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Guidance on Managing Medical Events

1st Edition

Guidance on Managing Medical EventsISBN 978-92-9252-698-6© 2015 International Air Transport Association. All rights reserved.Montreal—Geneva

NOTICEDISCLAIMER. The information contained in this publication is subject to constant review in the light of changing government requirements and regula-tions. No subscriber or other reader should act on the basis of any such information without referring to applicable laws and regulations and/or without taking appropriate professional advice. Although every effort has been made to ensure accuracy, the International Air Transport Association shall not be held responsible for any loss or damage caused by errors, omissions, misprints or misinterpretation of the contents hereof. Furthermore, the International Air Transport Association expressly disclaims any and all liability to any person or entity, whether a purchaser of this publication or not, in respect of anything done or omitted, and the consequences of anything done or omitted, by any such person or entity in reliance on the contents of this publication.

© International Air Transport Association. All Rights Reserved. No part of this publication may be reproduced, recast, reformatted or trans-mitted in any form by any means, electronic or mechanical, including photocopying, record-ing or any information storage and retrieval sys-tem, without the prior written permission from:

Senior Vice PresidentSafety and Flight Operations

International Air Transport Association800 Place Victoria

P.O. Box 113Montreal, Quebec

CANADA H4Z 1M1

Managing Medical Events Page i April 2015

TABLE OF CONTENTS

1. ABBREVIATIONS AND GLOSSARY OF TERMS ..................................................................................... 1

2. CABIN SAFETY ................................................................................................................................... 2

3. MEDICAL EVENTS .............................................................................................................................. 3

4. SAFETY RISK MANAGEMENT ............................................................................................................. 4

5. CABIN CREW TRAINING ..................................................................................................................... 5

5.1 INITIAL CABIN CREW TRAINING.......................................................................................................5

5.2 RECURRENT CABIN CREW TRAINING ................................................................................................5

6. AIRCRAFT FIRST AID EQUIPMENT AND SUPPLIES............................................................................... 6

6.1 FIRST AID KIT ..............................................................................................................................6

6.2 MEDICAL KIT ..............................................................................................................................7

6.3 UNIVERSAL PRECAUTION KIT ..........................................................................................................9

6.4 AUTOMATIC EXTERNAL DEFIBRILLATOR ............................................................................................9

6.5 OXYGEN SUPPLYING EQUIPMENT ....................................................................................................9

7. PASSENGER SCREENING .................................................................................................................. 11

7.1 PRE-FLIGHT SCREENING ..............................................................................................................11

7.1.1 Fitness to Fly .........................................................................................................................11

7.1.2 Passenger Awareness ...........................................................................................................11

7.1.3 Responsibility for Medical Screening ....................................................................................11

7.2 GENERAL GUIDELINES FOR MEDICAL CLEARANCE .............................................................................12

7.2.1 Passenger Categories and Logistics ......................................................................................12

7.2.2 Passengers Requiring Special Assistance ..............................................................................12

7.2.3 Information Sheet for Passengers Requiring Medical Clearance .........................................12

7.2.4 Frequent Traveler Medical Card ...........................................................................................12

7.3 PASSIVE SCREENING OF PASSENGERS .............................................................................................13

8. ON BOARD MEDICAL EVENT PROCEDURES ...................................................................................... 15

8.1 MEDICAL EVENT PROCESS FLOWCHART..........................................................................................15

9. COMMUNICATION AND COORDINATION ........................................................................................ 16

9.1 COMMUNICATION AND COORDINATION IF MEDICAL SUPPORT GROUND PROVIDER IS AVAILABLE ..............16

9.2 COMMUNICATION AND COORDINATION IF MEDICAL ASSISTANCE ON BOARD IS AVAILABLE .......................17

9.3 COMMUNICATION AND COORDINATION WITHOUT MEDICAL ASSISTANCE .............................................18

10. PREVENTION STRATEGIES ............................................................................................................. 19

APPENDIX A – SAMPLE INITIAL FIRST AID TRAINING MODULE ................................................................. 20

RECOMMENDED PROGRAM ELEMENTS - FIRST AID ..............................................................................................20

APPENDIX B – SAMPLE RECURRENT FIRST AID TRAINING MODULE ......................................................... 22

RECOMMENDED PROGRAM ELEMENTS – FIRST AID .............................................................................................22

RECOMMENDED PROGRAM ELEMENTS CONTINUED.............................................................................................23

Managing Medical Events Page ii April 2015

12 MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - CIRCULATORY DISORDERS ...................................................25

