Aero Medical and First Aid PDF

Aero-medical and First Aid Initial
Training
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AGENDA
DAY 1 DAY 2
1. General Principles 7. Basic First Aid
2. Aviation Physiology 8. Travel Hygiene
3. Medical Assessments 9. Lifesaving Procedures:

➢ Recovery Position
4. In-flight Medical Emergencies
➢ Choking
5. First Aid Equipment ➢ Cardiopulmonary Resuscitation (CPR)

➢ BLS Algorithm – adult, child and infant
6. Travel Health ➢ Automated External Defibrillator (AED)
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LEGAL ASPECTS
This training is based on European Aviation Safety Agency

(EASA) PART CC and ORO
Airline Operators should ensure that all cabin crew members receive training that provides
knowledge and skills in first aid.
1. Initial First Aid Training 2. Recurrent First Aid Training
As a minimum, subjects within the scope of Selected elements of first aid training are
initial first aid training include : addressed each year in recurrent training.
• Life-threatening medical emergencies
• Cardiopulmonary resuscitation (CPR)
• Management of injuries
• First-aid equipment and supplies.
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FIRST AID
The initial assistance that is given to a person that is ill or has become unwell
until further medical assistance is coming.
PRIORITIES in First Aid:

1. Always check safety;
2. Do no harm;
3. Preserve life;
4. Alleviate suffering;
5. Prevent the condition from worsening;
6. Promote recovery.
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Cabin Crew First Aid Duties
Assess
Report Identify
Monitor Give
Treatment
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FIRST AID TEAM
The cabin crew should be a coordinated team when dealing with a medical
case.
The team should be consisted of:

➢ 2 cabin crew that provide first aid to the casualty;
➢ 1 cabin crew that communicates with the flight deck;
➢ 1 cabin crew (at least) that keeps an eye on the safety of the flight and
the wellbeing of other passengers.
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PROBLEM / SYMPTOMS PROCEDURE
• Establish the symptoms.
• Plan what to do.
1. Unwell / Minor injury • Ensure the passenger is placed in the correct
position.
• Give first aid rapidly and calmly.
• Reassure the passenger and explain what you
are doing.
• Inform the flight deck.
2. Seriously ill, • Inform the flight deck.
Unconscious or Seriously • Assess according to the Basic Life Support
Injured (BLS) algorithm.
• Call for a volunteer medical personnel on-
board, via Passenger Announcement.
• Let the passenger take the drug themselves.
3. Needs to use drugs • Never pour liquid or put any pills into the
mouth, if the passenger is unconscious or
unable to swallow. If a surgery is to be
expected, nothing should be given via mouth, if
possible;
• Make a record of all the drugs or fluid taken,
together with the time and dose at which they
were taken.
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Immediately inform the flight deck about any
medical situation on board.
Issuing a call for medical personnel on board:

• a crew member should make a Public Announcement to look for
volunteer medical personnel on board;
• recommendation to take data of the volunteer medical personnel
and ask about their medical qualifications;
• the decision of a volunteer medical personnel is not binding.
Commander’s decision:
• Disembarkation of a seriously ill / disabled passenger;
• Intermediate landing as a result of a medical emergency situation on board.
Contact with a doctor on ground:

• Via radio, in order to obtain instructions.
Order airport medical service/ambulance:

• Order airport medical service or an ambulance, depending on the seriousness of the illness or
accident.
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WHEN TO CALL THE FLIGHT DECK (FD)?
Always report any on-board occurrence where passenger is:
UNWELL INJURED SERIOUSLY ILL UNCONSCIOUS
During the critical phases of the flight (taxi, take-off, landing)

the FD crew contact shall be limited to emergency and
abnormal situations (i.e. sudden cardiac arrest).
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Medical event on board
Once the crew will acknowledge the medical emergency on board, they need to assess if the airline
is subscribing to a Medical Support Ground Provider.
If yes, the crew is obliged to contact them to obtain medical assistance from the ground and to check
if medical assistance on board is available.
If there is a medical assistance available on board they will co-operate in the assessment of the
casualty.
Medical Support Ground Provider might advise the crew to divert, however, the final decision is
made by the Pilot in Command (PIC).
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Reporting and Documentation
Any non-standard or unusual situation experienced, must be reported

using a Medical Incident Report Form not later than 24 hours after the
duty.
Each submitted report is subject to analysis and, if applicable,

management actions, in order to address safety issues identified.
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Basic understanding of elementary survival techniques and survival aid, could make the difference
between life and death in case of an emergency.
Cabin crew should provide survival aid to passengers and to other crew members in the aircraft, as well
as in the wilderness, if necessary.
First aid & PROTECTION

(Survival First Aid)
SURVIVAL
FOOD LOCATION
WATER
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SURVIVAL FIRST AID
Medical situations that would require

Survival First Aid skills, not just in normal
or emergency operations inside the
aircraft, but also in the wilderness:
• Heatstroke
• Burns
• Fractures
• Severe bleeding
• Hypothermia / Frostbites.
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AVIATION PHYSIOLOGY
Our working environment
• Pressure & Air Quality

• Humidity
• Dehydration
• Alcohol and drugs
• Food and drinks
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AVIATION PHYSIOLOGY
Cabin Pressure
• Is kept constant thanks to the pressurized cabin.

• Corresponds to the pressure situation at a height of some 1600 m to 2400 m.
• In high altitudes, the pressure decreases impact on the human body.
• Does not constitute a problem for a healthy organism.
Note: Special consideration for passengers suffering from respiratory or circulatory

diseases, since their adaptive mechanisms are impaired, and their reserves are
smaller.
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AVIATION PHYSIOLOGY
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AVIATION PHYSIOLOGY
Relative Humidity
Very low, between 10% - 20%, due to the pressurization system in the cabin,
which takes air from outside (12% on average).
IMPORTANT: In order to compensate for the increased loss of fluid and possible
DEHYDRATION, the following should be applied:
Drink at least 2 dl (200 ml) of still water per hour of flying.
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AVIATION PHYSIOLOGY
DEHYDRATION
Dehydration: occurs when the person uses or loses more fluid than the intake
and the body doesn't have enough water and other fluids to carry out its normal
functions.
If the person doesn't replace the lost fluids, dehydration will occur.
Anyone may become dehydrated, but the condition is especially dangerous for young
children and elderly.
Mild to moderate Dehydration: Severe Dehydration:

• Dry skin, • Rapid breathing,
• Chopped lips, • Rapid heartbeat,
• Scratchy throat, • Muscle weakness,
• Itchy nose, • Severe dizziness,
• Dry eyes, • Up to unconsciousness.
• Dry mouth,
• Dizziness,
• Headache.
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AVIATION PHYSIOLOGY
• Alcohol increases the effects of dehydration and
Alcohol and dehydration increases the effects of alcohol on human
body.
drugs
• The presence of alcohol in the blood might interfere with
the normal utilization of oxygen by the tissues.
• Both prescription and non-prescription (over-the-counter)

drugs can impair judgment and degrade coordination.
Common side effects include drowsiness, confusion,
blurred vision and dizziness.
• The effects of some of these drugs can be even more

pronounced at altitude than they are on the ground.
Food and
Drinks
Low humidity in the aircraft and lower air pressure might reduce
the sense of taste by up to 30%, as the taste buds are affected.
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AVIATION PHYSIOLOGY
Hypoxia
Hypoxia is a lack or not sufficient amount of oxygen to the cells. This can result
from low oxygen content in the blood or problems with blood circulation. Hypoxia is a life-
threatening condition, as oxygen is vital for the human body.
The common causes of hypoxia:
• External: insufficient oxygen –

in case of a depressurized
cabin (lower air pressure) or
gas poisoning.
• Internal: lung conditions,

bleedings, heart problems,
shock, chocking.
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AVIATION PHYSIOLOGY
Hypoxia
CAUTION
RECOGNITION SEEK EMERGENCY
Rapid breathing
MEDICAL ASSISTANCE
Difficulty with speaking
Cyanosis ( bluish – grey ) lips,

WHAT TO
If the symptoms
fingertips DO? progressively get worse
Anxiety
Headache
Provide oxygen
Nausea
Euphoria
If the passenger loses
Inability to perform simple tasks Monitor consciousness
Feeling heavy, tired, sleepy
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AVIATION PHYSIOLOGY
Hypoxia
The time of useful

consciousness (TUC) - describes
the maximum time the crew can
make rational, life-saving
decisions and carry them out at
a given altitude without
supplemental oxygen.
Factors that contribute to hypoxia tolerance:
• FATIGUE - who is physically or mentally fatigued will have an increased risk of hypoxia.
• PHYSICAL EFFORT - during the physical activity, there is an increased need for oxygen,
and increased risk of hypoxia and as a result, a decrease in the amount of useful consciousness
time.
• ALCOHOL - can increase the risk of hypoxia and lower the hypoxia resistance.
• NIGHT TIME – during the night, hypoxia resistance sinks (the night vision is affected first).
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AVIATION PHYSIOLOGY
Hyperventilation
Hyperventilation or over breathing might be brought on by panic attacks,

hysteria, acute stress, anxiety, asthma, head injury etc.
It consists in taking much faster breaths than normal. This shallow, rapid
breathing could cause the carbon dioxide (CO2) levels to drop abnormally low.
Panic Attack
The hyperventilation is usually triggered by an

emotional cause, like panic attack and is
frequently associated with anxiety and fear of
flying.
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AVIATION PHYSIOLOGY
Hyperventilation
RECOGNITION WHAT TO DO? CAUTION
Unnaturally fast Make the casualty Be careful not to use a

breathing comfortable paper bag to re-breath
the casualties own
Feeling short of breath
Attempt to relief the exhaled air for too long,
casualty’s anxiety coaching is BEST
Red skin colour
Panic Be calm and reassuring Small kids DO NOT

usually
Anxiety COACH the casualty to hyperventilate, look
Attention – seeking slow down their for other causes
behaviour breathing
Reassure and help the
Dizziness or feeling faint casualty to regain control of
their breathing Oxygen will not help
Tingling in the hands in case of
Cramps in the hands and Give sips of water hyperventilation
feet
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AVIATION PHYSIOLOGY
Acute stress reactions
An acute stress reaction occurs due to a

particularly stressful event.
Acute means the symptoms develop quickly but do not usually last
long. The events are usually severe, and an acute stress reaction
typically occurs after an unexpected life crisis. This might be, for
example, a serious accident or other traumatic events.
SIGNS and SYMPTOMS WHAT TO DO
1. Deal with any possible body injury,

• Psychological symptoms: anxiety, low medical issue, or physical need first.
mood, irritability, reckless or aggressive 2. Keep the casualty in a quiet place, if
behaviour. possible.
3. Encourage them to take slow, deep
• Physical symptoms: heart palpitations, breaths.
feeling sick (nausea), chest pain, 4. If the person wants to talk, listen
headaches, abdominal pain, breathing without interrupting or changing the
difficulties. subject.
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AVIATION PHYSIOLOGY
Barotrauma
Gas expansion/contraction:
• in an aircraft environment, the body is exposed to high altitudes, lower

pressure and the gases within the body cavities will expand;
• during descent there is again a change in air pressure, causing the gases
to contract.
Gas expansion and contraction does not constitute a problem if the gas
communicates freely with the outside.
If the gas is trapped (e.g. ear infection) it will lead to an increase pain or
even damage to the surrounding body tissues, called BAROTRAUMA.
It mostly occurs in the ears, sinuses or even teeth.
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AVIATION PHYSIOLOGY
Ear & Sinus Barotrauma
Ear barotrauma is normally caused by common cold,

sinusitis, allergic rhinitis etc.
Sinus barotrauma is caused by a blocked, swollen,

infected sinus.
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AVIATION PHYSIOLOGY
Ear barotrauma
If the pressure and pain

