FLIGHT OPERATIONS Number 2016-020

Operations Manual Issue 07-09-2016

Applicability 27-09-2016
Air Crew Instruction
Expiry 05-01-2017

Part of OM Affected OM-E

Fleet(s) Affected A319 X A330/A340 X A380 X B777 X

References OM-E Section 11 page11,12,17,18,21,22,28,148,166 & 151.

Supersedes / Cancels

Summary

GMT Updates

Background

The current design of the algorithm DRSABCD in 11.1 does not provide adequate
information on primary assessment and only focuses on information for assessing
and management of a collapsed casualty, hence a new primary survey has been
implemented.
To reflect previous ACI 2016-008, references 11.2.1 and 11.2.3.1.1 have been
updated.
Due to 2015 CPR guidelines, the rate for chest compression on Children and Babies
are updated in 11.2.3.1.2 and 11.2.3.1.3 as well as the depth of compression for
Adults in 11.2.3.4.
To reflect the current available mask in the UPK, reference 11.6.11.3 and 11.6.12.5.3
have been updated.
FAK opening procedure and use has been updated to include the FAK location for
A319 in 11.6.12.2.2.

OM-E Section 11 amended as follows:

Contents

11.1 ASSESSING A CASUALTY

11.1.1 The Primary Survey

The primary survey is used to quickly check a casualty over for life threatening
conditions. It helps identify potentially life threatening conditions e.g. no breathing,
severe bleeding.

 
 
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ACI 2016-020 Issue Date: 07-09-2016

Scene Safety - Check for any dangers before approaching the casualty.

Check for level of consciousness (LOC) – Observe for verbal and physical
response using the AVPU scale:

A – Alert and Conscious (eyes open and follows commands).

V – Responds to Voice.

P – Responds to Pain (check for response by tapping on the shoulders).

U – Unresponsive, no meaningful movement.

Note: You may tap the shoulder and ask if the casualty is OK.

Casualty is Alert Casualty Responds to Voice,

Pain or Unresponsive

Ask for assistance from nearby Call for help and get emergency
colleagues equipment on scene

Is the Airway clear? Follow steps in “Assessment of

i.e. can speak, absence of any a Collapsed Casualty” (11.2.1)
obvious blockage/obstruction
If choking follow steps in
“Choking (11.2.4)”

Observe Breathing – Regular, quiet,

non-distressed

Look for signs of Bleeding – look

for any external bleeding
If bleeding follow steps in
“Bleeding (11.4.2)”

Check skin colour and body

temperature
If skin is pale, cold and clammy follow
steps in “Medical Shock (11.3.18)”
If body Temperature is High or low
follow steps in “Temperature
Related Disorders (11.3.24)”

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ACI 2016-020 Issue Date: 07-09-2016

If no immediate life threatening condition is identified, provide Basic Management*

to the casualty and proceed to Secondary Survey.

*Basic Management

1. Place casualty in position of comfort

2. Loosen tight clothing

3. Keep the casualty warm or open air vents

4. Give oxygen

11.1.2 The Secondary Survey

Once you have completed the primary survey and identified no life threatening
conditions you will need to carry out a secondary survey to identify any other medical
conditions. While conducting the secondary survey crew can fill out the Medical
Incident Report Form (MIRF) which will assist them in communication with the
MedLink physician.

11.2 Basic Life Support

11.2.1. Assessment of a Collapsed Casualty

If a casualty has colapsed, you must immediately initiate the collapsed casualty
action plan

D – Dangers
Assess the area for dangers or hazards which could cause you or the casualty an
injury.
Ensure that the scene is safe.

R – Response
Assess for verbal and physical responses.

Adults and children – Firmly tap on the Babies – Flick the soles of the feet
shoulders and shout into both ears. gently.
Continued on next page
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ACI 2016-020 Issue Date: 07-09-2016

No Response
S – Shout for help Response is present.
Treat as Fainting casualty.
“Help me, get the CSV/Purser and Defib”.

B – Breathing
Check for normal breathing by looking at the chest for a minimum of 5 seconds
to maximum of 10 seconds.
Gasping, which could sound like a snort, snore, or groan is not a sign of normal
breathing.