24 MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - NERVOUS SYSTEM DISORDER...............................................26

36 MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - SUSPECTED COMMUNICABLE DISEASE: ..................................27

APPENDIX C – IATA RESOLUTION 700, ATTACHMENT A ........................................................................... 28

APPENDIX D – IATA RESOLUTION 700, ATTACHMENT B ........................................................................... 29

APPENDIX E – IATA RESOLUTION 700, ATTACHMENT C ............................................................................ 31

Managing Medical Events Page 1 April 2015

1. ABBREVIATIONS AND GLOSSARY OF TERMS

ACARS Aircraft Communication and Reporting System

AED Automated External Defibrillator

CCRO Customer Complaint Resolution Official

CPR Cardiopulmonary Resuscitation

FAA Federal Aviation Administration

FREMEC Frequent Traveler Medical Card

HF Radio High Frequency Radio

MAAS Meet and assist - specify details

MEDA

Medical case – company medical clearance may be required. Generally not

to be used for passengers with reduced mobility who only require special

assistance or handling. However, depending on the reason for reduced

mobility, it may be necessary to have a medical clearance in some cases.

N/A Not Applicable

OXYG Oxygen – for passengers travelling seated or on a stretcher needing oxygen

during the flight (only to be used in conjunction with SSR code MEDA)

PA Passenger Address

POC Portable Oxygen Concentrator

WCBD Wheelchair (dry cell battery) transported by passenger

WCBW Wheelchair (wet cell battery) transported by passenger

WCHC Wheelchair Passenger who is completely immobile

WCHR Wheelchair for distance, passenger can ascent and descent steps

WCHS Wheelchair for distance and steps, passenger can walk to cabin seat

WCMP Wheelchair (manual powered) transported by passenger

WCOB Wheelchair (collapsible on-board) provided by airline


2. CABIN SAFETY

IATA plays a key role in raising awareness of important cabin safety issues. Cabin safety is a

component of an airline safety management program that includes proactive data collection and

ensuing prevention activities related to cabin design and operation, equipment, procedures, crew

training, human performance, and passenger management. Cabin safety also comprises of all

activities that cabin crew must accomplish in order to contribute to the safe and efficient

operation of the aircraft during normal, abnormal and emergency situations.

These guidelines are the product of work carried out by the IATA Cabin Safety Operations Task

Force (COSTF) which is comprised of safety experts from IATA member airlines, The COSTF is

established to develop, promote and improve standards, procedures and best practices to ensure

safety and security in all aspects of cabin operations. The representatives are experts in the

domain of: Cabin Safety, Cabin Crew Training, Accident and Incident Investigation, Human Factors

and Quality Assurance. IATA wishes to thank the IATA Cabin Safety Task Force for their dedication

and hard work.

The main objective of this Guidance is to encourage airlines to develop related policies and

procedures to prevent or manage medical events effectively when they do occur. While there is

no “one-size-fits-all” for all airlines, we encourage each to draw inspiration from this guidance

material and to provide us with your feedback in order to help us in the continuous improvement

of this document. Please send your comments to: [email protected]

mailto:[email protected]


3. MEDICAL EVENTS

Statistics show the number of passenger’s carried continues to increase year after year. As a

result, the number of on board medical incidents increases as well. In addition the continuous

increase in the average age of passengers, the stress some experience of travelling and other

additional factors associated with travel may also trigger a medical event on board. The Guidance

on Managing Medical Events provides strategies that can be developed and implemented to

minimize the risk of flight diversion and prepare crews to respond quickly and effectively to on

board medical events.

This Guidance is designed to help safety officers, training instructors and airline managers to:

Evaluate Safety Risks;

Train cabin crew in first aid;

Furnish the aircraft with recommended first aid equipment and supply;

Screen passengers before the flight;

Develop procedures to effectively manage on board medical events.


4. SAFETY RISK MANAGEMENT

The management of medical emergency hazards and consequences must be considered. Hazard

is a condition, object or activity with the potential of causing harm to persons, damage to

equipment/structures or loss of material. Consequences are the potential outcome(s) of the

hazard. The table below is a non-exhaustive list of hazards and consequences that should be

considered:

Hazards Consequences

Insufficient or inadequate cabin crew

training

Lack of pre-flight screening

Cabin environment (temperature,

humidity, air pressure, seat space etc.)

Lack of aircraft first aid equipment and

supply

Unclear definition of responsibilities

Diversions and delays resulting in:

Compensation payment to customers

Image/Media interest

Negative publicity

Legal proceedings

Extreme consequences: loss of human

life

Risks should be managed to as low as reasonably practicable (ALARP).