CHEWING GUM OR
does not go away
Pressure/ pain felt mostly CANDY, DRINKING
following descent and
in the ears SMALL AMOUNTS OF
landing, seek medical
WATER
help.
IF THE PRESSURE CAUSES

THE EARDRUM TO BURST,
Possible loss of hearing YAWNING THERE MAY BE SLIGHT
BLEEDING FROM THE
INNER PART OF THE EAR
Do not block bleeding from

TAKE A BREATH, PINCH
INNER/MIDDLE EAR the ear. Let the blood to be
THE NOSE AND, SWALLOW
AFFECTED soaked by a dressing placed
THE AIR IN YOUR MOUTH
on the ear
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AVIATION PHYSIOLOGY
Altitude meteorism
At altitude, the gases trapped in our stomach

and intestines may expand up to 25-30%.
Abdominal pain – reflecting as either mild ache or serious cramps, can

have many causes, as: indigestion, constipation, a stomach virus, a pancreas
condition, an internal fracture or, for a woman, menstrual cramps.
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AVIATION PHYSIOLOGY
Altitude meteorism
Stomach bloating PASS GASES
SEVERE PAIN COULD

Uncomfortable feeling, CAUSE THE
BURP
stomach pain PASSENGER TO FEEL
WEAK, EVEN FAINT
PASSING GAS,
USE THE TOILET
BURPING
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AVIATION PHYSIOLOGY
Decompression Sickness
Decompression sickness – a medical condition

caused by a rapid change in atmospheric pressure.
Dissolved gasses (nitrogen) in the human body emerge

as bubbles in blood and body tissues during
decompression, causing damage to organs and tissues or
give rise to severe pain.
In normal circumstances on the flight, this condition

might appear in very rare cases when a scuba diver
did not follow the recommendations to have a break from
diving and flying.
Since bubbles can form in or migrate to any part of the

body, decompression sickness can produce many
symptoms and its effects may vary from joint pain and
rashes to paralysis and death.
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AVIATION PHYSIOLOGY
Decompression sickness
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AVIATION PHYSIOLOGY
Decompression sickness
CAUTION
RECOGNITION WHAT TO DO? SEEK EMERGENCY
MEDICAL
ASSISTANCE
PAIN IN THE JOINTS,
PROGRESSING Provide oxygen
THROUGHOUT THE If the symptoms
WHOLE BODY progressively get
worse
ASK ABOUT
HEADACHE RECENT DIVING
Lower altitude (higher

WEAKNESS, pressure). Consider
DIZZINESS Landing
If the passenger lost
consciousness
SIGNS AND Hospitalization
SYMPTOMS OF (Hyperbaric Chamber)
HYPOXIA
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AVIATION PHYSIOLOGY
Air sickness WHAT TO DO

1. Leaning back and trying not to move
Air sickness is a specific form of the head sideways helps with the
motion sickness which is induced by nausea.
air travel.
2. Seat the casualty closer to the front
Often the tremors of the plane trigger of the airplane, where the movement
airsickness. is reduced.
3. Recommend them to avoid digital

screens and reading materials.
4. Ask the casualty to focus on

something far (the land on the
observation window).
It may cause:
5. Only light food (crackers or other
➢ cold sweats; bland snacks) and non-fizzy drinks
➢ nausea; are recommended.
➢ vomiting during the flight. 6. If the passenger feels weak, faint,
seek professional medical help.
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MEDICAL ASSESSMENT
Assessing the casualty
I. Primary Assessment
• BAP rule
• AVPU scale – to assess level of consciousness
II. Measuring of vital signs
III. Secondary Assessment
• SAMPLE interview – to assess medical condition

• WILDA interview – in case of pain
• Head-to-toe Assessment (Body check)
• External clues
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MEDICAL ASSESSMENT
I. Primary Assessment (Primary Survey)
The Primary Survey - the first stage in any first aid assessment.
It is intended to help you quickly identify whether there is an immediate
threat to the casualty’s life.
Steps:
1. Danger (check if it is safe to approach the casualty)
2. Response (AVPU assessment)
3. Open Airway
4. Check Breathing
5. Assess Circulation.
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MEDICAL ASSESSMENT
BAP rule – Brain, Airways, Pulse (Circulation)
Consciousness, Breathing Circulation

responsiveness
Vital questions:
Is the casualty conscious/responsive?
Is the casualty not breathing or only gasping for air?
Does the casualty have problems with blood circulation?
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MEDICAL ASSESSMENT
CONSCIOUSNESS
Unconsciousness is the state in which a

person is unable to respond to stimuli and
appears to be asleep. They may be
unconscious for a few seconds, as in
fainting, or for longer periods of time.
People who become unconscious don’t

respond to loud sounds or shaking. They
may even stop breathing or their blood
circulation may be affected.
This calls for immediate attention. The

sooner the person receives emergency
first aid, the better their outlook will be.
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MEDICAL ASSESSMENT
CONSCIOUSNESS
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MEDICAL ASSESSMENT
CONSCIOUSNESS
A – Alert and awake ✓ The casualty is fully awake and talking to you.
✓ Can answer questions sensibly, in real time.
V – Voice stimulus ✓ Responding to your calling. The casualty provides a sort of

response when you talk to them. This could be through the
eyes, which open when you speak to them, or by voice which
may only be as little as a grunt or moan. Or it could be by
moving a limb when prompted to do so.
P – Pressure/Pain
stimulus ✓ If you tightly squeeze the casualty’s hand, or squeeze the
trapezium muscle / pinch the ear - do they moan or groan?
U – Unresponsive to ✓ This outcome is noted if the casualty does not give any Eye,
any stimuli Voice or Motor response to voice or pain.
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MEDICAL ASSESSMENT
BREATHING (Open AIRWAY)
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MEDICAL ASSESSMENT
BREATHING
LOOK, LISTEN, FEEL for normal breathing:

Open the airway by tilting the head backwards and lifting the chin forward.
This pulls the tongue away from the rear wall of the throat and relieves
and/or prevents airway blockage.
Jaw thrust (if spinal cord injury suspected)
Hold the head stable in a neutral position.
With your index fingers push the lower jaw forward.
Check for normal breathing for 10 seconds:

➢ Look for movements of the chest and the belly at same time.
➢ Listen for any abnormal sounds.
➢ Feel the air being exhaled on your cheek.
What to do?
If the casualty breaths normally – Recovery Position.
No detectable breathing or any abnormal, irregular, ineffective breathing indicates the
necessity to start resuscitation immediately.
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MEDICAL ASSESSMENT
BREATHING
Oxygen is vital for survival.
If oxygen supply to the brain is interrupted:
• in 3-5 minutes - irreversible damage to

the brain;
• in 7-8 minutes - the brain will die.
On average, person can survive: approximately 3 minutes without oxygen.
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MEDICAL ASSESSMENT
CIRCULATION
The presence of normal breathing on a

casualty means that blood circulation is
present.
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MEDICAL ASSESSMENT
II. Vital Signs
Vital signs are measurements of the

body's most basic functions.
4 main vital signs are routinely

monitored:
• Breathing rate
• Oxygen saturation
• Body temperature
• Pulse rate
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MEDICAL ASSESSMENT
II. Vital Signs

BREATHING RATE
It is very important to check for

breathing throughout the treatment
given to any casualty.
Check: rate, quality and effort put

into breathing.
The respiration rate is usually measured
when a person is at rest.
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MEDICAL ASSESSMENT
II. Vital Signs
Oxygen Saturation (SKIN COLOR)
Skin color is one indicator of overall health

and is linked to oxygenation and blood
circulation. Cold and clammy skin indicates
circulatory problems.
• Assess for pallor, cyanosis or any change

in the natural color of the casualty’s skin.
• Look at the color of the hands and

fingers: are they blue, pink, pale or
mottled?
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MEDICAL ASSESSMENT
II. Vital Signs
Oxygen saturation (SKIN COLOR)
Skin paleness may be caused by reduced blood flow and oxygen or by a

decreased number of red blood cells.
It can occur all over the skin or appear more localized in certain areas.
Besides the skin that is naturally pale, the paleness may hide more serious medical
problems: cold exposure, shock, a blockage in the artery etc.
NOTE: Regardless of the natural skin colour (light/dark), paleness may be noted in the
following areas:
Inner membranes of the lower eye lids

Palms
Fingernails
Tongue
Mucous membranes inside the mouth.
Any change in natural skin colour - pale, greyish skin or even red, hot skin may indicate a
medical condition.
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MEDICAL ASSESSMENT
II. Vital Signs

SKIN COLOR AWARENESS
Skin color is particularly important in detecting

cyanosis.
• In light-skinned people, cyanosis presents

as a dark bluish tint to the skin and mucous
membranes .
• In dark-skinned people, cyanosis may
present as gray or whitish (not bluish)
skin around the mouth, and the conjunctivae
may appear gray or bluish.
• In people with yellowish skin tone,
cyanosis may cause a grayish-greenish
skin tone.
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MEDICAL ASSESSMENT
II. Vital Signs
TEMPERATURE
Body Temperature: assess the body temperature - the forehead and the limbs
temperature by feeling the patient’s hands: are they cool or warm?
Low or high body temperature may be an important indicator of a life-threatening problem.

You can feel exposed skin, but use a thermometer to obtain an accurate reading.
Normal body temperature is 37°C but can be slightly higher or lower. A

temperature above 38ºC is usually caused by infection, but can be the result of
heat exhaustion or heatstroke.
A lower body temperature may result from exposure to cold and/or wet conditions—hypothermia—or it
may be a sign of life-threatening infection or shock. There are several different types of thermometer.
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MEDICAL ASSESSMENT
II. Vital Signs
PULSE
Each heartbeat creates a wave of pressure as blood is pumped along the arteries.
Where arteries lie close to the skin surface, such as on the inside of the wrist and at
the neck, this pressure wave can be felt as a pulse.
The pulse could give extra information about the status of blood circulation.
It could be difficult at times to feel the pulse in an aircraft environment.
Other things could have an impact on pulse: age, gender, prescribed

medicine, how fit the person is, emotional status etc.
Pulse measurement should not be taken into consideration as a

single item. Aim to perform a complete assessment and take
into consideration all findings.
Taking the pulse could help in monitoring if the casualty is

getting better or worse (check the pulse every 10 minutes).
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MEDICAL ASSESSMENT
II. Vital Signs
PULSE
Measure the pulse only on a CONSCIOUS person.
The pulse should NOT be checked on a person that is

unconscious!
While checking the pulse, use your fingers (not the thumb) and
press against the skin.
Pay attention to:

• the rate (number of beats per minute: feel for 30 seconds and
multiply by 2)
• strength (strong or weak)
• rhythm of pulse (regular or irregular).
The pulse of a healthy person at rest should be strong and

regular. An abnormally fast or slow / irregular pulse rate at rest
could be a sign of illness.
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MEDICAL ASSESSMENT
II. Vital Signs

PULSE
The normal pulse rate in adults is 60–100 beats per minute. The
rate is faster in children and may be slower in very fit adults.
An abnormally fast or slow pulse may be a sign of illness.
PULSE RATE (beats per minute)
ADULT 60 - 100 Puberty+
CHILD 70 - 140 1 year old - puberty
INFANT 90 - 150 Birth – 1 year old
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MEDICAL ASSESSMENT
II. Vital Signs