No breathing
Not breathing at all or only “gasping” is a sign
of cardiac arrest in someone who does not
respond.
Start CPR as soon as possible.
Shout “I’m starting CPR, CSV/Purser start
Defib”.
Fully expose the chest and start CPR.

C – Cardio Pulmonary Resuscitation

(CPR)
This consists of: Normal breathing is present
C – 30 Compressions Place in the recovery position.
A – Open the airway with head tilt-chin lift Give Oxygen and monitor vital
B – Give 2 breaths signs.

(Open the airway with the head tilt-chin lift. Put

1 hand on the forehead and the fingers of the
other on the bony part of the chin. Avoid
pressing on the soft part of the neck or under
the chin. Tilt the head back and lift the chin to
raise the tongue off the back of the throat and
unblock the airway.
For children and babies, tilt the head only until
the nose is pointing to the ceiling. Over tilting
the head could block the airway)

D – Defibrillator
The Automated External Defibrillator (AED) must be operated as quickly as possible
to increase the chances of survival.
Only Emirates trained and authorised “On duty” Cabin Crew are to operate the
Defibrillator.
The AED can be used on all age ranges (adults, children and babies).

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11.2.3.1.1 Adults (8 years and above)

1. Lay casualty down on his back on a firm, flat surface. Kneel beside the
casualty.
2. Move clothes out of the way.
3. Put the heel of one hand in the
centre of the chest between the
nipples. Place the heel of your other
hand on top of the first. Interlock the
fingers.
4. Push straight down at least 5 cm
(2 inches) but no more than 6 cm
(2.4 inches) at a rate of at least 100
to 120 compressions a minute.
Keep elbows locked.

5. After each compression, let the

chest come back up to its normal
position (recoil).
• Continue to give compressions
and breaths at a ratio of 30:2.
 

11.2.3.1.2 Children (1-7 years)

1. Lay the child down on his back on a firm, flat surface. Kneel beside the child.
2. Move clothes out of the way.
3. Put the heel of one hand in the
centre of the chest between the
nipples. Place the heel of your other
hand on top of the first. Interlock the
fingers.
You may need to use only 1 hand
for compressions for smaller
children. Whether you use 1 or 2
hands, it is important to reach the
correct depth.
4. Push straight down about 5 cm (2 inches) at a rate of at least 100 to 120
compressions a minute. Keep elbows locked.
5. After each compression, let the chest come back up to its normal position (recoil).
• Continue to give compressions and breaths at a ratio of 30:2.

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11.2.3.1.3 Babies (0-1 year)

1. Lay the baby down on his back on a firm, flat surface. Kneel beside the baby.
2. Move clothes out of the way.
3. Put 2 fingers in the centre of the
chest just below the nipple line. Avoid
tip of breastbone.
4. Press the chest straight down about
4 cm (11/2 inches) at a rate of at least
100 to 120 compressions a minute.
5. After each compression, let the chest
come back up to its normal position
(recoil).
• Continue to give compressions and
breaths at a ratio of 30:2.

11.2.3.4 CPR Differences

ADULTS CHILDREN BABIES/INFANTS

8 years and 1-7 years 0-1 year
above
Rescue Breathing Mouth to Mouth and
Mouth to Mouth. Mouth to Mouth.
technique. Nose

In the centre of
Chest In the centre of the In the centre of the
the chest
Compressions chest between the chest just below the
between the
location. nipples. nipple line.
nipples.
Two hands about 5
Two hands at
cm (2 inches).
Chest least 5 cm (2 Two fingers about 4
Compressions inches) but no cm (1.5 inches).
You may use one
technique and more than 6 cm
hand for
depth. (2.4 inches).
compressions for
smaller children.
Chest
100 – 120 per 100 – 120 per 100 – 120 per
Compressions
minute. minute. minute.
Speed.
Compression/
breaths Ratio 30:2. 30:2. 30:2.

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11.6.11.3 Management

 Contact MedLink immediately and follow their advice. If unable to establish

connection, PA for medical assistance on board.

 Inform Flight Deck as soon as possible so that the destination station can be
informed before arrival/or offload can be arranged if required.

 Relocate the casualty to a more isolated area of the cabin if appropriate and if
space is available. If the casualty is relocated make sure that the cleaning
crew at destination will be advised to clean both locations.

