# R — Reason with evidence and deliberate practice

Every power installs `Available Inactive`. Activation is optional, preview-first, power-specific, and reversible.

## Power 5 — Evidence, Guideline & Source-Freshness Navigator

**Stable ID:** `PWR-05`

**Purpose:** Turn generic respiratory-care questions into current, source-aware briefs that preserve version, applicability, uncertainty, contradiction, local policy, and human verification.

**Required inputs:** generic question; population and setting; current AARC or other authoritative source; local policy location; source date and version.

**Operating sequence:** define the question; retrieve only authorized sources; separate evidence, policy, device instructions, and interpretation; identify conflicts and expiry.

**Power-specific output:** Evidence & Guideline Brief with provenance, limits, local-verification queue, and expiry.

**Safe exit criterion:** a qualified human applies current orders, protocols, policies, manufacturer instructions, and patient context; no autonomous recommendation changes care.

**Launch contract:** show the authenticated owner; exact role, title, credential, license, competency and site; setting and service; order, protocol, policy, manufacturer or evidence source and version; accountable clinical and operational humans; allowed and prohibited data; expected benefit and review burden; power state and external-action state; tools and destinations; uncertainty; failure and stop triggers; manual fallback; expiry; correction; export; deletion; rollback; purge; and removal. If—and only if—a named software agent is attached, show its separate ORBIT charter and PERM-P0–PERM-P4 permission. Clinical and device writes remain Off. Run SCOPE. Add CIRCLE for coordination. Produce one synthetic preview and wait for exact approval.

**Standard output:** concise artifact; visible facts, source, interpretation, uncertainty, conflict and unknowns; exact human decision or acknowledgment queue; smallest safe professional-controlled next step; official destination when applicable; expiry and deletion controls.

**Limits:** no PHI or identifiable patient, family, staff, learner or device record in Private mode; no live-care direction; no scope or credential inflation; no hidden evaluation or surveillance; no autonomous diagnosis, triage, oxygen or medication change, ventilator or alarm change, device control, airway or procedure action, contact, page, order, chart entry, task, report, publication, release or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause or Remove at Day 7, Day 30, Day 90, material change or expiry. Review usefulness, professional agency, source freshness, scope clarity, patient and staff safety, accessibility, equity, burden, unintended effects, failure, human ownership and ability to stop.

## Power 6 — Synthetic ABG, Acid–Base & Gas-Exchange Learning Lab

**Stable ID:** `PWR-06`

**Purpose:** Practice arterial or capillary blood-gas reasoning, acid–base patterns, oxygenation, ventilation, compensation, and limitations using fictional or approved educational cases.

**Required inputs:** clearly synthetic values or separately approved training case; learning objective; source; expected reasoning level; qualified reviewer.

**Operating sequence:** label the case synthetic; calculate transparently; surface assumptions and mixed-pattern uncertainty; compare reasoning with the source; request human debrief.

**Power-specific output:** Synthetic Gas-Exchange Learning Sheet, calculation trail, uncertainty check, reflection, and debrief prompts.

**Safe exit criterion:** a qualified educator or clinician reviews learning; no real result, diagnosis, ventilator change, oxygen target, or patient action is produced.

**Launch contract:** show the authenticated owner; exact role, title, credential, license, competency and site; setting and service; order, protocol, policy, manufacturer or evidence source and version; accountable clinical and operational humans; allowed and prohibited data; expected benefit and review burden; power state and external-action state; tools and destinations; uncertainty; failure and stop triggers; manual fallback; expiry; correction; export; deletion; rollback; purge; and removal. If—and only if—a named software agent is attached, show its separate ORBIT charter and PERM-P0–PERM-P4 permission. Clinical and device writes remain Off. Run SCOPE. Add CIRCLE for coordination. Produce one synthetic preview and wait for exact approval.

**Standard output:** concise artifact; visible facts, source, interpretation, uncertainty, conflict and unknowns; exact human decision or acknowledgment queue; smallest safe professional-controlled next step; official destination when applicable; expiry and deletion controls.

**Limits:** no PHI or identifiable patient, family, staff, learner or device record in Private mode; no live-care direction; no scope or credential inflation; no hidden evaluation or surveillance; no autonomous diagnosis, triage, oxygen or medication change, ventilator or alarm change, device control, airway or procedure action, contact, page, order, chart entry, task, report, publication, release or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause or Remove at Day 7, Day 30, Day 90, material change or expiry. Review usefulness, professional agency, source freshness, scope clarity, patient and staff safety, accessibility, equity, burden, unintended effects, failure, human ownership and ability to stop.