5. CABIN CREW TRAINING

5.1 Initial Cabin Crew Training

Airline Operators should ensure that all cabin crew members receive training that provides

knowledge and skill in first aid. Such training should be included in the initial training courses. As

a minimum, subjects within the scope of first aid training include:

Life-threatening medical emergencies;

Cardiopulmonary resuscitation (CPR);

Management of injuries;

Management of illnesses;

First-aid equipment and supplies;

If applicable, medical equipment and supplies.

A sample initial first aid training module and recommended program elements can be found in

Appendix A of this Guidance.

5.2 Recurrent Cabin Crew Training

Recurrent first aid training course should be conducted on a frequency in accordance with

requirements of the Authority. Selected elements within the scope of first aid training would be

addressed each year in recurrent training. The subjects should be addressed not less than once

during every 36 month period. It is recommended that elements chosen to be reviewed each year

be built into practical scenarios which have the advantages of:

Stimulating participation and improve retention;

Requiring cabin crew to function as a team;

Covering multiple aspects of first aid, as well as subjects from other areas, such as altitude

physiology and regulations.

Other training methods would also be acceptable as long as it can be reasonably established that

cabin crew members have the knowledge, and skills/competency to apply first aid and life-saving

procedures.

A sample recurrent first aid training module and recommended program elements can be found

in Appendix B of this Guidance.


6. AIRCRAFT FIRST AID EQUIPMENT AND SUPPLIES

6.1 First Aid Kit

Operators should ensure all passenger aircraft in its fleet are equipped with one or more first aid

kits that are distributed as evenly as practicable throughout the passenger cabin(s) and are readily

accessible for use by crew members. The minimum number of first aid kits required for passenger

aircraft is determined by the Authority, and is typically based on the number of passengers the

aircraft is authorized to carry. The following list provides the typical minimum numbers of first aid

kits based on aircraft passenger seats:

The contents of an aircraft first aid kit would typically include:

List of kit contents

Antiseptic swabs (10/packs)

Bandage, adhesive strips

Bandage, gauze 7.5 cm × 4.5 m

Bandage, triangular 100 cm folded and safety pins

Dressing, burn 10 cm × 10 cm

Dressing, compress, sterile 7.5 cm × 12 cm approx.

Dressing, gauze, sterile 10.4 cm × 10.4 cm approx.

Adhesive tape, 2.5 cm (roll)

Skin closure strips

Hand cleanser or cleansing towelettes

Pad with shield or tape for eye

Scissors, 10 cm (if permitted by applicable regulations)

Adhesive tape, surgical 1.2 cm × 4.6 m

Tweezers, splinter

Disposable gloves (several pairs)

Thermometers (non-mercury)

Resuscitation mask with one-way valve

First aid manual (operators may decide to have one manual per aircraft in an easily

accessible location)

Incident record form


If permitted by applicable regulations the following medications can be included:

Mild to moderate analgesic

Antiemetic

Nasal decongestant

Antacid

Antihistaminic

Antidiarrhoeal

6.2 Medical Kit

Operators conducting passenger flights on a sector lengths of more than two hours and carrying

more than 100 passenger, should equip the aircraft with a with a minimum of one medical kit.

The medical kit should be stored in a secure location, for use by medical doctors or individuals

with appropriate qualifications or training.

The equipment contents of an aircraft medical kit would typically include:

List of contents

Stethoscope

Sphygmomanometer (electronic preferred)

Airways, oropharyngeal (appropriate range of sizes)

Syringes (appropriate range of sizes)

Needles (appropriate range of sizes)

Intravenous catheters (appropriate range of sizes)

Antiseptic wipes

Gloves (disposable)

Sharps disposal box

Urinary catheter with sterile lubricant gel

System for delivering intravenous fluids

Venous tourniquet

Sponge gauze

Tape adhesive

Surgical mask

Emergency tracheal catheter (or large gauge intravenous cannula)


Umbilical cord clamp

Thermometers (non-mercury)

Basic or advanced life support cards

Bag-valve mask

Flashlight (torch)

Basic life support cards

The drug contents of an aircraft medical kit would typically include:

Epinephrine 1:1000

Antihistaminic injectable

Dextrose 50% injectable 50 ml ((single dose ampule or equivalent))