PULSE
Wrist pulse (radial) should be checked

on adults and children (place 2-3 fingers
at the base of the thumb).
Brachial Pulse (inside the upper arm,

between the shoulder and elbow) should
be the ideal location for infants.
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MEDICAL ASSESSMENT
Once the casualty is out of immediate danger and

you have completed a primary survey, continue
with a secondary assessment.
This involves finding out what happened, general

observations, talking with the casualty and physical
examinations of their body in order to gather
information about the ill or injured person.
Circumstances will determine how detailed the

examination or questions should be.
If a person can describe any of the symptoms in

particular, focus your questions on that problem.
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MEDICAL ASSESSMENT
GENERAL GUIDELINES
➢ Write the answers you get;

➢ Look at the general appearance;
➢ Gather information from the people around him;
➢ Show empathy;
➢ Explain what you are doing and ask for permission to touch;
➢ Summarize the information at the end.
Chronic medical condition – the casualty has a history & usually takes
medicine;
Acute medical problem – the casualty might not have a medical history
/ medication or it could be an episodic exacerbation of the pre-existing
medical condition.
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MEDICAL ASSESSMENT
SAMPLE Interview
S Signs and symptoms What is wrong? Could you describe me what/how

do you feel?
For how long you have these symptoms now?
Do you have any other symptoms?
A Allergies Do you have any known allergies? If yes, how do

you react?
M Medication taken/ Do you take any medicine/substance? What

medicine do you take? When did you last take it?
prescribed
medication
P Previous medical Do you have any other health problems?
Did you have any surgery or hospitalization
history / pregnancy recently?
Is there any possibility to be pregnant?
L Last oral intake When did you last eat or drink anything (even a
bite)? What was it?
E Events leading up to What do you think that had happened to make
your condition worst?
the incident Did anything out of the ordinary happen in the
last few days/weeks?
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MEDICAL ASSESSMENT
PAIN Assessment
Pain is an unpleasant sensory and emotional experience arising from actual or potential
tissue damage.
Acute pain usually lasts hours / days and is associated with tissue damage,
inflammation, a surgical procedure or a brief disease process.
Acute pain serves as a warning that something is wrong.
Chronic pain, in contrast, worsens and intensifies over time and persists for months,
years. It accompanies disease processes such as cancer, HIV/AIDS, arthritis. Chronic
pain can also accompany an injury that has not resolved over time.
Address the following topics:
W Words to describe the pain Ask the casualty to describe the pain: aching, stabbing,
tender, numb, dull, burning, radiating, squeezing,
cramps, etc.
I Intensity (1-10) Ask the casualty to rate the pain they are experiencing, on a scale
from 1-10; 1 is no pain and 10 the worst pain they ever experienced.
L Location Ask the casualty where is exactly located in the body or if it

radiates to other parts.
D Duration Ask the casualty when did the pain started and if it is constant /
intermittent.
A Aggravating/alleviating Ask what could have triggered the pain; what is aggravating or
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MEDICAL ASSESSMENT

HEAD-TO-TOE ASSESSMENT
When a traumatic injury is suspected, if time

permits and the casualty is breathing
normally, perform a Head-to-Toe
Assessment, so called a “Body Check”.
By inspecting the patient’s body, first aiders

should make a note of all injuries, starting at
the head and proceeding through the neck,
chest and abdomen, to the extremities.
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MEDICAL ASSESSMENT
HEAD-TO-TOE ASSESSMENT
Parts of the LOOK & FEEL for:
body
• Bruising (contusions)
Head • Blood/fluids coming from the ears/nose
• Bleeding (internal/external)
Neck • Pupil size and response to light
• Swelling/deformity
Chest • Fractures and spinal deformity
• Wounds and evidence of penetrating injury
Abdomen • Breathing distress/pain on breathing
• Skin: cyanosis, warmth, pallor, sweating, discoloration
Limbs • Tenderness (localised or generalised)
• Sensation to touch and pain
• Motor function - normal movements in joints
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MEDICAL ASSESSMENT

EXTERNAL CLUES
If the passenger is unresponsive and

breathing normally, look also for external
clues about their condition:
• Medical certificates, cards indicating

medical conditions (diabetes, allergies)
• The presence of certain medication

(inhaler, EpiPen)
• Lockets, bracelets, key rings, tattoos

• Smartphones (Health or Medical ID’s
apps).
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MEDICAL ASSESSMENT
Passengers with special needs
Might require special attention:

WCHR/WCHS/WCHC;
- Passengers with hearing disability/Deaf passenger;
- Visually impaired/Blind passenger;
- Invalid/ Incapacitated passenger;
- Mentally disabled passenger;
- Passengers requiring additional oxygen supply;
- Passenger with medical equipment:
• RPD: Respiratory Personal Device
• POC: Portable oxygen concentrator.
- Pregnant passengers;
- Infants.
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IN-FLIGHT MEDICAL EMERGENCIES
RECOVERY POSITION
The recovery position is used for

an unconscious casualty that
takes normal breaths.
Why to put a person in recovery

position?
1. To keep the airway open and

prevent tongue from blocking the
airway.
2. For fluids to drain from the mouth,

reducing the risk of inhaling vomit.
3. To keep the person in a stable

position.
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1. Respiratory Disorders
ASTHMA
Asthma is a serious respiratory condition.
The airways in the lungs go into spams,

causing airway constriction.
In addition, there is also inflammation and

mucus in the airways.
This contributes to breathing difficulties.
It is usually connected to allergic reaction

or other forms of hypersensitivity (smoke,
pollution, infections, cold air).
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Asthma
CAUTION
WHAT TO DO? SEEK EMERGENCY
Make the casualty comfortable, MEDICAL ASSISTANCE
Position: slightly forward (supporting the upper
Difficulty breathing body), leaning the arms on a tray table or the back
of a chair This is a first-time asthma
attack and the casualty has no
Wheezing Be calm and reassuring. medication
Difficulty speaking; short Allow the casualty to use their asthma

phrases; whispering medication
The second dose
Coughing Reliever inhaler is usually BLUE; use
according to the prescription,
of the inhaler did
NOT help
Anxiety Encourage to take the first dose as soon as
possible,
Grey-blue color of the lips, nail The casualty is getting worse;
Encourage to breath slowly and deeply, is becoming more exhausted;
beds, earlobes
needs more time to breathe
Exhaustion leading the between words. (2-3 words
OXYGEN – high flow. break; 2-3 words break…)
casualty to stop breathing
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Respiratory Disorders
Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is a type of obstructive

lung disease characterized by long-term poor airflow.
The main symptoms include shortness of breath and cough.

COPD is a progressive disease, meaning it typically worsens over time.
What to do?
Treat like
asthma.
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2. Conditions related to the Immune System
ALLERGIC REACTIONS
The Immune system has an important job: to defend your body from invaders such as
bacteria and viruses that mean you harm.
Allergy occurs when the immune system over reacts to substances in the
environment which are harmless to most people.
These substances are known as allergens and are found in dust mites, pets, pollen, insects,
ticks, molds, foods, some medications etc.
MILD
SEVRE
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2. Conditions related to the Immune System
ALLERGIC REACTIONS
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Allergic Reactions
Peanuts allergy procedure – in case a passenger with severe allergic reactions is on board
CAUTION
MEDICAL ASSISTANCE
Remove the allergen.

Mild symptoms – slow
progression
Allow to take his own medication.
You should see improvements in 5 If the symptoms are
min. after the auto-injector is used. severe or not getting
better after medication.
Allow for a second dose of medication A second wave might
after 5-10 min if there are still reappear after 20-30 min.
symptoms.
Severe symptoms – fast
progression
Give Oxygen.
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Allergic Reactions
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Allergic Reactions
General steps on how to use an allergy auto

injector:
1. Remove the auto-injector from the carry tube. Keep your fingers
and thumb away from the tip.
2. Hold the adrenaline auto injector firmly in your fist and pull off
the safety cap.
3. Place the injector tip against the outer thigh, holding the
injector at a right angle (approx. 90°) to the thigh.
4. You can give the injection through clothing but avoid pockets.
5. Push down firmly until you hear or feel a click, confirming the
injection has started; keep it pushed in.
6. Hold for at least 10 seconds.
7. Remove the adrenaline auto-injector and treat the injection as a
biohazard.
8. Record the time the injection was given.
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3. Nervous System Disorders
STROKE
A stroke is caused by:
• a blood clot blocking a blood vessel in the

brain (ischemic stroke) or
• bleeding in the brain (hemorrhagic stroke),

causing damage to the brain tissue.
The symptoms vary on the part of the brain that

has been damaged.
How to assess a casualty? FAST
F A S T
Face Arm Speech Time
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In-flight medical emergencies
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STROKE
CAUTION
MEDICAL ASSISTANCE
Headache
Comfortable position,
Dizziness but not with legs raised
One part of the body is If you suspect stroke, it is

weak the case for an emergency
One part of the face / one landing.
arm drops If proper treatment is
GIVE OXYGEN given within 3 hours from
Memory loss
the first symptoms, the
chances to recover are
Difficult to concentrate higher.
Difficult to talk
Do not give anything
Difficulty in answering to eat or drink
simple questions
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Headache & Migraine
alcohol-
A Headache is the most common induced
neurological condition that people may hangover brain
experience. tumour
stroke
Typical causes for headaches are muscle

tension from neck or shoulders, fatigue, panic blood
stress, dehydration etc. attacks clots
It can be a sign for more serious medical

conditions: infections, bleeding inside the overuse of pain bleeding in
brain. medication, or around
known as rebound the brain
headaches
A Migraine is a complex, recurrent
headache disorder affecting usually one
glaucoma concussion
side of the head. The pain comes with
other associated symptoms. dehydration
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Headache & Migraine
SIGNS and SYMPTOMS
• Headache
• Nausea
• Vomiting
• Sensitivity to bright light
Seek Emergency Medical

WHAT TO DO
Assistance
1. Check vital signs and take history (past headaches, history of

If the casualty has severe
migraines or recent head injury). headache with numbness /
abnormal sensations in the
2. Give plenty of water to drink, as the casualty might be dehydrated. body, confusion, fever, stiff
neck, vomiting, difficulty
3. Advise to rest. talking and / or walking.
4. Put wet towel on the forehead.
5. If the pain is severe or the casualty experience fever, stiff neck,

persistent vomiting and confusion, make an announcement for
medical personnel on board.
6. Monitor the casualty.

