Guidance on Managing Medical Events. 1st Edition

Transcription

1 Guidance on Managing Medical Events 1st Edition

2 NOTICE DISCLAIMER. The information contained in this publication is subject to constant review in the light of changing government requirements and regulations. 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 transmitted in any form by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without the prior written permission from: Senior Vice President Safety and Flight Operations International Air Transport Association 800 Place Victoria P.O. Box 113 Montreal, Quebec CANADA H4Z 1M1 Guidance on Managing Medical Events ISBN International Air Transport Association. All rights reserved. Montreal Geneva

3 TABLE OF CONTENTS 1. ABBREVIATIONS AND GLOSSARY OF TERMS CABIN SAFETY MEDICAL EVENTS SAFETY RISK MANAGEMENT CABIN CREW TRAINING INITIAL CABIN CREW TRAINING RECURRENT CABIN CREW TRAINING AIRCRAFT FIRST AID EQUIPMENT AND SUPPLIES FIRST AID KIT MEDICAL KIT UNIVERSAL PRECAUTION KIT AUTOMATIC EXTERNAL DEFIBRILLATOR OXYGEN SUPPLYING EQUIPMENT PASSENGER SCREENING PRE-FLIGHT SCREENING Fitness to Fly Passenger Awareness Responsibility for Medical Screening GENERAL GUIDELINES FOR MEDICAL CLEARANCE Passenger Categories and Logistics Passengers Requiring Special Assistance Information Sheet for Passengers Requiring Medical Clearance Frequent Traveler Medical Card PASSIVE SCREENING OF PASSENGERS ON BOARD MEDICAL EVENT PROCEDURES MEDICAL EVENT PROCESS FLOWCHART COMMUNICATION AND COORDINATION COMMUNICATION AND COORDINATION IF MEDICAL SUPPORT GROUND PROVIDER IS AVAILABLE COMMUNICATION AND COORDINATION IF MEDICAL ASSISTANCE ON BOARD IS AVAILABLE COMMUNICATION AND COORDINATION WITHOUT MEDICAL ASSISTANCE PREVENTION STRATEGIES APPENDIX A SAMPLE INITIAL FIRST AID TRAINING MODULE RECOMMENDED PROGRAM ELEMENTS - FIRST AID...20 APPENDIX B SAMPLE RECURRENT FIRST AID TRAINING MODULE RECOMMENDED PROGRAM ELEMENTS FIRST AID...22 RECOMMENDED PROGRAM ELEMENTS CONTINUED...23 Managing Medical Events Page i April 2015

4 12 MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - CIRCULATORY DISORDERS MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - NERVOUS SYSTEM DISORDER MONTHS RECURRENT FIRST AID SAMPLE SCENARIO - SUSPECTED COMMUNICABLE DISEASE:...27 APPENDIX C IATA RESOLUTION 700, ATTACHMENT A APPENDIX D IATA RESOLUTION 700, ATTACHMENT B APPENDIX E IATA RESOLUTION 700, ATTACHMENT C Managing Medical Events Page ii April 2015

5 1. ABBREVIATIONS AND GLOSSARY OF TERMS ACARS AED CCRO CPR FAA FREMEC HF Radio MAAS MEDA N/A OXYG PA POC WCBD WCBW WCHC WCHR WCHS WCMP WCOB Aircraft Communication and Reporting System Automated External Defibrillator Customer Complaint Resolution Official Cardiopulmonary Resuscitation Federal Aviation Administration Frequent Traveler Medical Card High Frequency Radio Meet and assist - specify details 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. Not Applicable Oxygen for passengers travelling seated or on a stretcher needing oxygen during the flight (only to be used in conjunction with SSR code MEDA) Passenger Address Portable Oxygen Concentrator Wheelchair (dry cell battery) transported by passenger Wheelchair (wet cell battery) transported by passenger Wheelchair Passenger who is completely immobile Wheelchair for distance, passenger can ascent and descent steps Wheelchair for distance and steps, passenger can walk to cabin seat Wheelchair (manual powered) transported by passenger Wheelchair (collapsible on-board) provided by airline Managing Medical Events Page 1 April 2015

6 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

7 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. Managing Medical Events Page 3 April 2015

8 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 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 Consequences 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). Managing Medical Events Page 4 April 2015

9 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. Managing Medical Events Page 5 April 2015

10 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 Managing Medical Events Page 6 April 2015

11 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) Managing Medical Events Page 7 April 2015

12 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. Managing Medical Events Page 8 April 2015

13 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

14 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 o The passenger is able to operate the device and to respond to any alarms. 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 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 Managing Medical Events Page 10 April 2015

15 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 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 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 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 nonairline 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. Managing Medical Events Page 11 April 2015

16 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 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 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 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) 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 Managing Medical Events Page 12 April 2015

17 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); Managing Medical Events Page 13 April 2015

18 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). Managing Medical Events Page 14 April 2015

19 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 Managing Medical Events Page 15 April 2015

20 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 Coordinate with cabin crew to contact medical support ground provider for assistance Make a PA call for medical assistance and inform flight deck about a medical emergency on board Coordinate with flight deck to contact medical support ground provider for assistance Medical assistance on board makes him- /herself known to cabin crew Medical assistance on 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 Managing Medical Events Page 16 April 2015

21 9.2 Communication and Coordination if Medical Assistance on board is available Event Flight Deck Cabin Crew Medical Assistance 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 Receive information from the cabin crew on the status of the passenger Make a PA call for medical assistance and inform flight deck about a medical emergency on board Cabin crew supports medical assistance on board with aircraft first aid equipment and supply. Keep flight deck informed at all times. Medical assistance on board makes him- /herself known to cabin crew Medical assistance on board will assist cabin crew in dealing with the medical emergency 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 assistance on board will advise if diversion is required Managing Medical Events Page 17 April 2015

22 9.3 Communication and Coordination without Medical Assistance Event Flight Deck Cabin Crew 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 If diversion is advised: check if access to diversion point is available. Inform next available airport, cabin crew and passengers. Make a PA call for medical assistance and inform flight deck about a medical emergency on board 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 Nobody makes him- /herself available 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. Managing Medical Events Page 18 April 2015

23 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

24 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 Managing Medical Events Page 20 April 2015

25 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. Managing Medical Events Page 21 April 2015

26 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 Managing Medical Events Page 22 April 2015

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

28 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

29 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. Managing Medical Events Page 25 April 2015

30 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

31 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

32 APPENDIX C IATA RESOLUTION 700, ATTACHMENT A Managing Medical Events Page 28 April 2015

33 APPENDIX D IATA RESOLUTION 700, ATTACHMENT B Managing Medical Events Page 29 April 2015

34 Managing Medical Events Page 30 April 2015

35 APPENDIX E IATA RESOLUTION 700, ATTACHMENT C Managing Medical Events Page 31 April 2015

36