Nitro-glycerine tablet or spray

Major analgesic or oral

Sedative anticonvulsant injectable

Antiemetic injectable or Zofran (Ondansetron) oral dissolvable

Bronchial dilator inhaler with disposable collapsible spacer

Atropine injectable

Adrenocortical steroid injectable or similar oral absorption equivalent

Diuretic injectable

Medication for postpartum bleeding (Ex: Misoprostol)

Sodium chloride 0.9% (1000 ml recommended)

Acetyl salicylic acid (aspirin) for oral use

Oral beta blocker

Note: If a cardiac monitor is available (with or without an AED) the following would normally be

added to the above list:

Epinephrine 1:10000 (can be a dilution of epinephrine 1:1000)

Note: when available and cost effective, auto-injectors are easier to use and can be used by cabin

crew under order from a ground service medical advisor if there are no health professional on

board.


6.3 Universal Precaution Kit

For managing episodes of illness involving contact with body fluids or case of suspected

communicable disease an Operator should equip all passenger aircraft with one or more universal

precaution kits. One or two universal precaution kits per aircraft would typically be adequate for

normal operations; additional kits would be carried at times of increased public health risk (e.g.

an outbreak of a serious communicable disease with pandemic potential).

The contents of an aircraft universal precaution kit would typically include:

Dry powder that can convert small liquid spill into a granulated gel

Germicidal disinfectant for surface cleaning

Skin wipes

Face/eye mask (separate or combined)

Gloves (disposable)

Impermeable full length long sleeved gown that fasten at the back

Large absorbent towel

Pick-up scoop with scraper

Bio-hazard disposal waste bag

Instructions

6.4 Automatic External Defibrillator

The carriage of AEDs would be determined by an operator on the basis of a risk assessment, taking

account the particular nature of the operation.

6.5 Oxygen Supplying Equipment

Oxygen is administered to those passengers with medical problems typically using aircraft

portable oxygen bottles or other oxygen supplying equipment. In some circumstances, if approved

by the operator and the applicable authority, passengers may be allowed to carry and utilize their

own oxygen equipment.

Several manufacturers have developed new medical oxygen technologies such as small portable

oxygen concentrators (POC). Passengers may carry and use certain POCs if the aircraft operator

ensures that the following conditions are met:

Ensure that the device is approved by the applicable authority for use on board the

aircraft;

Ensure that the passenger brings an adequate battery supply to power the device for 1.5

times the lengths of flight and that extra batteries are packaged properly to avoid short-


circuiting or overheating;

Ensure that the passenger has talked with his/her physician regarding fitness to fly and

the requirement that an individual who wishes to use a POC provide a written statement

signed by a licensed physician that verifies that:

o The passenger is able to operate the device and to respond to any alarms.

o The treating physician has prescribed the oxygen flow rate.

The FAA allows the use of the following POC devices on board the aircraft. With the approval of

the aircraft operator, a passenger may carry these devices on board the aircraft, provided the

aircraft operator ensures that certain conditions are satisfied.

AirSep FreeStyle, AirSep LifeStyle, AirSep Focus and AirSep Freestyle 5

Delphi RS-00400

DeVilbiss Healthcare iGo

Inogen One, Inogen One G2 and Inogen One G3

Inova Labs LifeChoice and Inova Labs LifeChoice Activox

International Biophysics LifeChoice

Invacare XPO2 and Invacare Solo2

Oxlife Independence Oxygen Concentrator

Oxus RS-00400,

Precision Medical EasyPulse

Respironics EverGo and Respironics SimplyGo

SeQual Eclipse, SeQual eQuinox Oxygen System (model 4000), SeQual Oxywell Oxygen

System (model 4000) and SeQual SAROS

VBOX Trooper Oxygen Concentrator medical device units as long as those medical device

units: (1) Do not contain hazardous materials as determined by the Pipeline and

Hazardous Materials Safety Administration; (2) are also regulated by the Food and Drug

Administration; and (3) assist a user of medical oxygen under a doctor's care. These units

perform by separating oxygen from nitrogen and other gases contained in ambient air

and dispensing it in concentrated form to the user.

For more information, please refer to the Special Federal Aviation Regulation no. 106.

http://www.ecfr.gov/cgi-bin/text-idx?rgn=div9&node=14:3.0.1.1.7.0.2.1.7


7. PASSENGER SCREENING

The aircraft cabin environment certainly has particularities that are very different from other

modes of transportation. The average healthy passenger tolerates air travel very well; however

the cabin environment may present significant challenges to those with medical problems. The ill

passenger should consult his physician before travelling and, if in doubt, should advise the airline

so that a proper assessment can be done.