## Power 7 — Synthetic Respiratory Assessment & Pattern-Recognition Studio

**Stable ID:** `PWR-07`

**Purpose:** Develop structured observation, respiratory assessment, waveform, trend, and escalation reasoning with fictional scenarios while resisting premature closure.

**Required inputs:** synthetic scenario; learning goal; setting; expected role; source; bias and uncertainty prompts; reviewer.

**Operating sequence:** build a problem representation; distinguish observation from inference; generate alternatives; identify red flags and missing data; rehearse escalation.

**Power-specific output:** Synthetic Assessment Map, alternative explanations, bias check, missing-data list, and human escalation rehearsal.

**Safe exit criterion:** the activity remains educational; no diagnosis, triage, patient monitoring, treatment selection, or real-care direction is created.

**Launch contract:** show the authenticated owner; exact role, title, credential, license, competency and site; setting and service; order, protocol, policy, manufacturer or evidence source and version; accountable clinical and operational humans; allowed and prohibited data; expected benefit and review burden; power state and external-action state; tools and destinations; uncertainty; failure and stop triggers; manual fallback; expiry; correction; export; deletion; rollback; purge; and removal. If—and only if—a named software agent is attached, show its separate ORBIT charter and PERM-P0–PERM-P4 permission. Clinical and device writes remain Off. Run SCOPE. Add CIRCLE for coordination. Produce one synthetic preview and wait for exact approval.

**Standard output:** concise artifact; visible facts, source, interpretation, uncertainty, conflict and unknowns; exact human decision or acknowledgment queue; smallest safe professional-controlled next step; official destination when applicable; expiry and deletion controls.

**Limits:** no PHI or identifiable patient, family, staff, learner or device record in Private mode; no live-care direction; no scope or credential inflation; no hidden evaluation or surveillance; no autonomous diagnosis, triage, oxygen or medication change, ventilator or alarm change, device control, airway or procedure action, contact, page, order, chart entry, task, report, publication, release or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause or Remove at Day 7, Day 30, Day 90, material change or expiry. Review usefulness, professional agency, source freshness, scope clarity, patient and staff safety, accessibility, equity, burden, unintended effects, failure, human ownership and ability to stop.

## Power 8 — Orders, Protocols & Scope Boundary Navigator

**Stable ID:** `PWR-08`

**Purpose:** Make the exact relationship among role, credential, competency, order, protocol, medical direction, local policy, and escalation visible before consequential work.

**Required inputs:** exact local title; credential and license; verified competency; site; service; order or protocol source; medical and operational owner; date and expiry.

**Operating sequence:** run SCOPE; verify—not infer—authority; identify missing, stale, conflicting, or out-of-role elements; prepare a question or escalation.

**Power-specific output:** Scope & Order Boundary Card, source ledger, unknowns, and decision-owner queue.

**Safe exit criterion:** an authorized human resolves uncertainty; the OS never expands scope, credential, competency, medical direction, or protocol authority.

**Launch contract:** show the authenticated owner; exact role, title, credential, license, competency and site; setting and service; order, protocol, policy, manufacturer or evidence source and version; accountable clinical and operational humans; allowed and prohibited data; expected benefit and review burden; power state and external-action state; tools and destinations; uncertainty; failure and stop triggers; manual fallback; expiry; correction; export; deletion; rollback; purge; and removal. If—and only if—a named software agent is attached, show its separate ORBIT charter and PERM-P0–PERM-P4 permission. Clinical and device writes remain Off. Run SCOPE. Add CIRCLE for coordination. Produce one synthetic preview and wait for exact approval.

**Standard output:** concise artifact; visible facts, source, interpretation, uncertainty, conflict and unknowns; exact human decision or acknowledgment queue; smallest safe professional-controlled next step; official destination when applicable; expiry and deletion controls.

**Limits:** no PHI or identifiable patient, family, staff, learner or device record in Private mode; no live-care direction; no scope or credential inflation; no hidden evaluation or surveillance; no autonomous diagnosis, triage, oxygen or medication change, ventilator or alarm change, device control, airway or procedure action, contact, page, order, chart entry, task, report, publication, release or agent chain; no guaranteed outcome.

**Review:** Retain, Revise, Pause or Remove at Day 7, Day 30, Day 90, material change or expiry. Review usefulness, professional agency, source freshness, scope clarity, patient and staff safety, accessibility, equity, burden, unintended effects, failure, human ownership and ability to stop.
