IN-FLIGHT MEDICAL EMERGENCIES AND ILLNESS

General

When a passenger or crew becomes acutely ill and apprehension exists about the passenger’s ability to survive the flight, diversion to the nearest appropriate facility must be considered. The Commander should bear in mind that his cabin crew has all been suitably trained in first-aid, and accept their advice accordingly. In an attempt to limit the number of diversions to those that are essential, an effort should be made to obtain some medical opinion on the necessity to divert.

All cabin crew members are required to know the location and use of contents of all first aid kits and equipment onboard, including any drugs carried. Cabin crew are not expected or required to act beyond the limits of trained competence. When voluntary professional assistance is sought from passengers, all reasonable measures must be taken to identify the professional status of the volunteer. In all inflight medical incidents seek for a doctor / nurse or similarly qualified person via Public Address System and advise them of the Emergency Medical Kit and its contents. Having acquired professional assistance the overall responsibility for managing the situation remains with the aircraft crew. With or without professional advice one of these decisions will be required:
1) The situation is satisfactorily resolved.
2) The situation is containable with the facilities available but further professional assistance will be required after the scheduled landing.
3) Further professional assistance is urgently required and an unscheduled landing is necessary.

It is the cabin crew’s responsibility to keep the Commander informed at all times. His decision will rest on the information available, as well as other operational factors and the ultimate authority and responsibility is his.

Medical Conditions that may require an Unscheduled Landing

The items listed below are only for reference; they are not the only conditions that may require an unscheduled landing:
• Stoppage of breathing and pulse;
• Unconsciousness;
• Severe shock;
• Uncontrollable bleeding;
• Internal bleeding;
• Heart attack;
• Prolonged or recurrent epileptic fits;
• Complications with emergency childbirth.

Cabin Crew Actions

Cabin crew shall follow instructions as set out in Cabin Crew Manual (CCM).

Flight Crew Actions

First Actions
Upon first notification of the medical situation, the flight crew shall:
• Note the time and the information passed from the cabin crew on the OFP;
• Assess the current situation against the guidelines below and if the warranted, plan a diversion to a suitable airport;
• Direct the CIC to assign a cabin crew member to act as a liaison between the involved cabin crew and the flight crew.

Continuing Actions
As the situation develops, flight crew shall:
• Continuously assess the situation against the guidelines below and if warranted, initiate a diversion to a suitable airport;
• Determine, with the cabin crew, whether medical assistance is required at destination;
• Record all updated information on the OFP.

Landing Preparations
If an unscheduled landing or medical assistance at destination is required, liaise with cabin crew to determine:
1) Patient information (sex, age, any known medical history, symptoms);
2) If professional medical assistance has been given;
3) The current status of the patient;
4) Any treatment given so far;
5) The location of the patient on the aircraft and the exits to be used to disembark the patient;
6) Whether the patient is mobile or if a stretcher or other assistance to disembark will be required.

Approaching the Airport
• Declare medical urgency (PAN PAN);
• Pass all of the information gathered as above;
• Determine, with ATC, parking areas and any other special ground handling requirements.

Inform passengers about the situation and ask not to interfere with the disposition of the medical case.

Infectious Disease

From time to time the situation arises whereby the crew attention is drawn to the fact that one of the passengers has an infectious disease. On many occasions this passenger is a small child covered in spots that may well be any of the common childhood illnesses such as measles, chicken pox or rubella.

When making the decision as to whether or not one should carry this passenger the following points should be taken into consideration:
• With many of the infectious illnesses, by the time the rash has appeared the actual infective period may be over. This means of course that the people who are suffering from an infectious illness such as chicken pox are in fact at their most infectious stage when they have no visible signs of the illness and are mixing with the general population.
• Many simple viral infections, which are not particularly infectious, cause spots and rashes that in many ways are similar to the commonly known infectious illnesses. It is often medically impossible to determine whether the rash is in fact that from a common infectious illness or that from a simple viral infection.
• Infectious diseases are spread by droplet infection and the infected individual has to actually cough or sneeze into the face of a non immune individual for there to be any possibility of infection. If a child or individual is thought to be infectious, adequate precautions can be taken by sitting the child between parents, preferably at a bulkhead seat, and telling the parents not to let the child move around the aircraft unnecessarily. If the infectious individual is boarded first, and remains in their seat, it makes it virtually impossible for cross transmission of infection to occur.
• Common infectious diseases such as mentioned above are endemic in the population and consequently most of the population have immunity to this illness and will not be able to transfer the illness through themselves to a third party.
• The infectious illnesses which Health Authorities are most likely to be interested in are those which relate to gastro enteritis type illnesses (i.e. generally associated with vomiting and diarrhoea and hepatitis), and these are rarely associated with a skin rash. These people should be treated as infectious in the same manner as those above, and preferably sat beside friends or relatives and requested not to move around the aircraft unless absolutely necessary.

If cabin crew aboard aircraft suspect that a passenger is running a temperature or may have an infectious illness or be suffering from food poisoning, they must inform the Commander. He will relay this information to Handling Agents or ATC (as appropriate), giving details of the case and asking them to alert the Airport Health Control Officials.

This should be done as soon as possible on Handling or ATC R/T frequency or by relay, in order to give Health Authorities maximum warning period so that arrangements can be made for qualified personnel to meet the aircraft as it arrives on stand. International aviation facilitates the transmission and spread of infectious disease and increasing incidence of confirmed cases arriving from overseas makes this action particularly important.