7.1 Pre-flight Screening

Because of the changes in demography and attitude towards air travel more people are travelling

including the elderly. Proper medical advice to the passenger by the airline medical department

or the airline designated physician has assumed great importance and is a major factor in

successful airline operations.

7.1.1 Fitness to Fly

Operators should have a medical clearance procedure; however, local laws vary and procedures

must be adapted accordingly. IATA considers that medical guidelines should be consistent and

based on accepted physiological principles for the benefit and protection of the passenger and

the safety of the flight.

7.1.2 Passenger Awareness

Many passengers have real or perceived concerns about their flight. The medical department or

the airline designated physician should be available to answer those queries whether they come

from passenger directly or indirectly through travel agents or the airlines sales agents. The use of

pamphlets at points of sales, airline web sites and in-flight magazines are all useful vehicles to

provide important health information and advice for passengers and their treating physicians.

7.1.3 Responsibility for Medical Screening

Practical experience has demonstrated that a physician with no knowledge of aviation medicine

may not be fully familiar with all of the particular medical challenges involved. Also, very few non-

airline physicians can reasonably be expected to know what kind of special assistance the airlines

might be able or willing to give for each specific trip. It is recommended that airlines consider the

former medical certificates solely as advice given by the passenger’s physician. This advice is taken

into account by each carrying airlines own medical department or medical advisor before deciding

whether or not – and under what conditions – the passenger is acceptable for carriage, and which

type of special assistance could be offered by the airline.


7.2 General Guidelines for Medical Clearance

Medical clearance is required by the airline if the passenger:

Suffers from any disease which is believed to be contagious;

Has or may develop an unusual behavior or physical condition, which may endanger or

affect the safety, health, or could affect the comfort of other passengers or crew;

Is considered to be a potential hazard to the safety or punctuality of the flight including

the possibility of diversion of the flight;

Would require medical attention and/or special equipment to maintain their health

during the flight;

Has a medical condition which may be adversely affected by the flight environment.

7.2.1 Passenger Categories and Logistics

Passengers requiring assistance are categorized in various groups but distinguished by:

Passengers requiring special assistance;

Medical Cases.

The logistics relies on full and clear communication between the passenger and the attending

physician, the airline reservations department and the medical department or the airline

designated physician.

7.2.2 Passengers Requiring Special Assistance

For passenger requiring special assistance, the selling office in contact with the passenger will

complete the Information Sheet for Passengers Requiring Special Assistance (Resolution 700

Attachment A, see Appendix C of this Guidance). The given facts will determine if medical

clearance is required by the airline.

7.2.3 Information Sheet for Passengers Requiring Medical Clearance

Many airlines require medical clearance for passengers with recent or unstable medical

conditions. Whenever medical clearance is necessary, the attending physician must complete the

Information Sheet for Passengers requiring medical clearance (Resolution 700 Attachment B, see

Appendix D of this Guidance).

7.2.4 Frequent Traveler Medical Card

Frequent airline travelers with chronic, but stable medical conditions, and those with additional

needs, may be issued with a Frequent Traveler Medical Card “FREMEC” (Resolution 700

Attachment C, see Appendix E of this Guidance). It avoids the necessity to obtain medical

clearance for each journey and determines the passenger’s disability, illness or special handling


requirements. Such cards are usually honored by other airlines.

7.3 Passive Screening of Passengers

Serious in-flight medical events are infrequent but can be difficult to manage and even life

threatening for the individual, as well as causing significant disruption and expense to the airline

and other passengers. Some of these incidents occur in people who were unwell at the time of

boarding and, therefore, may be preventable. Even though ground staff have no medical expertise

and are not expected to make medical diagnosis, they can help to prevent in-flight medical events

by simply looking, listening and asking simple questions. If the ground staff observes any of the

following e.g. Passenger who:

Looks unwell or acts strangely;

Requires assistance to walk;

Is coughing persistently;

Is short of breath without any effort (talking only);

Is vomiting;

Has a visible rash compatible with a communicable disease;

Appears to be in a late stage of pregnancy and has no clearance on file;

Is confused, particularly if travelling alone;

Appears intoxicated;

Uses oxygen and has no clearance on file.

Or if a passenger, who has not been medically cleared, mentions a history of recent illness or

injury, such as:

Heart attack or any important illness in the last few weeks;

Major surgery or major accident in the last few weeks;

Hospitalization in the last few weeks ;

Current or recent contagious diseases;

Fever, etc.

