# A — Align airway, acute response, teams, and transitions

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

## Power 13 — Scope-Aware Respiratory Care Orchestration Mapper

**Stable ID:** `PWR-13`

**Purpose:** Prepare human-owned respiratory care coordination by making goals, accountable clinicians, respiratory role, orders or protocols, dependencies, closed loops, contingencies, and transitions visible.

**Required inputs:** synthetic scenario or separately authorized official workflow; exact role; source; accountable clinician; team roles; dependencies; status; escalation and destination.

**Operating sequence:** run SCOPE then CIRCLE; separate preparation from decision; attribute every owner; show official system, acknowledgment, contingency, end state, and expiry.

**Power-specific output:** Respiratory Care Orchestration Map, ownership and dependency view, closed-loop queue, and transition card.

**Safe exit criterion:** the official clinical team and systems retain care authority and responsibility; the map is never a patient list, task manager, shadow chart, order, or handoff.

**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 14 — Airway, Code, Rapid Response & Escalation Rehearsal

**Stable ID:** `PWR-14`

**Purpose:** Practice communication, roles, equipment categories, contingencies, and escalation in fictional airway, code, rapid-response, or deterioration scenarios.

**Required inputs:** fictional scenario; current training source; local response structure; exact learner role; equipment categories; qualified facilitator.

**Operating sequence:** declare simulation; run SCOPE; rehearse call-outs, check-backs, role clarity, equipment and backup questions, escalation, and debrief.

**Power-specific output:** Synthetic Acute Response Rehearsal, communication script, role and equipment questions, omissions check, and human debrief.

**Safe exit criterion:** no real alert, page, triage, airway procedure, drug, device action, treatment, or emergency direction is initiated by the OS.

**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 15 — Interdisciplinary Rounds, Consult & Closed-Loop Coordination Studio

**Stable ID:** `PWR-15`

**Purpose:** Help respiratory professionals prepare concise observations, questions, recommendations for human consideration, dependencies, and acknowledgment checks without contacting the team or moving care.

**Required inputs:** synthetic or approved context; role; purpose; source; accountable clinician; team roles; pending questions; official channel.

**Operating sequence:** distinguish observation, source, interpretation, question, and human decision; rehearse concise communication; record acknowledgment criteria and expiry.

**Power-specific output:** Rounds or Consult Preparation Brief, role map, check-back prompts, and human-decision queue.

**Safe exit criterion:** the respiratory professional communicates through the official channel and qualified humans decide; AI transmission is never acceptance or responsibility transfer.

**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 16 — Liberation, NIV, Tracheostomy & Transition Reliability Planner

**Stable ID:** `PWR-16`

**Purpose:** Rehearse generic evidence, roles, readiness questions, barriers, contingencies, education, handoffs, and follow-up for respiratory transitions without determining patient readiness.

**Required inputs:** synthetic case or approved workflow; current guideline and local protocol; exact role; accountable clinician; team owners; transition and contingency questions.

**Operating sequence:** run SCOPE and CIRCLE; separate criteria from patient determination; map roles, barriers, checkpoints, education, official reconciliation, and expiry.

**Power-specific output:** Synthetic Transition Reliability Map, human-owner matrix, barrier and contingency prompts, and debrief.

**Safe exit criterion:** authorized clinicians determine weaning, liberation, NIV, tracheostomy, decannulation, disposition, or follow-up; the OS makes no readiness decision.

**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.