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Seizures
A seizure or a convulsion refers to involuntary

contractions of different muscles.
Causes for seizures:

• Epilepsy
• Head trauma / tumour
• Hypoglycaemia
• Stroke
• Drug overdose/drug withdrawal
• Fever
• Infection
• Hypoxia.
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EPILEPSY
Epilepsy is a neurological disorder

in which brain activity becomes
abnormal, causing seizures.
People with epilepsy have recurrent

seizures through their lifetime.
2 types of epileptic seizures,

according to the magnitude of
symptoms:
• Minor epileptic seizure

• Major epileptic seizure
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Minor epileptic seizure
RECOGNITION CAUTION
WHAT TO DO
SEEK EMERGENCY
Seizure:
• Calm the patient MEDICAL
• SUDDEN “SWITCHING OFF”, ASSISTANCE
• Note the time the episode started
• The person may look blankly into (how long did the seizure last),
space;
• Remove all harmful objects,
• MINOR TWITCHING USUALLY IN ONE • If the patient is having their
AREA OF THE BODY: LIPS, EYES, • Ensure a quiet environment, first seizure;
HEAD, ARMS, LEGS; • Calm and reassure the patient, • IF THE SEIZURE REPEATS;
• Uncontrolled movements: lip • Stay with the patient until he/she is • IF THE SEIZURE CONTINUES
smacking, chewing, making loud fully recovered. FOR MORE THAN 5
noises. MINUTES.
Recovery: Monitor the casualty
• The casualty stops staring, may not
be aware of what happened, • If the patient is unaware of this
• The automatic movements stop. condition, advise him/her to seek
medical advice after landing.
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Major epileptic seizure
RECOGNITION
WHAT TO DO
Seizure: CAUTION
Protect the patient
• Sudden unconsciousness, SEEK EMERGENCY
• Arching of the back , whole body • Check if there is a doctor on board,
MEDICAL
becomes stiff, the jaw may be • Note the time the episode started (how long
clenched, did the seizure last), ASSISTANCE
• Convulsions / shaking, • Remove all harmful objects,
• Loosen tight clothing,
• The airway may become blocked and
breathing may be difficult and noisy, • Pad spaces where the casualty could hit their • IF THE PATIENT DOESN’T
head, arms, etc. REGAIN CONSCIOUSNESS
• Blood stained saliva may appear , if • DO NOT move the casualty during the FOR MORE THAN 10
the lips or tongue were bitten, seizure, MINUTES;
• Possible loss of bladder / bowel • DO NOT put anything in his/hers mouth or
• If the patient stops
control. restrain during the seizure.
breathing, START CPR;
Monitor the patient • If the patient is having their
Recovery: first seizures;
• Level of response, breathing, • IF THE SEIZURES REPEAT;
• Muscles relax,
• Clear the airway if necessary,
• Breathing becomes normal, • IF THE SEIZURES
• Place in the recovery position if the casualty is
• The patient slowly regains consciousness: very weak and sleepy following the seizure. CONTINUE FOR MORE
may be confused, tired, and not aware of THAN 5 MINUTES.
what happened. DC2P-Personal Data
RECOGNITION Febrile seizures
Most often it occurs as the result
of the fast raise of the child’s
body temperature, usually the WHAT TO DO CAUTION
result of a throat or ear
infection. •Protect the child SEEK EMERGENCY
•Note the time the episode started MEDICAL
Usually occurs between birth (how long did the seizure last), ASSISTANCE
and 5 years of age. •Remove all harmful objects,
•Pad any area the child might injure
during the episode, •If the child doesn’t regain
Seizure:Convulsions , twitching, consciousness for more
clenched jaw, hands, feet, •Remove extra clothing – if difficult
than 10 minutes;
Red skin, sweating,
wait till the seizure stops,
•If the child stops breathing,
Blank stare, •Cool the child, be careful not to over
START CPR;
Breathing affected, drooling from the
cool,
•If the child is having their
mouth. •Open the air outlet.
first seizure;
•If the seizures repeat;
Monitor the child
•If the seizures continues for
Recovery: The child stops staring,
starts breathing normally, •Level of response, breathing, more than 5 minutes.
Convulsions stop, •Clear the airway if necessary,
The automatic movements stop. •Place in the recovery position,
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4. Circulatory Disorders
Heart
Attack
Angina
Pectoris
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HEART ATTACK
A heart attack (myocardial infarction) is a

life-threatening medical situation.
A heart attack happens when blood flow to

the heart suddenly becomes blocked,
usually by a blood clot.
Without the blood coming in, the heart can't

get oxygen.
If not treated quickly, the heart muscle

begins to die.
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HEART ATTACK
CAUTION
RECOGNITION WHAT TO DO
SEEK EMERGENCY
• Make the patient comfortable MEDICAL ASSISTANCE
• Central chest pain, may also • POSITION: Semi – sitting position,
be felt in the jaw and or down • Check if there is a doctor on board,
one or both arms, • Be calm and reassuring.
• Allow the patient to use their • Whenever a heart attack is
• Breathlessness, heart medication, if any. suspected, especially if
• Discomfort high in the • ASPIRIN – to be chewed slowly following treatment chest pain
abdomen, (make sure there is no Aspirin remains intense, and the
ALLERGY), patient feels no relief;
• Sudden dizziness, faintness,
• NITROGLYCERINE – 1 dose under • If the patient loses
collapse, the tongue (as indicated by consciousness, stops breathing,
• Pale skin, bluish lips, prescription), START CPR;
• Sudden sweating, • OXYGEN – high flow. • DO NOT give Aspirin if he/she
• Feeling of impending doom. IS ALLERGIC to it.
Monitor the patient: When taking Nitroglycerin, there is a

high risk of sudden blood pressure
• Level of response, breathing, drop and collapse.
intensity of pain.
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ANGINA PECTORIS (CHEST PAIN)
Angina pectoris is temporary chest pain or discomfort

that keeps coming back, as a result of decreased
blood flow to the heart muscle.
Angina is not a heart attack, but it is a sign of increased
risk for heart attack.
The signs and symptoms are similar to the ones of a

heart attack.
It could be triggered by stress and physical activity.
WHAT TO DO
• Check vital signs.
• Perform SAMPLE.
• Angina is usually relieved within a few minutes by resting
and by taking prescribed medicine, so encourages the
casualty to rest.
• Make them feel comfortable and be reassuring.
• Encourage the casualty to take their own medicine, as
prescribed by physician.
• If the symptoms don’t go away with rest and medication,
suspect a heart attack and follow the procedure.
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SUDDEN CARDIAC ARREST (SCA)
The heartbeat is controlled by electrical impulses.

When these impulses change pattern, the heartbeat
becomes irregular.
Sudden Cardiac Arrest is therefore an

electrical malfunction of the heart that
causes the heart to stop functioning and
pump blood to the body.
A defibrillator could be life-saving in case of a

sudden cardiac arrest, as it corrects irregular
heartbeats.
Without treatment, cardiac arrest is fatal within
minutes.
Sudden Cardiac Arrest is different from a heart
attack (in a heart attack, the heart doesn’t
usually stop beating), however SCA may occur
during a heart attack or during the recovery of
a heart attack.
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SUDDEN CARDIAC ARREST (SCA)
SIGNS and SYMPTOMS
• Sudden collapse; loss of consciousness.

• No breathing or gasping for air (agonal breathing).
• Some cases present also stiff muscles, involuntary movements
(seizures).
Seek Emergency Medical
WHAT TO DO
Assistance (EMA)
1. Assess the casualty: AVPU.
2. Open the airway and check Whenever CPR
breathing. manoeuvres and the use
of an AED is needed.
3. Start CPR and use the
Automated External
Defibrillator (AED).
4. Follow the instructions
provided by the AED prompt.
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Deep Vein Thrombosis (DVT)
“Economy Class Syndrome”
DVT is a medical condition in which a blood
clot is formed in a large vein (usually in the
leg).
.
This condition could become dangerous if the clot is
travelling through the bloodstream and lodge in the
lungs, heart or in the brain, causing complications that
may lead to death.
Look for emergency assistance if there are symptoms

of Pulmonary Embolism:
• Sudden shortness of breath;
• Sharp chest pain that becomes worse with deep
breathing or coughing;
• Coughing up blood;
• Fainting;
• Rapid pulse or irregular heartbeat;
• Anxiety or sweating.
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Fainting
Fainting is a brief loss of consciousness, lasting from a few seconds up to
a few minutes.
Fainting isn’t usually a cause for concern, but it can sometimes be a

symptom of a serious medical problem.
There are some reasons why someone might faint:
✓ standing up too quickly – this could be a sign of low blood pressure;

✓ not eating or drinking enough;
✓ being too hot;
✓ being very upset, angry, or in severe pain;
✓ heart problems;
✓ taking drugs or drinking too much alcohol;
✓ seizures;
✓ hyperventilation;
✓ hypoglycemia.
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Fainting
WHAT TO DO
1. Check the time, open the airway and check breathing. Take vital signs.
2. If the person is breathing normally, put them in recovery position.
3. Consider providing oxygen.
4. If the person has not lost consciousness, just they are very pale and dizzy, advise to lie
down.
5. Lose tight clothing.
6. Lower cabin temperature.
7. Once the patient regains consciousness, help them sit up gradually. The person might
faint again.
8. Try to find out the cause of fainting (e.g. not eating, stress, a medical condition etc.).
9. Offer something cold and sweet to drink.
10. Monitor the level of response, breathing.
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Shock
Shock is a life threatening condition, when the

circulatory system cannot provide enough
blood and/or essential elements like oxygen
and glucose to the tissues.
There are 4 types of shock, according to the

cause that lead to the condition:
• Low volume shock (hypovolaemic shock)
• Cardiogenic shock
• Allergic shock
• Septic (infectious) shock.
Hypovolaemic shock
This type of shock occurs when the body loses
important amounts of body fluids or blood. It is
caused by severe bleeding, prolonged
diarrhoea / vomiting, burns.
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Shock
WHAT TO DO
RECOGNITION
• Treat any obvious signs of shock
• SEVERE BLEEDING – stop the bleeding, SEEK EMERGENCY
Initially: MEDICAL ASSISTANCE
• SEVERE ALLERGIC REACTION –
• Pale, cool, sweaty skin, feeling epinephrine (EPI PEN),
faint, shivering, • VERY LOW SUGAR LEVEL – give sugary
• Rapid, shallow breathing, drinks, CAUTION
• Grey –blue skin: lips, fingernail • SEVERE BURNS – dehydration - keep
beds, warm. • Even though the casualty
feels thirsty DO NOT allow
• Weakness , dizziness, nausea, Position them to eat or drink,
possible vomiting,
• Loosen tight clothing at the neck, chest, • If the person is pregnant, help
•Eventually:
Thirst. her to lie down on her LEFT
and waist,
• Help the casualty to lie down and raise side,
• Restlessness, aggressiveness,
and support his/her legs, • If the person lost
• Gasping for air,
• Keep them warm by covering him/her consciousness and is not
• Unconsciousness, with a blanket, breathing START CPR.
• Cardiac Arrest. • Administer oxygen.
Monitor the casualty

• Level of response, breathing.
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Glucose related Disorders

DIABETES
Diabetes is a condition that occurs when the body cannot properly regulate the
glucose (sugar) levels in the bloodstream.
This happens when the body is unable to produce or utilize insulin, the hormone
responsible for the regulation of sugar in the blood.
The treatment is a combination of controlled diet and medication.
If people that develop diabetes do not get proper treatment for their condition,
the sugar in the blood can get dangerously high or low:
1. Hypoglycaemia (low blood sugar)
2. Hyperglycaemia (high blood sugar).
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Diabetes
HYPOGLYCAEMIA HYPERGLYCAEMIA
WHAT TO DO 1. Check vital signs. 1. Check vital signs.
2. Raise the sugar level in their 2. Monitor the casualty, make them feel
body QUICKLY. comfortable.
3. Provide juice with extra
sugar, honey or chocolate. 3. Call for medical assistance at destination.
4. Encourage the patient to eat The casualty has to be treated in hospital.
a proper meal within 20
minutes of incident.
5. If the patient does not
recover after drinking and
eating, look for other
possible causes.
6. DO NOT GIVE INSULIN, as
insulin lowers the blood
sugar.
If unsure the person has hypo- or hyperglycaemia, GIVE SUGAR.
Sugar will help in case of hypoglycaemia, additional sugar will not harm in case of
hyperglycaemia.
Seek Emergency If the casualty lost If the casualty lost consciousness.
Medical Assistance consciousness. In this case,
follow the Unconscious person
procedure.
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Gastro-intestinal Disturbances
VOMITING, DIARRHOEA
Vomiting / nausea are usually related to air

sickness (a sickness of motion) on board, but it could
appear also in food poisoning, alcohol intoxication,
drug abuse, pregnancy etc.
Diarrhoea could be caused by a number of pathogens like

bacteria, viruses and parasites.
They usually result from consuming contaminated food or

water, but infection can be passed from person to person.
Good hygiene helps prevent infectious diarrhoea.
Vomiting and diarrhoea may occur either separately or

together.
Both conditions can cause the body to lose vital fluids and
salts, resulting in dehydration.
When they occur together, the risk of dehydration is

increased.
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Vomiting / Diarrhoea
SIGNS and SYMPTOMS
Diarrhoea and vomiting might be accompanied by:
o Abdominal pain
o Pale, sweaty, clammy skin
o Dizziness, light-headedness, weakness if dehydration is severe
o Muscle weakness and irregular heartbeat in children, due to dehydration.
WHAT TO DO Seek Emergency Medical Assistance
1. Check vital signs.
If vomiting and/or diarrhea are
2. In order to replenish the lost salts and water and rehydrated
severe and the casualty develops:
the person, prepare an isotonic
drink: 1 litre of chest pain, difficulty breathing,
Water + 1 teaspoon of Salt + 4 or 5 severe abdominal pain.
teaspoons of Sugar. The casualty should sip it
slowly and often. You can add lemon juice to change the
taste.
3. If the casualty is hungry, advise to eat easily digested foods
like crackers or rice for the next 24 hours.
4. Relocate the casualty near a lavatory and keep it open only
for them.
5. Dispose all contaminated materials in a biohazard bag.
6. Use protective equipment.
7. Seek medical advice especially if dealing with children /
elderly with severe vomiting and diarrhoea. They can quickly
become dehydrated.
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Alcohol Intoxication
RECOGNITION: ACTIONS:
Mental confusion or unconsciousness; Assist the person to a comfortable and safe
Repeated vomiting; place. Use a calm, strong voice. Be firm.
Seizures; Assess if the person is in a life-threatening

Slow or irregular breathing; situation and GET HELP IF YOU NEED IT.
Lie the intoxicated person in the recovery
Low body temperature; position if they loose consciousness and
Pale, clammy, or bluish skin. breath normally.
Check breathing regularly.

