Clinical Pathways as Safety Specifications for Physical AI in Hospital Wards

Physical AI systems increasingly map multimodal observations, language instructions, and learned world representations into physically consequential actions. Robotics foundation models, vision-language-action models, and world-model-based autonomous systems can condition decisions that move vehicles, robots, drones, and industrial machines. This transition exposes a safety problem that is not fully captured by conventional AI content moderation or by classical robot safety alone: a black-box model may issue a physically consequential action while appearing confident, plausible, and semantically aligned. The resulting failure can be silent, arising from sensor drift, occlusion, state-estimation error, distribution shift, hallucinated affordances, or invalid physical assumptions before downstream hardware controllers detect a violation. Across embodied foundation models, world models, robotics simulation, embodied safety benchmarks, safe control, runtime assurance, uncertainty estimation, verification, and guardrail evaluation, model capability and safety mechanisms have advanced along largely separate technical tracks. A recurring gap synthesized here is that no single stream surveyed in this review supplies a complete runtime authorization boundary between black-box Physical AI models and physical execution. The resulting analysis develops a bounded problem formulation, a definition of silent physical-action failure, a taxonomy of runtime guardrail functions, and evaluation requirements for comparing guardrails as Physical AI assurance mechanisms.

Physical AI refers to AI systems that understand, reason about, and act in accordance with the physical world and its underlying laws, dynamics, and constraints. Unlike conventional AI systems, physical AI interacts continuously with uncertain physical environments, and its actions produce consequences that are physically irreversible. As existing trustworthy AI frameworks have been developed primarily for digital AI systems, they do not fully capture the distinctive challenges of physical AI, such as physical safety, cyber-physical security, and physical manufacturing process. To address this gap, we present a survey of trustworthy physical AI principles. First, we characterize the core capabilities and challenges of physical AI. Second, we examine the role of physics in AI. Third, we trace the end-to-end physical AI life cycle across five core stages and introduce Trustworthy Physical AI Operationalization (T-PAIO). Fourth, we develop the Trustworthy Physical AI (T-PAI) framework, a theoretical framework that organizes key trustworthiness principles and provides a foundation for governing trustworthy physical AI systems.

Embodied AI systems are increasingly expected to reason and act over extended horizons in physical environments. This growing capability brings safety to the foreground, because failures in the physical world can harm people, damage objects, and disrupt workplaces. Although safe embodied AI has attracted substantial attention, the literature remains fragmented across planning, policy design, and runtime execution. Long-horizon robotic manipulation is a particularly revealing anchor domain for this problem because semantic misgrounding, subtask-level error propagation, execution drift, and contact-rich physical risk can accumulate within the same closed-loop system. This survey therefore provides a structured review of safety in long-horizon robotic manipulation from an embodied AI perspective. We organize the literature by intervention locus, covering planning-time, policy-time, and execution-time safety, and we analyze the strength of the evidence that each line of work provides, distinguishing formal guarantees, statistical support, and empirical safety heuristics. This framework clarifies the distinct roles of backbone capability papers, direct safety mechanisms, and benchmark or evaluation studies, while exposing where current safety claims are well supported and where they remain indirect. We identify persistent gaps, including limited evidence for policy-time safety, weak formal support for contact-rich long-horizon manipulation, immature uncertainty-triggered intervention, and a shortage of manipulation-specific safety benchmarks. We conclude by outlining research directions for cross-layer assurance, evaluation design, and safer deployment of long-horizon robotic agents in real-world settings.