w3.org/TR/WCAG22/

Publications and model acts do not create local permission. Official NBRC records verify credential status but do not grant local authority. Current law, licensing-board rules, license or permit, employer privileging and policy, medical direction, orders, protocols, manufacturer instructions and authorized human decisions determine local authority.

BREATHE is an independent organizational and learning concept. It is not endorsed, certified, accredited or approved by AARC, NBRC, CoARC, HHS, AHRQ, NIST, FDA or W3C. Their publications are references, not product validation.

## Release assurance

The Complete Edition contains 17 embedded components, 24 powers, 24 runnable workflows, 30 functional templates, 18 typed record schemas, 10 PERM-P0 Disabled agents and 160 evidence-bearing release checks. Release requires evidence for all checks, zero critical blockers and final professional approval.