Do not leave person alone.
DON’Ts:
Don’t provoke a fight by arguing with or laughing at the person who is drunk.
Don’t try to counsel the person– confront the behaviour later.
Don’t give anything to eat or drink—coffee and food will not help, and the person may choke.
Don’t give the person any drugs (i.e.: PAINKILLERS); these drugs with alcohol may be fatal.
Don’t induce vomiting.
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Temperature related medical conditions
HEAT EXHAUSTION & HEATSTROKE
HEAT EXHAUSTION
This is a disorder caused by loss of salt and water through
excessive sweating.
It develops gradually, often affecting people who are not acclimatized

with hot and humid conditions.
A dangerous cause of heat exhaustion happens when the body

produces more heat than it can cope with.
Some non-prescription drugs, like ecstasy can affect the body’s
temperature regulation system.
HEATSTROKE (SUNSTROKE)
The condition is caused by a failure of the “thermostat”

in the brain to regulate body temperature.
The body becomes dangerously overheated due to high fever or
prolonged exposure to heat.
Heatstroke follows heat exhaustion, when sweating ceases and

the body cannot be cooled by evaporation of sweat.
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HEAT EXHAUSTION & HEATSTROKE
HEAT EXHAUSTION HEAT STROKE
SIGNS & Development: gradually, after exposure to Development: rapid. It can develop with little
SYMPTOMS hot and humid conditions. warning, resulting in unconsciousness within
minutes of the casualty feeling unwell.
• Weakness, dizziness
• Muscle cramps • Hot and dry skin
• Headache • Absence of sweating in late stages
• Rapid breathing • Temperature above 40°C
• Confusion • Decrease level of consciousness
• Nausea & Vomiting • Cardiac arrest
• Sweating with pale, clammy skin
WHAT TO DO 1. Check vital signs. 1. The best way to cool the casualty is to
spray them with water and fan them,
2. Help the casualty to cool: give plenty repeatedly. A cold, wet cloth may also
of cold water to drink or juice with ice work, and ice packs in the armpits and
chips. groin may be affective.
3. Lie down the casualty in a cooler 2. Once the casualty’s temperature appears to
place (galley) and raise legs to have returned to normal, replace the wet
improve blood flow to the brain. sheet with a dry one, to avoid overcooling.
4. Remove unnecessary clothing. 3. Monitor vital signs: loss of consciousness
5. Place wet cloth on the forehead, back usually occurs with heatstroke.
of the neck. 4. If the casualty’s temperature rises again,
repeat the cooling process.
Seek Emergency If the symptoms become worse.

Medical Assistance
If the casualty lost consciousness.
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Hypothermia
This condition develops when the body temperature

drops below 35°C.
The blood supply to the superficial blood vessels in the

skin, for example, shuts down to maintain the function of
the vital organs such as the heart and brain.
The condition is caused by exposure to low temperature,

cold, wet, windy conditions.
Elderly people, infants and those who are thin and frail are
particularly vulnerable.
Lack of activity, chronic illness and fatigue all

increase the risk; alcohol and drugs can exacerbate
the condition.
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Hypothermia
SIGNS and SYMPTOMS
• Feeling cold, shivering (lack of shivering with severe hypothermia)
• Pale, dry skin
• Confusion
• Lethargy
• Slow, weak pulse
• Slow, shallow breathing
• Blurred consciousness or unconscious
• Cardiac arrest
1. Check vital signs. If symptoms get worse and the casualty becomes
unconscious.
2. Lay down the casualty in a sheltered, comfortable
If the casualty is a baby.
and dry place.
3. Remove and replace any wet clothing.
4. Wrap the casualty in a foil survival bag, add extra
layers of clothes and cover the head.
5. Avoid movement.
6. Give hot drinks and high energy food, like
chocolate.
7. Wait for approximately 30 min for the body
temperature to increase and monitor vital signs.
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Frostbites
The tissues of the extremities (usually the fingers

and toes) might freeze due to low temperatures.
In severe cases, this can lead to permanent loss of

sensation, tissue death and gangrene, as the
blood vessels and soft tissues become
permanently damaged.
Frostbite usually occurs in freezing or cold and windy

conditions.
People who cannot move around to increase their

circulation are particularly susceptible.
In many cases, frostbite is accompanied by hypothermia.
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Frostbites
SIGNS and SYMPTOMS
• “Pins-and-needles” sensation
• Paleness (pallor)
• Numbness
• Hardening and stiffening of the skin
• A color change of the skin of the affected area: first white, then mottled and blue.
• On recovery, the skin may be red, hot, painful, and blistered. Where gangrene occurs, the tissue may become
black due to loss of blood supply.

1. Check vital signs.
The casualty should be treated in the
2. Move the casualty to a warm environment. hospital at destination.
3. Gently remove boots, gloves etc.
4. Warm the affected area in your hands, lap, without rubbing
as this might damage the skin.
5. Warm the affected part in tepid water (below 40°C)
6. Dry gently and apply a light dressing of dry bandage.
7. Raise the affected area to reduce swelling.
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Emergency Child Birth
The process of giving birth is called

labor and it has 3 stages:
❑ First stage – dilation of the neck of the

womb (from about 6 to 12 hours)
❑ Second stage – descent of the baby

from the womb to the vaginal entrance,
delivery (up to 2 hours)
❑ Third stage – delivery of the afterbirth

(up to 30 minutes)
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Emergency Child Birth
FIRST STAGE SECOND STAGE THIRD STAGE

WHAT TO DO
1. Stay with the mother; let her 1. PAY STRICT ATTENTION TO HYGIENE and 1. Some bleeding is normal, but
walk and encourage her to wear protective equipment. observe for excessive bleeding
breathe deeply during 3. Tell the mother to grasp her knees. This will which could lead to shock.
contractions. help her to push with the contractions. 2. Once the placenta is delivered,
4. Inspect the vaginal area and protect the place it in a biohazard bag and keep
2. Avoid giving water or food.
rectum with sterile pads. it intact.
Wet her lips or give her an ice
5. Support the baby’s head as it emerges. 3. After the placenta is delivered and
cube.
DO NOT PULL BABY’S HEAD. there is a delay in medical
3. You can administer oxygen if 6. Check that there is no membrane covering the assistance, the umbilical cord
needed. baby’s face. If there is, tear it away. should be tied up with a sterile
4. Set up the galley: place 7. Note the time of birth. bandage, 4 fingers from the baby’s
plastic bags on the floor with 8. DO NOT PULL OR CUT THE UMBILICAL abdomen, to stop the blood flow.
paper tissues; arrange a CORD. 4. Clean the mother with sanitary
confortable space, with 9. Clean the baby’s mouth. The baby should pads.
mother’s clothes. start to cry. If not, assess the child according to
the algorithm for paediatric emergencies.
10. DO NOT SMACK THE BABY.
11. Dry and wrap immediately the baby and put
her/him on the mother (new-borns lose body
heat very quickly).
12. Make sure the baby is lying on the side, with
the head slightly downwards, so that fluids can
drain from nose and mouth.
Seek Emergency Medical Assistance

Childbirth on board is considered a medical emergency that requires proper medical care for the mother and the baby.
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Death on board
• Doctor must be called.
• If possible, a medical doctor shall declare death.
• In general, the flight might proceed to the scheduled destination. If death

takes place a few minutes after take-off it might be preferable to return to the
station of departure.
• The Commander may, however, decide to land at the nearest suitable

aerodrome, if the cause of death and/or possibility of infection requires so.
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Death on board
WHAT TO DO ON BOARD?
• the deceased should be laid down (arms crossed; eyes closed), out of the
sight of the other passengers, if possible in a separated area;
• in case the death occurred due to contagious disease, all precautions shall
be taken to prevent infection of the other passengers.
AFTER LANDING?
• the Commander shall submit a short statement in duplicate to the
Authorities and to the Operator;
• this statement must contain the name of the deceased as well as the
circumstances, time and geographical location of death;
• the Commander shall look after the baggage, personal belongings of the
deceased.
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IATA’s suggested protocol when a person has been declared dead
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SURVIVAL FIRST AID
If an accident occurs in the wilderness, in case of a crash or a diversion, it

will be cabin crew’s responsibility to deal with the situation. The specific
sequence of actions when dealing with such situations is:
1. Remain calm, provide efficient first aid treatment.
2. Keep the casualty warm and lying down. Do not move this injured person until you have discovered the
extent of the injuries.
3. Start resuscitation immediately, if casualty is not breathing.
4. Stop any bleeding.
5. Give your patient reassurance. Watch carefully for signs of shock.
6. Check for cuts, fractures, breaks and injuries to the head, neck or spine.
7. Do not allow people to crowd the injured person.
8. Do not remove clothing unless it is imperative.
9. Decide if the casualty can be moved. If this is not possible, prepare a suitable living area in which shelter,
heat and food are provided.
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FIRST AID EQUIPMENT
First Aid and Emergency Medical Kits
The kits should be able to withstand temperature extremes, frequent jostling, and
repetitive ascents and descents.
The need of first aid kits should be based on audit of the inflight incidents and the type of
aircraft (number of passengers): 1 first aid kit for 100 passengers.
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FIRST AID EQUIPMENT
First Aid and Emergency Medical Kits
First Aid and Emergency Medical Kits usually

contain different types of medicine and
equipment necessary to give first aid:
• bandages;
• wound dressings;
• antiseptic wound treatment;
• disposable gloves;
• burn compresses;
• splints, scissors, and safety pins;
• medicine
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FIRST AID EQUIPMENT
Oxygen bottle
Oxygen bottles can be used for

first aid purposes and as
supplemental oxygen after
decompression.
The bottles can be of different

types, containing a certain
amount of compressed oxygen ;
An oxygen bottle could provide:

High flow oxygen or Low flow
oxygen, according to the user’s
needs.
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FIRST AID EQUIPMENT
Oxygen bottle
Many medical conditions would require administration of oxygen on the flight, as part
of first aid actions.
If oxygen is needed:
➢ Inform the Flight Deck Crew;

