1st Edition
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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
WCHR Wheelchair for distance, passenger can ascent and descent steps
WCHS Wheelchair for distance and steps, passenger can walk to cabin seat
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
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.
Note: The total time of initial and recurrent training will vary depending on equipment available,
size of class, numbers of training personnel available etc.
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
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
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.
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.
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.