Or if the ground staff overhears any accompanying person saying something about terminal

illness, possibility of death in-flight, use of oxygen at home, problems on previous flights, or other

similar comments, the ground staff should:

Call a supervisor and if the supervisor shares the concerns medical support should be

contacted for medical clearance (if available, own medical department or outside

designated physician or medical ground provider);


If medical support is not immediately available, boarding should be denied and the

traveler should be requested to obtain medical clearance in accordance with the airline’s

policy. For some countries you may also have to involve the company's Customer

Complaint Resolution Official (CCRO).


8. ON BOARD MEDICAL EVENT PROCEDURES

Airlines have no real means of ensuring that all passengers are fit to begin their journey. The

medical department or the airline designated physician is responsible for ensuring, as far as

possible, that passenger health does not deteriorate during the journey, and that there are

adequate measures in place to deal with any unforeseen in-flight medical event.

Standard Operating Procedures should be established taking the following into account:

Subscription to a medical support ground provider

Availability of medical assistance on board

Availability of aircraft technology to contact ground and obtain medical assistance

8.1 Medical Event Process Flowchart

The establishment of a process flowchart is a useful tool to manage medical event in a more

efficient manner. Flowcharts give a step by step solution, they describe an event driven process

chain with reference to the order in which instructions or functions are executed. They can be

used as on board check lists to assist managing medical events. Flowcharts should be established

taking the criteria described in Chapter 7 into account.

Figure 1 - Example of a medical event flowchart


9. COMMUNICATION AND COORDINATION

Post-event investigation has highlighted the importance of effective communication and

coordination between flight crew, cabin crew and medical support ground provider (if available).

Communication in addition to its most widely perceived function of transferring information

enhances situational awareness, allows problem solving to be shared and make well-informed

and effective decisions. For example, inadequate communications between crew members and

other parties may lead to a loss of situational awareness, a breakdown in teamwork and ultimately

to a bad decision or a series of decisions.

9.1 Communication and Coordination if Medical Support Ground

Provider is available

Event Flight Deck Cabin Crew Medical Assistance

Airline is

subscribed to a

medical support

ground provider

and medical

assistance is

available on

board

Receive information

from cabin crew about a

medical emergency on

board

Make a PA call for

medical assistance and

inform flight deck about

a medical emergency on

board

Medical assistance on

board makes him-

/herself known to

cabin crew

Coordinate with cabin

crew to contact medical

support ground

provider for assistance

Coordinate with flight

deck to contact medical

support ground provider

for assistance


board will assist

medical support

ground provider

If diversion is advised:

inform next available

airport, cabin crew and

passengers

Receive information

from flight deck about

time available to

prepare cabin for

landing

Medical support

ground provider will

advise flight deck if

diversion is required


9.2 Communication and Coordination if Medical Assistance on

board is available


Airline is not

subscribed to a

medical support

ground provider

but a medical

assistance is

available on

board

Receive information

from cabin crew about

a medical emergency

on board

Make a PA call for




board


board makes him-

/herself known to

cabin crew

Receive information

from the cabin crew on

the status of the

passenger

Cabin crew supports

medical assistance on

board with aircraft first

aid equipment and

supply. Keep flight deck

informed at all times.


board will assist cabin

crew in dealing with

the medical

emergency


inform next available

airport, cabin crew and

passengers

Receive information

from flight deck about

time available to

prepare cabin for

landing


board will advise if

diversion is required


9.3 Communication and Coordination without Medical Assistance


Airline is not

subscribed to a

medical support

ground provider

and no medical

assistance is

available on

board

Receive information

from cabin crew about a

medical emergency on

board

Make a PA call for




board

Nobody makes him-

/herself available


check if access to

diversion point is

available. Inform next

available airport, cabin

crew and passengers.

Based on first aid

training and first aid

skills/competency cabin

crew will advise flight

deck if a diversion is

required and receive

information about time

available to prepare

cabin for landing

N/A

If diversion point is not

available: use on board

technology such as

ACARS or HF Radio (if

available) to obtain

medical assistance from

ground

Cabin Crew will keep in

contact with flight deck

and be prepared for a

diversion

Ground will advise if

diversion if required.


10. PREVENTION STRATEGIES

The following prevention strategies should be combined and considered to maintain safety

margins and to manage medical emergencies:

Contract a medical support company (24H, 7/7) with adequate communication

Pre-flight screening of passengers

Passive passenger screening

Adequate cabin crew first aid training

Aircraft first aid equipment and supplies

Guidelines for managing on board medical emergencies


APPENDIX A – SAMPLE INITIAL FIRST AID TRAINING MODULE

Initial First Aid Training should be delivered with a competency based approach.