➢ No smoking reminder to passengers shall be done;
➢ Remove bottle from compartment;
➢ Wear shoulder strap;
➢ If not already connected, connect the mask to the outlet;
➢ Remove any grease or make up from patient’s face;
➢ Open ON/OFF valve carefully;
➢ While turning the valve carefully select the required flow;
➢ Check flow rate;
➢ Fit mask securely on the patient’s nose and mouth;
➢ Time check by assisting person;
➢ Bottle shall be stowed for landing. If the patient’s condition requires oxygen for
landing – Commander must be informed and buddy must be briefed.
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FIRST AID EQUIPMENT
AUTOMATED EXTERNAL DEFIBRILLATOR
(AED)
An Automated External Defibrillator (AED) is a portable device designed to treat the most
common causes of Sudden Cardiac Arrest (SCA). The device delivers electrical shocks to the
heart, in order to correct an abnormal heart rhythm. The AED will analyze the heart rhythm
and classify it as shockable or non-shockable.
The AED will give visual and verbal instructions to guide the user through every stage of
restoring the casualty’s normal heartbeat. The crew must follow the instructions received from
the device.
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AUTOMATED EXTERNAL DEFIBRILLATOR
(AED)
What can be found inside the

AED kit?
✓ Adult & children pads

✓ CPR mask for adults
✓ CPR mask for children
✓ Gloves
✓ Razor
✓ Scissors
✓ Non-sterile towel dressing
✓ Seals.
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TRAVEL HEALTH
Alertness
Management
USE OF ALCOHOL BLOOD AND

NARCOTICS
AND OTHER MEDICATION BONE MARROW
AND/OR DRUGS
DRUGS DONATION
Aviation safety
requires the full The use of narcotics
decision-making and/or drugs that
ability of all airline have not been As a rule, if a Crew Crew members
employees, therefore prescribed by member finds it should not normally
all employees are a medical necessary to take, or act as blood and
expected to perform practitioner is has been prescribed bone marrow
their job with clear expressly forbidden some form of donors. Should
mind, free of the at any time. medication, her circumstances
influence of alcohol. fitness to fly must be require differently,
reconsidered, and Crew members who
she shall seek aero- are scheduled for
To be able to meet medical advice flight duties must
this requirement, before commencing not donate blood
employees shall not or continuing flying within 24 hours
consume any This also applies to
sleep inducing drugs. duties. prior to scheduled
alcohol for a start of the duty.
minimum period of
8 hours before any
duty. The minimum
period might vary.
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TRAVEL HEALTH
Circadian
Rhythm
Physical, mental and behavioural
changes that follow a daily cycle.
Jet lag
Also called jet lag disorder, is

a temporary sleep problem
that can affect anyone who
quickly travels across
multiple time zones.
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TRAVEL HEALTH
Sleep Physiology
Sleep is a state of unconsciousness from which the person

can be awaked.
Sleep deprivation and sleepiness is responsible for:
➢Accidents;
➢Missed education;
➢Occupational impairment.
The brain has 3 major states of activity and

function:
➢ Wakefulness;
➢ Non Rapid Eye Movement Sleep (N-REM
Sleep);
➢ Raid Eye Movement Sleep (REM Sleep).
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TRAVEL HEALTH
Fatigue
Fatigue is a feeling of constant tiredness or weakness and can be physical,
mental or a combination of both.
Although fatigue is sometimes described as tiredness, it is different to just feeling tired or sleepy.
May result in impaired standards of operation

with increased likeliness of error:
Slow reaction time;
Reduced attentiveness;
Impaired memory;
Withdrawn mood.
If the person is getting enough sleep, good nutrition and exercising regularly but still find it hard to
perform everyday activities, concentrate or be motivated at normal levels, he / she may be
experiencing fatigue that needs further investigation.
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TRAVEL HEALTH
STRESS
STRESS is a physical, mental, or emotional factor that causes tension in the
body (mental and/or physical)
Stresses can be external (from the environment, psychological, or social

situations) or internal (illness, or from a medical procedure).
Stress can initiate

the "fight or flight" response,
a complex reaction of neurologic
and endocrinological systems.
Stress is your body's response to certain situations. It’s subjective,

so something that is stressful for you may not be stressful for someone else.
There are many different kinds of stress and not all of them are bad.
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TRAVEL HEALTH
STRESS
Acute stress
The most common form. Its the short –
term stress that comes from obvious
triggers.
Episodic acute stress

The same as acute form, but it happens
more frequently.
Chronic stress
The grinding stress that wears people
away day after day, year after year.
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TRAVEL HEALTH
Nutrition: DOs and DON’Ts
➢ Eat before starting each duty;

➢ Avoid sugary foods;
➢ Avoid highly processed foods (fast food);
➢ Vegetables (the base of your diet);
➢ Include in your diet high quality, minimally
processed foods:
▪ Protein (eggs, lean meat, some dairy,
beans)
▪ Fats (nuts & seeds, avocado, olive oil)
▪ Carbs (vegetables, fruits, whole grains).
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TRAVEL HEALTH
Immunisation
The World Health Organization’s (WHO) International

Health Regulations for many countries prescribe
vaccination of crew and passengers against defined
diseases, often specifying that such immunization is
only required upon entry “after leaving or transiting
infected areas”.
Medical advice is to be sought concerning the period

to be observed before returning to flying duties
following immunization.
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BASIC FIRST AID
INJURIES
FRACTURES BLEEDING
WOUNDS BURNS
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BASIC FIRST AID
Injuries
Dressings and Bandages
Dressings – are pads or compresses applied to a wound to promote healing, stop

bleeding and protect the wound from further harm. A dressing is designed to be in direct
contact with the wound (e.g. gauze, eye pad etc.).
Bandages - often are used to hold a dressing in

place and maintain pressure on it, give support
to injured parts or restrict movement.
Safety pins – used to secure in place the ends of bandages.
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BASIC FIRST AID
Injuries
Checking Circulation after

Bandaging
Once a bandage has been applied on a limb, it is
important to check circulation on that hand / foot,
immediately after. They can swell after an injury
and a bandage can become too tight and interfere
with circulation in that area.
Capillary refill time: briefly press on a

nail or on the skin of the hand / foot until
it turns pale. Then release the pressure
and the colour should return as soon as
you let go (within 2 seconds).
If the colour doesn’t return or returns slowly,

the bandage could be too tight. Readjust the
bandage.
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BASIC FIRST AID EYE INJURY
FOREIGN PARTICLES IN THE EYE / CHEMICAL SPLASH
WHAT TO DO
SIGNS & SYMPTOMS
• Feeling of something 1. Perform SAMPLE.
under the eyelid. 2. If the casualty is wearing contact lenses, ask
• Discomfort and pain them to remove it from the affected eye.
in the eye. 3. Ask the casualty to bend the head towards the
• Excessive blinking, injured eye.
redness to the eye. 4. Using gloves, gently hold the victim’s eyelids
• WASH
If chemical splash, the apart and pour water in the inner corner of the
victim could declare eye, so that the fluid could run across the eye.
what kind of Ensure copious amounts of water are used in
substance could have case of a chemical splash.
been. Pain might be 5. If there is still discomfort or in case of a
severe. chemical contamination, cover both eyes with
eye pads (sterile gauze).
6. Do not attempt to remove foreign particles that
are firmly lodged.
DIRECT INJURY TO THE EYE
SIGNS & SYMPTOMS WHAT TO DO

• Bruising and swelling around the eye. 1. Perform SAMPLE.
• Pain, possible bleeding. 2. If the eye is swollen or bleeding, apply cold
• Visual disturbances. compresses for around 30 minutes. Do not
• In case of impalements, foreign object protruding apply cold compress if there is a penetrating
from the eye. injury to the eye.
3. If there is an object sticking out of the eye,
stabilize the object with pads around it. Cover
the uninjured eye as well, to limit movement.
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BASIC FIRST AID
Head Injuries
Head injury is a trauma to scalp, skull or brain.
There is a wide range of head injuries, from a minor bump

to a serious brain injury.
SIGNS AND SYMPTOMS
WHAT TO DO CAUTION
• Bruising, swelling or bleeding 1. Assess vital signs. SEEK EMERGENCY
(history of trauma) 2. Assess the severity of the injury. MEDICAL
• Headache, nausea, vomiting 3. Control bleeding by putting direct
• Memory loss pressure over the wound. ASSISTANCE
• Blood or clear fluid from the nose 4. Apply cold compress to minimize
or ears swelling. If the patient
• Blurred vision, unequal pupils 5. Limit the head movements. develops
• Slow breathing 6. If clear fluid is emerging from one or convulsions
both ears - place absorbent
compresses on the ear and keep in If the patient’s level
place with gauze.
of response falls
7. Monitor closely, as the casualty
might become unconscious.
If the patient stops
breathing, START
CPR.
DO NOT GIVE ANY SLEEPING PILLS / SEDATIVES/ TRANQUILIZERS.
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BASIC FIRST AID
ABDOMINAL & CHEST
INJURY
• Trouble breathing;
• Shallow breathing;
• Tenderness at site of injury;
• Deformity & bruising of chest;
RECOGNITION
• Pain upon movement/deep
breathing/coughing;
• Dusky or blue lips or nail beds;
• May cough up blood;
• Crackling feeling upon touching victim's skin
(sounds and feels like "Rice Krispies").
• Assess;
• Make a PA for a doctor on board;
• Assist the victim into a position of comfort
(typically seated upright, shoulders relaxed);
WHAT TO DO? • Monitor patient's condition carefully;
• Be vigilant, keep alert for any changes;
• Seek emergency assistance.
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Sharp object injury
Sharp contaminated objects represent a risk

to cabin crew and to passengers, i.e.
hypodermic needles or broken glass,
especially when hidden in unlikely places.
SQUEEZE WASH DISINFECT DRESSING DOCTOR REPORT
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BASIC FIRST AID
BLEEDING
Bleeding, also known as a haemorrhage, or simply blood loss, is blood escaping from the
circulatory system from damaged blood vessels. Different injuries could involve bleeding.
Loss of more than 1 liter of blood constitutes danger to life. The crew should take immediate
actions to stop any bleeding. Bleeding could be external (that you can see) and internal (inside
the body). INTERNAL
EXTERNAL INTERNAL
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BASIC FIRST AID
INTERNAL BLEEDING
Internal bleeding can be caused by damage to a

blood vessel.
INTERNAL BLEEDING
SIGNS & SYMPTOMS WHAT TO DO SEEK Emergency

Medical Assistance
• Typical signs of 1. Treat as hypovolemic shock. • Seek emergency
hypovolemic 2. If unconscious and breathing normally, medical care as soon
shock. recovery position. as possible.
• Possible vomits 3. Monitor the casualty by checking vital
looking as coffee signs.
grounds.
• Cold, pale,
clammy skin.
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BASIC FIRST AID
EXTERNAL BLEEDING
• CAPILLARY
In droplets – treat the wound.
• VENOUS
Dark red, flowing uniformly – lie the patient
flat, stop the bleeding, apply compression
bandage (gauze, hard object, elastic
bandage).
• ARTERIAL
Pulsating, light red – stopping the bleeding
has the highest priority!!!
Apply compression dressing and a second

one on the top.
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BASIC FIRST AID
EXTERNAL BLEEDING
SEVERE BLEEDING
SIGNS & COMPLICATIONS WHAT TO DO

SYMPTOMS
• Blood would • Shock. 1. If bleeding is severe, DO NOT waste time looking for
be spurting • Loss of suitable padding, but be prepared to use the patient’s hand
or flow consciousness. or your hand if you have gloves to put pressure on the
briskly from • Wound infection. wound, if the patient is unable to do this unaided.
the wound. 2. Wearing gloves, apply direct pressure over the wound
with a sterile dressing. If blood comes out through the first
dressing, apply a second dressing over it. If bleeding again
through the second dressing, remove them both and apply
a new one, making sure you put pressure on the point of
bleeding.
3. Secure the dressing with a bandage.
4. Raise the affected area above the heart level.
5. The casualty should rest for at least 10 minutes.
6. If an arm is injured, you can apply an elevation sling.
7. Treat for shock if develops.
8. Administer oxygen.
9. Seek Emergency Medical Assistance if bleeding can’t be
stopped.
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BASIC FIRST AID
NOSE BLEEDING
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BASIC FIRST AID
NOSE BLEEDING
NOSEBLEED
SIGNS & WHAT TO DO

SYMPTOMS
• Bleeding 1. Perform SAMPLE.
from the 2. Check for trauma.
nose 3. Ask the casualty to pinch the
• Swallowing nose, lean forward and keep
blood the pressure for at least 10
minutes.
4. Ask the casualty not to blow the
nose.
5. Give a glass to spit the blood, not
to be ingested. Ingested blood
might lead to vomiting.
6. Advise the person to avoid hot
liquids or rapid movements.
7. Monitor for shock signs if bleeding
does not stop. Nosebleed could
be dangerous in case of head
trauma, if the casualty has
blood diseases like anaemia or
haemophilia; if they take blood
thinning medication.
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WOUNDS
Wounds are injuries that break the skin or other body tissues.
They include cuts, scrapes, scratches, and punctured skin. They often happen because
of an accident. Minor wounds usually aren't serious, but it is important to be cleaned.
WHAT TO DO
1. Clean the wound with running water.