 Designate one Cabin Crew to look after the casualty, preferably the Cabin
Crew that has already been dealing with this traveller. More than one Cabin
Crew may be necessary if more care is required.

 Retrieve the universal precautions kit from its storage – see 11.6.12 – Medical
Equipment for contents and location.

 If possible, designate a specific lavatory for the exclusive use of the casualty.
If not possible, clean and disinfect the commonly touched surfaces of the
lavatories (faucet, door handles, waste bin cover, counter top) with soap and
water, and disinfectant Wipes available in the Universal Precaution Kit, after
each use by the casualty.

 The casualty should be asked to wear the face mask provided from the
Universal Precaution Kit. As soon as the mask becomes damp/ humid, it
should be replaced by a new one. These masks should not be reused but
safely disposed afterwards in the biohazard bag.

 After touching the used mask, proper hand hygiene must be practiced
immediately.

 If the casualty is coughing ask him/her to follow respiratory etiquette:

 Provide tissues and advise to use the tissues to cover the mouth and
nose when speaking, sneezing and coughing.

 Advise the ill traveller to practice proper hand hygiene. If the hands
become visibly soiled they must be washed with soap and water.

 Provide an air sickness bag for used tissues; dispose this in the
Biohazard bag.

 If the casualty is unable to tolerate a mask, the designated Cabin Crew

Member(s), or any person in close contact (less than 1 meter) with the
casualty, should wear a medical mask. When wearing a mask, crew must
ensure that hand-face contact, adjusting or removing the mask, be kept to a
minimum.

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The designated crew should wear disposable gloves when assisting the
casualty and when in direct contact with blood or other body fluids.

 If you suspect a communicable disease, please complete a Passenger

Locator Form. This form is used to collect a customer’s contact information.
These forms are located within the UPK. The arrival station may ask you to
give this form to customers sitting close to the sick customer. The forms will be
kept by the arrival station’s health authority.

11.6.12.5.3 List of Content

Equipment Use

First response procedures

Gloves (25 pairs)
Prevent the spread of infection through droplet or air
Face masks (20)
borne route
Antiseptic hand gel Used to clean and disinfect hands
(2 bottles)
Antiseptic wipes Used to clean any surface areas
Disposable To monitor temperature
thermometer
For eye protection and prevention of
One pair of goggles
splashes of body fluids
For re-sealing the kit after use
Yellow seals
Disposal of medical waste e.g. blood, saliva,
Biohazard bag
vomit etc.

 
 
 
 
 
 
 
 
 

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11.6.12.2.2 Procedure for use

 The FAK is used to treat more serious first response cases onboard e.g. a
condition that cannot be managed with the medication found in the Amenities
Container. It must not be opened for non-first aid related issues.

 Permission must be sought from the Purser (or deputy when applicable)
before opening a first aid kit. The Purser must inform the Captain when the
first FAK is opened.

 The first kit to be opened must be from the L1/ML1 station (for non A319
aircraft) or Galley 2 for A319 only. Crew must advise the Purser of what
medication was used. This kit should be reused where possible to avoid
opening additional kits unnecessarily.

 If additional kits are required to be opened, the Captain’s permission must be

sought through the Purser before opening. The Captain will advise what kit
should be opened.

Medical situation  Yes
No
requires First Aid Kit?

Contact for permission to 
 Manage the situation 
open the FAK
using medicatio ns from 
(SCCM to review the situation 
amenities container
and determi ne the need for 
 Update SCCM
opening th e FAK)

First FAK
SCCM/deputy to:
 Advise crew to open 
FAK fro m L1/ML1 
station (for nonA319 A/
C) and Galley 2 for A319 
only.
 Inform captain of the 
opening of the kit

Note: re‐use same kit where 
possi ble; avoi d opening 
another kit unnecessarily

Additional FAK
(Only when necessary, i.e. 
item needed is not available 
or is insufficient from 1st  kit)
SCCM/deputy to:
 Inform the captain and 
request permission to 
open another kit
 Advise crew to  open 
additional k it

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Action

Cabin Crew shall comply with the amended instructions.

Originator Kellie White Title SEP-TM

Approved
Capt Martin Mahoney Title SVP-FT
by

Signature Date 07-09-2016

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