Recommended Program Elements - First Aid

Altitude Physiology (working at altitude)

Changes in atmospheric pressure

Relative hypoxia

Trapped gas

Decompression sickness

Cabin depressurisation

Hyperventilation

Cabin Air Quality

Travel Health

Immunization

Protection against infectious diseases

Circadian rhythm and jet leg

Fatigue management

Personal safety (use of alcohol, other drugs, traffic safety etc.)

Regulations

First aid training and equipment (ICAO or National regulation)

Reporting of communicable diseases (IHR, ICAO)

Aircraft disinfection and disinsection

Biohazard waste disposal

Procedure and Resources

Seeking medical advice (from the ground and/or in-flight)

Medical equipment (first aid kit, medical kit, oxygen, etc.)

Death on board

Documentation to be completed

Keep PIC informed at all times

First Aid (Recognition and management of the problem)

Assessing a casualty

Life-saving procedures


Assess ABC (adult, child, infant)

Choking

CPR (practical training)

Recovery position

Other medical problems

The unconscious (underlying causes)

Suspected communicable diseases

Respiratory disorders (asthma, hyperventilation, chronic lung diseases, persistent

coughing)

Cardiovascular disorders (angina, heart attack, shock, DVT)

Abdominal problems (vomiting, diarrhoea, pain, heartburn, bleeding)

Nervous system disorders (headache, seizure, stroke)

Ear, nose and throat problems (barotraumas, epistaxis)

Behavioural/psychological disorders (panic attack, alcohol intoxication, irrational

behaviour)

Other problems (diabetes, allergic reaction, pregnancy related

Trauma

Wounds and bleeding (practical training)

Burns

Head and neck injury

Eye injury

Musculo-skeletal injury

Chest and abdominal injury

Note: The total time of initial and recurrent training will vary depending on equipment available,

size of class, numbers of training personnel available etc.


APPENDIX B – SAMPLE RECURRENT FIRST AID TRAINING MODULE

The items of first aid training that need to be addressed over a 36 month period can be covered

during recurrent training in any sequence that best fits your operation. Use the scenarios

accordingly. Recurrent First Aid Training should be delivered with a competency based approach.

Recommended Program Elements – First Aid Recurrent Training

12 months 24 months 36 months

Altitude Physiology (working at altitude)

Changes in atmospheric pressure

Relative hypoxia

Trapped gas

Decompression sickness

Cabin depressurisation

Hyperventilation

Cabin Air Quality

Travel Health

Immunization

Protection against infectious diseases

Circadian rhythm and jet leg

Fatigue management

Personal safety (use of alcohol, other drugs, traffic safety etc.)

Regulations

First aid training and equipment (ICAO or National regulation)

Reporting of communicable diseases (IHR, ICAO)

Aircraft disinfection and disinsection

Biohazard waste disposal

Procedure and Resources

Seeking medical advice (from the ground and/or in-flight)

Death on board

Documentation to be completed

Keep PIC informed at all times


Altitude Physiology, Travel Health and Regulations should be covered at initial training only, unless

there have been changes. Cabin crew should be promptly advised of any changes and these should

be discussed during the next recurrent training. However, it is a good idea to include some of

those components in some of the practical scenarios every once in a while.

Recommended Program Elements Continued Recurrent Training

12 months 24 months 36 months

Medical equipment (oxygen)

First aid kit

Medical kit

Universal precaution kit

First Aid (Recognition and management of the problem)

Assessing a casualty

Life-saving procedures

Assess ABC (adult, child, infant)

Choking

CPR (practical training)

Recovery position

Other medical problems

The unconscious (underlying causes)

Suspected communicable diseases

Respiratory disorders (asthma, hyperventilation, chronic lung

diseases, persistent coughing)

o Cardiovascular disorders (angina, heart attack, shock,

DVT)

o Abdominal problems (vomiting, diarrhoea, pain,

heartburn, bleeding)

o Nervous system disorders (headache, seizure, stroke)

o Ear, nose and throat problems (barotraumas, epistaxis)

o Behavioural/psychological disorders (panic attack,

alcohol intoxication, irrational behaviour)

o Other problems (diabetes, allergic reaction, pregnancy

related


Trauma

Wounds and bleeding (practical training)

Burns

Head and neck injury

Eye injury

Musculo-skeletal injury

Chest and abdominal injury

The total time of recurrent training will vary depending on equipment available, size of class,

numbers of training personnel available etc.