2. Disinfect the wound.
3. Apply a dry, sterile bandage.
4. Place the patient in a comfortable
position.
5. Do not pre – treat the wound with
cream, powder.
6. Do not remove foreign objects from
the wound.
7. In case of a larger wound, stop the
bleeding, cover with sterile dressing
and immobilize the affected area.
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BASIC FIRST AID
BURNS
Burns are damage to the skin created in most of the cases by heat,
chemicals, radiation or electricity. Burns could be a minor medical problems
or a life-threatening medical emergency.
According to the damage caused to the skin and tissues,

burns are classified in 3 degrees:
1st Degree Burn (the first layer of the skin is

affected) Red skin, painful, mild swelling.
2nd Degree Burn (all layers of the skin are affected)

It may cause swelling and red, or discoloured skin.
Blisters may develop, and pain can be severe.
3rd Degree Burn (this burn reaches to the fat layer

beneath the skin).
Burned areas may be black, brown or white. The
skin may look leathery. Third-degree burns can
destroy nerves, causing numbness.
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BASIC FIRST AID
BURNS
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BASIC FIRST AID
FRACTURES
A fracture is a brake of a bone.
Fractures could be:

• closed (the skin has not been penetrated by the bone)
• open (the bone pierce the skin and sticks out).
In both cases, a fractured bone could create damage to the muscles, blood vessels and nerves.
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BASIC FIRST AID
FRACTURES
SIGNS & SYMPTOMS

WHAT TO DO
• Swelling 1. DO NOT attempt to put back the bone in
• Sensitivity to touch the correct position.
• Deformation 2. Ask the casualty not to move the injured
• Pain when moving area.
the affected area 3. Prevent the fractured point joint form
• Bruising at the site moving, by immobilizing the joints on
• Bleeding (open each end of the bone.
fracture) 4. For stabilizing use splinters from FAK, or
• Possible bending or other rigid materials like
twisting of the cushions/magazines, if necessary.
affected area 5. Fix the improvised splint in place with
gauze or bandages.
6. Place ice (in a bag) on the area, in order
to alleviate the pain and swelling. Do not
put ice directly on the skin.
7. In case of an open fracture, stop the
bleeding by using a compression
bandage and treat the open wound. Apply
2 roller bandages on both sides of the
wound and secure in place with another
bandage.
8. Once immobilized, elevate the area. An
elevation sling could be used.
9. Monitor for signs of shock and treat
accordingly.
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BASIC FIRST AID
FRACTURES
How to apply an elevation sling:
• the casualty should hold the hand across the chest;

• taking a triangular bandage from the first aid kit, put it under the arm
that needs to be elevated;
• cross the bandage over the arm; SLINGS
• tide the bandage at the back.
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BASIC FIRST AID STRAINS and SPRAINS
These injuries are affecting the soft tissues of a joint: muscles, ligaments (tissues that connect bone to
bone) and tendons (connect muscles to bones).
They are caused by sudden twisting or wrenching movement resulting in pain, swelling, impaired
movement.
Strain – Overstretching or tearing of a muscle or tendon.

Sprain – Overstretching or tearing of a ligament.
SIGNS & SYMPTOMS WHAT TO DO
• Bruising 1. Rest the affected area; apply a bag of ice on

• Pain around the the area, but not directly to the skin; apply a
affected joint bandage and immobilize; elevate.
• Swelling 2. Distinguishing between a fracture and strain
• Limited flexibility or sprain can be difficult, and these injuries
often occur together.
3. It is recommended that these injuries be
treated as a fracture until medical evaluation
is available.
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TRAVEL HYGIENE
Communicable & Infectious
Diseases
Infectious diseases can be caused by bacteria, viruses, or other organisms that
enter the body through a wide range of methods.
Communicable (contagious) disease is one that is spread from one person to

another through a variety of ways that include:
Physical contact with an infected person, such as through touch (staphylococcus);
Sexual intercourse (gonorrhea, HIV);
Fecal/oral transmission (hepatitis A), or droplets (influenza, TB);
Contact with a contaminated surface (Norwalk virus);
Food (salmonella, E. coli);
Blood (HIV, hepatitis B);
Water (cholera);
Bites from insects or animals capable of transmitting the disease (mosquito: malaria and yellow fever; flea:
plague);
Travel through the air (tuberculosis or measles).
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TRAVEL HYGIENE
Communicable Diseases
MODES OF TRANSMISSION
Here are some possible ways of pathogen transmission in the airplane

environment:
Ways of TRANSMISSION
SIGNS and SYMPTOMS
Respiratory • Coughing
Via air, droplets in the air or • Sneezing.
from contact with
contaminated surfaces.
Gastrointestinal • Nausea
Contact with contaminated • Stomach pain
surfaces, stool or vomit, or • Vomiting or diarrhea
from contaminated food or • Fever.
water.
Blood borne • Visible bleeding (due to injury or not).
Contact with open cuts,
scrapes, or mucous
membranes (lining of mouth,
eyes, or nose).
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TRAVEL HYGIENE
Communicable Diseases
ICAO coordinates global efforts to ensure that all

Contracting States have a preparedness plan to
mitigate the risks from a communicable disease, by
reducing the risk of dissemination of disease through
air transport.
The primary strategy of the World Health

Organization (WHO)is to mitigate the risks from a
communicable disease and to contain the disease
within the outbreak area.
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TRAVEL HYGIENE
Reporting Communicable Diseases
The flight crew shall promptly notify the ATC about identifying a
suspected case(s) of communicable disease, or other public
health risk, on board the aircraft .
ATC (Air Traffic Control) shall forward a message as soon as

possible to the public health authority (PHA) or the appropriate
authority designated by the State as well as the aircraft operator
or its designated representative, and the aerodrome authority.
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TRAVEL HYGIENE
Hygiene on board
Means to reduce infection risks:
➢ Practice routine handwashing;
➢ Identify sick and potentially infectious travelers;
➢ Treat all body fluids (such as diarrhea, vomit, or blood) like they are
infectious;
➢ Wear recommended personal protective equipment (PPE);
➢ Clean and disinfect contaminated areas;
➢ Dispose waste using recommended procedures.
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TRAVEL HYGIENE
Hygiene on board
Hand washing:
Wash hands often with soap and water for at least 20 seconds after
assisting sick travellers or touching potentially contaminated body fluids or
surfaces.
Use alcohol-based hand rub (containing at least 60% alcohol) if soap and water are not available.
Avoid touching your mouth, eyes, and nose with unwashed or gloved hands.
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PROCEDURE FOR MANAGING INFECTIOUS and CONTAGIOUS DISEASES
Whenever suspecting a contagious disease during embarkation or in-flight, the Cabin Crew shall follow the
protocol below:
1. Inform the Commander immediately.

2. The Flight Crew must inform the relevant authorities.
3. If the sick passenger was discovered in-flight, ask for medical assistance via PA.
4. Cabin Crew should try to relocate other passengers (at least 2 meters for the sick passenger, if
possible).
5. Instruct other passengers to cover their nose and mouth.
6. Crew must protect their hands and face, wash their hands with soap, use disinfectants, avoid
touching the sick passenger.
7. Designate one crew member to deal with the sick passenger (preferably the crew who dealt with
the passenger before).
8. If needed (coughing, bleeding etc.) provide tissues, bags, masks, etc.
9. Cabin crew shall ask the sick passenger if they were in contact with a sick person, possibly
infectious, in the last 21 days (E-Events from SAMPLE).
10. Block a toilet for the sick passenger.
11. For disposal of contaminated tissues use biohazard bag.
12. Ask the accompanying passengers if they have any similar symptoms.
13. No passenger or crew member shall disembark without the permission of the public health
officer.
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TRAVEL HYGIENE
Aircraft Disinfection and

Disinsection
DISINFECTION DISINSECTION
Measures are taken to control or kill Measures are taken to control or kill the
infectious agents on a human or animal insect vectors of human diseases present
body, on a surface or on baggage, cargo, in or baggage, cargo, containers,
containers, conveyances, goods and postal conveyances, goods and postal parcels.
parcels by direct exposure to chemical or
physical agents.
Current WHO approved chemicals:
Recommended products:
‘Pyrethroids’ – synthetic chemicals based on
‘Accelerated’ hydrogen peroxide (AHP) natural extract of chrysanthemums
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TRAVEL HYGIENE
Aircraft Disinfection
A large percentage of air in most modern aircrafts is re-circulated.

However, air is only reused after having gone through HEPA filters.
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TRAVEL HYGIENE
Aircraft Disinfection
SAFETY:
➢ The chemicals used are often

corrosive and toxic and have to
be handled with care;
➢ After fumigation, adequate

ventilation is necessary before
the re-entry of personnel;
➢ Protective Equipment Worn: Dust

