Guidance on Managing Medical Events

1st Edition
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Guidance on Managing Medical Events

ISBN 978-92-9252-698-6
2015 International Air Transport Association. All rights reserved.
MontrealGeneva
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

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 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

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

Managing Medical Events Page 1 April 2015

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: cabin_safety@iata.org

Managing Medical Events Page 2 April 2015

3. MEDICAL EVENTS
Statistics show the number of passengers 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.

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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 Diversions and delays resulting in:
training
Compensation payment to customers
Lack of pre-flight screening
Image/Media interest
Cabin environment (temperature,
Negative publicity
humidity, air pressure, seat space etc.)
Legal proceedings
Lack of aircraft first aid equipment and
supply Extreme consequences: loss of human
life
Unclear definition of responsibilities

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

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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.

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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

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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)

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 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.

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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-

Managing Medical Events Page 9 April 2015

 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.

Managing Medical Events Page 10 April 2015

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 passengers 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.

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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 passengers disability, illness or special handling

Managing Medical Events Page 12 April 2015

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);

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 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 airlines
policy. For some countries you may also have to involve the company's Customer
Complaint Resolution Official (CCRO).

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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

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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 Receive information Make a PA call for Medical assistance on
subscribed to a from cabin crew about a medical assistance and board makes him-
medical support medical emergency on inform flight deck about /herself known to
ground provider board a medical emergency on cabin crew
and medical board
assistance is
Coordinate with cabin Coordinate with flight Medical assistance on
available on
crew to contact medical deck to contact medical board will assist
board
support ground support ground provider medical support
provider for assistance for assistance ground provider
If diversion is advised: Receive information Medical support
inform next available from flight deck about ground provider will
airport, cabin crew and time available to advise flight deck if
passengers prepare cabin for diversion is required
landing

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9.2 Communication and Coordination if Medical Assistance on
board is available
Event Flight Deck Cabin Crew Medical Assistance
Airline is not Receive information Make a PA call for Medical assistance on
subscribed to a from cabin crew about medical assistance and board makes him-
medical support a medical emergency inform flight deck about /herself known to
ground provider on board a medical emergency on cabin crew
but a medical board
assistance is
Receive information Cabin crew supports Medical assistance on
available on
from the cabin crew on medical assistance on board will assist cabin
board
the status of the board with aircraft first crew in dealing with
passenger aid equipment and the medical
supply. Keep flight deck emergency
informed at all times.
If diversion is advised: Receive information Medical assistance on
inform next available from flight deck about board will advise if
airport, cabin crew and time available to diversion is required
passengers prepare cabin for
landing

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9.3 Communication and Coordination without Medical Assistance
Event Flight Deck Cabin Crew Medical Assistance
Airline is not Receive information Make a PA call for Nobody makes him-
subscribed to a from cabin crew about a medical assistance and /herself available
medical support medical emergency on inform flight deck about
ground provider board a medical emergency on
and no medical board
assistance is
If diversion is advised: Based on first aid N/A
available on
check if access to training and first aid
board
diversion point is skills/competency cabin
available. Inform next crew will advise flight
available airport, cabin deck if a diversion is
crew and passengers. required and receive
information about time
available to prepare
cabin for landing
If diversion point is not Cabin Crew will keep in Ground will advise if
available: use on board contact with flight deck diversion if required.
technology such as and be prepared for a
ACARS or HF Radio (if diversion
available) to obtain
medical assistance from
ground

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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

Managing Medical Events Page 19 April 2015

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

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 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.

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 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.

Recurrent Training
Recommended Program Elements First Aid
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

Managing Medical Events Page 22 April 2015

 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

Managing Medical Events Page 23 April 2015

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

Managing Medical Events Page 24 April 2015

12 Months Recurrent First Aid Sample Scenario - Circulatory disorders

The Cabin Crew could be presented with the following scenario:

A business man in late 50s 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.

Managing Medical Events Page 25 April 2015

24 Months Recurrent First Aid Sample Scenario - Nervous system
disorder

The Cabin Crew could be presented with the following scenario:

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.

Managing Medical Events Page 26 April 2015

36 Months Recurrent First Aid Sample Scenario - Suspected
communicable disease:

The Cabin Crew could be presented with the following scenario:

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.

Managing Medical Events Page 27 April 2015

APPENDIX C IATA RESOLUTION 700, ATTACHMENT A

Managing Medical Events Page 28 April 2015

APPENDIX D IATA RESOLUTION 700, ATTACHMENT B

Managing Medical Events Page 29 April 2015

Managing Medical Events Page 30 April 2015
APPENDIX E IATA RESOLUTION 700, ATTACHMENT C

Managing Medical Events Page 31 April 2015