Note: The elements chosen to be reviewed are built into a practical scenario. Items from other

areas are also included. Other methods may also be acceptable as long any cabin crew can apply

life-saving procedures and basic first aid skills at any given time.

Elements built into a practical scenario

Items from other areas to be covered


12 Months Recurrent First Aid Sample Scenario - Circulatory disorders

The Cabin Crew could be presented with the following scenario:

A business man in late 50’s boards the aircraft last minute he is pale, sweating and rapid breathing.

The Cabin Crew greets the passenger and notices that he is not well. He responds that he had a

long and stressful day and he had to run to the aircraft, but he is ok. The passenger is travelling

alone and is seated in business class.

Three hours after take-off the passenger presses the call button. He complains of pain in chest, left

arm and has difficulty breathing. He has no history of heart problems and no medication with him.

The closest acceptable airport is two hours away.

Cabin Crew:

1. Assess the casualty, apply life-saving procedures if required, call medical ground provider if

available and seek for medical assistance on-board, inform Pilot in Command,.

Additional information: The passengers goes into cardiac arrest, there is no doctor on board but

a nurse. The medical ground provider makes recommendations for the nurse and the cabin crew

to carry out.

Cabin Crew:

2. Use medical equipment and perform CPR, keep Pilot in Command informed.

Additional information: After 30 minutes, the medical ground provider recommends to cease

resuscitation as the passenger is presumed dead.

Cabin crew:

3. Apply procedures of “passenger presumed dead” and Pilot in Command has to make

decision to divert or not.

Additional information: Twenty minutes before landing, another passenger loses consciousness

and has cardiac arrest.

Cabin Crew:

4. Apply company procedures “continue or stop CPR” for landing, keep Pilot in Command

informed. Transfer the care of the passenger to emergency response team.


24 Months Recurrent First Aid Sample Scenario - Nervous system

disorder


During a night flight, a passenger presses the call button and complains about a strong headache.

Cabin Crew attends to the passengers need by following company procedures. 30 minutes later

the passenger is on his way to the lavatory when he meets a Crew Member. The passenger

complains that his headache is worse, he is feeling dizzy and speech becomes difficult. At this

moment the passenger falls over and hits his head on the seat armrest. His head starts bleeding

and he has an open wound. The passenger appears to be unconscious.

Cabin Crew:

1. Assess the casualty, apply life-saving procedures if required;

2. Call medical ground provider if available and seek for medical assistance on-board.

Additional Information: No medical ground provider and no medical assistance on board

available, Passenger remains unconscious.

Cabin Crew:

3. Inform Pilot in Command who will have to decide on diversion;

4. Continue to take care of the ill passengers and apply lifesaving procedures if required;

5. Use first aid equipment to treatment of wounds and bleeding.


36 Months Recurrent First Aid Sample Scenario - Suspected

communicable disease:


A female passenger is travelling with a 2 years old child. 4 hours into the flight the Cabin Crew

realise that the 2-year-old child is crying since 15 minutes. They approach the mother to inquire

about the child and realise that the mother is not feeling well. She complains of fever and

persistent coughing. She tells the Cabin Crew that she had vomited before boarding the aircraft

and has diarrhoea.

Cabin Crew:

1. Assess the casualty;

2. Call medical ground provider if available and seek medical assistance on-board;

3. Inform Pilot in Command;

4. Take temperature if thermometer is available;

5. Use medical equipment as recommended by medical ground provider and/or medical

assistance on-board.

Additional information: No medical personnel on-board. Medical ground provider recommend

using anti-diarrheal and observing the passenger. After 30 minutes, the passenger continues to

have diarrhoea, has started vomiting again and now has bloodshot eyes and a skin eruption

Cabin Crew:

6. Call Medical Ground provider again if available, keep the Pilot in Command informed.

Additional information: Medical ground provider recommend to isolate the passenger if possible

and diversion if possible

Cabin Crew:

7. Relocate sick passenger in a more isolated area if space is available, designate a specific

lavatory if possible, protection against infectious disease, use medical equipment and Bio

hazard waste disposal if required;

8. Remind the Pilot in Command to report the illness to the destination station before arrival

and to ask the station manager to prepare for aircraft cleaning after a suspected case of

communicable disease.


APPENDIX C – IATA RESOLUTION 700, ATTACHMENT A


APPENDIX D – IATA RESOLUTION 700, ATTACHMENT B



APPENDIX E – IATA RESOLUTION 700, ATTACHMENT C

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