and aerosols may be dangerous;
all staff should wear protective
masks, boots, coats, trousers and
gloves.
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TRAVEL HYGIENE
Aircraft Disinsection
Cockroaches, ants and other insect pests can enter the aircraft through cargo goods, baggage
or catering equipment.
They are not usually regarded as direct disease transmitters but can be harmful as they may
contaminate food or cause damage to the aircraft infrastructure particularly the electronic
equipment.
Some of these insects may find suitable conditions and breeding sites on board if regular
treatment and preventive measures are not undertaken.
DISEASES OF CONCERN (examples):
Malaria (mosquitoes)
Dengue (mosquitoes)
Yellow Fever (mosquitoes)
Zika (mosquitoes)
DC2P-Personal Data
TRAVEL HYGIENE
Aircraft Disinsection
Examples of Approved Methods of Disinsection:
➢ Pre-flight: The spray is applied before the passengers board the aircraft but not more than 1
hour before the doors are closed.
➢ Blocks away: Spraying is carried out by crew members when the passengers are on board,
after closure of the cabin door and before the flight takes off. An aerosol containing an insecticide
for rapid action is used.
➢ Top of Descent: Carried out as the aircraft starts its descent to the arrival airport. Applied with
the air recirculation system set at from high to normal flow. Cargo holds should also be
disinsected.
DC2P-Personal Data
TRAVEL HYGIENE
Handling of biohazard
waste
Biohazard – a biological
Universal Precaution Kit
agent, organism or The contents of an aircraft universal precaution kit
substance that poses a would typically include:
threat to human health.
•Dry powder that can convert small liquid spill into a granulated gel
It includes bacteria, •Germicidal disinfect ant for surface cleaning
viruses, spores and toxins •Skin wipes
that impact negatively on •Face/eye mask (separate or combined)
human health.
•Gloves (disposable)
•Impermeable full length long sleeved gown that fastens at t he back
•Large absorbent towel
•Pick-up scoop with scraper
•Bio-hazard disposal waste bag
DC2P-Personal Data
LIFESAVING PROCEDURES
The Unconscious &
RECOVERY POSITION
DC2P-Personal Data
The Unconscious &
RECOVERY POSITION
✓ If the person is lying in recovery position for more than 30 minutes, change the side,
using the same maneuvers.
✓ Monitor breathing every minute.
✓ If there are injuries, place the casualty on the non injured side.
✓ If there are chest and lung injuries, place the patient on the side of the injury to
prevent possible bleeding and affecting the healthy lung.
✓ During landing, an unconscious person that breathes normally should be secured in
the first row, if possible. Provide a buddy for the casualty. In case the medical
treatment would require different positioning of the casualty, exceptional solution can be
applied with the approval of the Commander of the flight.
✓ Place visibly pregnant women on their LEFT side in recovery position.
On the right side of the vertebral column in the abdominal cavity it is a large vein called
Inferior Vena Cava.
This large diameter vein has very thin walls and can be put under pressure causing the
blood traveling back to the heart to be either restricted or even completely stopped.
DC2P-Personal Data
CHOKING
A foreign object sticking at the back of the throat may either block the throat, or
induce muscular spasm.
DC2P-Personal Data
Cough!
Are you choking?
5
abdominal
thrusts!
5 back
slaps!
DC2P-Personal Data
CHOKING
Following successful treatment, foreign

material may nevertheless remain in the
upper or lower airways and cause
complications later.
Victims with a persistent cough, difficulty

swallowing or the sensation of an object being
Seek emergency medical still stuck in the throat should, therefore, be
assistance if: referred for a medical opinion.
If after 3 cycles the obstruction
does not clear
Abdominal thrusts and chest compressions
5 back slaps + 5 thrusts
can potentially cause serious internal
= 1 cycle
injuries and all victims successfully treated
If the casualty lost consciousness, with these measures should be examined
lay him/her on the floor and start afterwards for injury.
CPR
DC2P-Personal Data
INFANT CHOKING
Recognition:
Second step
• Difficulty breathing;
• Making strange noises
• Making no sound when
trying to breath;
• Coughing in distress;
• Drooling;
• Eventual loss
of consciousness.
First step
DC2P-Personal Data
CPR (CARDIOPULMONARY RESUSCITATION)
CPR is a life saving emergency procedure.

It can prevent damage to vital organs
such as brain, heart, lungs, kidneys etc.
The aim of resuscitation is to give oxygen

to the body as rapidly as possible,
irrespective of the primary cause of the
passenger’s condition, to prevent irreversible
damage to the brain.
Each resuscitation council belonging to ILCOR

(International Liaison Committee on
Resuscitation)
developed resuscitation guidelines appropriate
for their own region.
This course is base on the Basic Life Support
guideline released by the European
Resuscitation Council (ERC).
DC2P-Personal Data
CPR TECHNIQUE - COMPRESSIONS
Place the patient on his back on a hard surface.
Note: in the galley it is more space for CPR maneuvers.
The helper should kneel next to the patient at thorax level.

Uncover the thorax.
Place the heel of one hand in the center of patient’s chest.

Place the heel of your other hand on top of the first hand.
Interlock the fingers of your hands and ensure that the pressure is not applied over the patient’s
ribs.
Do not apply any pressure over the upper abdomen or the bottom end of the bony sternum
(breast-bone).
Kneel above the patient’s chest and, with your arms straight, press down on the sternum 5-6
cm.
After each compression, release all the pressure on the chest without losing contact
between your hands and the sternum.
Compression and relaxation should take equal amounts of time

The rate is 30 chest compressions, followed by 2 breaths RATIO 30:2.
Minimum 100-120 compressions per minute. DC2P-Personal Data
CPR TECHNIQUE - MOUTH-TO-MASK
BREATHS
➢ With the casualty lying flat on their back, remove any obvious obstructions from the mouth. Attempt to clear
the mouth only when you have a clear view of the content and you are sure you will not push it down the
airway.
➢ Cover mouth and nose with the mask.

➢ Put the narrow end of the mask at the top of the nose.
➢ For infants, use the pediatric mask. If it is not available, use the adult one, but place the mask upside down,
so that the nose part is under the chin.
➢ Open the airway by tilting the head and lifting the chin.
➢ Press the mask against the face to make an airtight seal.
➢ Give 2 breaths: 1 second each. Blow steadily and watch for the chest to rise.
➢ After each breath, turn your own head sideways in order to breathe in fresh air and to watch the chest
falling down.
➢ If the casualty is a child or an infant, always start cardiopulmonary resuscitation with 5 rescue
breaths and then continue with chest compressions. Continue then CPR with a rate of 30 compressions: 2
rescue breaths.
➢ If only a face shield (plastic barrier with a filter) is available: place the shield over the casualty’s face so that
the filter is over the mouth and pinch the nostrils shut. Deliver rescue breaths through the filter.
DC2P-Personal Data
CPR TECHNIQUE - MOUTH-TO-MOUTH
BREATHS
➢ Put one hand on the forehead, 2 fingers on the chin and tilt the head to
open the airway.
➢ Pinch the nose closed and give 2 breaths (1 second each).

➢ Blow steadily and watch for the chest to rise.
➢ If the casualty is an infant, take a breath, cover mouth and nose with your
mouth, making sure you form a good seal. Blow steadily into the infant’s
mouth and nose. The aim is to make the chest rise.
➢ For pediatric population, always start CPR maneuvers with 5 rescue

breaths.
DC2P-Personal Data
CPR TECHNIQUE: RESPIRATION
DC2P-Personal Data
Check for safety
Check for response
Get help
ADULT BASIC LIFE
SUPPORT (BLS) Check for breathing
ALGORITHM
Inform others
30 chest compressions
2 rescue breaths
DC2P-Personal Data
BLS
ALGORITHM
DC2P-Personal Data
CPR (CARDIOPULMONARY
RESUSCITATION)
Procedure after effective resuscitation:
➢ Place the casualty in recovery position;

➢ Administer oxygen;
➢ Protect patient from cold;
➢ Check breathing (monitor).
DC2P-Personal Data
CPR (CARDIOPULMONARY
RESUSCITATION)
Discontinue Reanimation:
➢ The casualty starts breathing normally;
➢ Upon the instructions of a physician;
➢ When rescuers are exhausted;
➢ When it is no longer safe to continue.
DC2P-Personal Data
Check for Safety
Check for Response
Unresponsive?
PEDIATRIC BLS
ALGORITHM Get Help
Check for Breathing
Not breathing normally?

Infant – from birth to 1
year of age (first aid Inform Others
definition)
5 Rescue Breaths
Child – between 1 year
Still Unresponsive?
and puberty (first aid
definition) 30 Chest Compressions, 2 Rescue Breaths
DC2P-Personal Data
PEDIATRIC CPR
Start with 5 Rescue Breaths

Blow steadily into the mouth and nose for
about 1-1.5 s. The aim is to make the chest
rise.
30:2 (compressions: breaths)
Minimum 120 compressions per
minute.
DC2P-Personal Data
DEFIBRILLATION
Age guidelines for resuscitation with defibrillation:
Adult: 8 years and above

Child: 1 - 7 years old
Infant: birth - 1 year old.
When the heart stops beating efficiently, a cardiac arrest has occurred.
A machine called an automated external defibrillator (AED) can be used to correct the
heart rhythm by giving an electric shock.
AEDs are available in many public places, including shopping centers, railroad stations, airports
and also some airlines have the device on board.
DC2P-Personal Data
AED
1. Take out the AED;

2. Turn it ON (press the GREEN button);
3. Pull out the pads and apply them on bare
skin;
4. Do not touch the casualty (heart rhythm is
being analyzed);
5. If shock is advised, press the ORANGE
button to deliver shock;
6. If no shock is advised, continue CPR and
follow the instructions of the voice prompts.
The AED Operator should instruct the crew to screen for breathing and
start CPR, if needed. Continue CPR for 2 minutes and follow the instructions
of voice prompts. Perform rescue breaths in accordance to First Aid training.
DC2P-Personal Data
AED
Correct PADs
application
Please note in case a child

between 1 - 8 years old or
weighing under 25 kg (55 lbs.)
apply PADs as on the picture
One pad below the right collarbone and the second pad
over the casualty’s ribs, in line with the left armpit.
Make sure the pads are not touching each other.
Make sure the pads stick to the skin. The First Aider should continue CPR until pads
are placed properly on the bare skin. It is extremely important that CPR is stopped
only after the pads are attached.
DC2P-Personal Data
THANK YOU!
DC2P-Personal Data

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Aero-medical and First Aid Initial

1. General Principles 7. Basic First Aid

2. Aviation Physiology 8. Travel Hygiene

3. Medical Assessments 9. Lifesaving Procedures:

5. First Aid Equipment ➢ Cardiopulmonary Resuscitation (CPR)

This training is based on European Aviation Safety Agency

1. Initial First Aid Training 2. Recurrent First Aid Training

PRIORITIES in First Aid:

The team should be consisted of:

Issuing a call for medical personnel on board:

Contact with a doctor on ground:

Order airport medical service/ambulance:

UNWELL INJURED SERIOUSLY ILL UNCONSCIOUS

During the critical phases of the flight (taxi, take-off, landing)

Any non-standard or unusual situation experienced, must be reported

Each submitted report is subject to analysis and, if applicable,

First aid & PROTECTION

SURVIVAL FIRST AID

Medical situations that would require

Our working environment

• Pressure & Air Quality

• Is kept constant thanks to the pressurized cabin.

Note: Special consideration for passengers suffering from respiratory or circulatory

Drink at least 2 dl (200 ml) of still water per hour of flying.

Mild to moderate Dehydration: Severe Dehydration:

• Both prescription and non-prescription (over-the-counter)

• The effects of some of these drugs can be even more

The common causes of hypoxia:

• External: insufficient oxygen –

• Internal: lung conditions,

Cyanosis ( bluish – grey ) lips,

Feeling heavy, tired, sleepy

The time of useful

Factors that contribute to hypoxia tolerance:

Hyperventilation or over breathing might be brought on by panic attacks,

The hyperventilation is usually triggered by an

RECOGNITION WHAT TO DO? CAUTION

Unnaturally fast Make the casualty Be careful not to use a

Panic Be calm and reassuring Small kids DO NOT

Acute stress reactions

An acute stress reaction occurs due to a

SIGNS and SYMPTOMS WHAT TO DO

1. Deal with any possible body injury,

• in an aircraft environment, the body is exposed to high altitudes, lower

It mostly occurs in the ears, sinuses or even teeth.

Ear & Sinus Barotrauma

Ear barotrauma is normally caused by common cold,

Sinus barotrauma is caused by a blocked, swollen,

RECOGNITION WHAT TO DO? CAUTION

If the pressure and pain

IF THE PRESSURE CAUSES

Do not block bleeding from

At altitude, the gases trapped in our stomach

Abdominal pain – reflecting as either mild ache or serious cramps, can

RECOGNITION WHAT TO DO? CAUTION

Stomach bloating PASS GASES

SEVERE PAIN COULD

Decompression sickness – a medical condition

Dissolved gasses (nitrogen) in the human body emerge

In normal circumstances on the flight, this condition

Since bubbles can form in or migrate to any part of the

Lower altitude (higher

Air sickness WHAT TO DO