CCPPM - Chapter 10: Aviation Medicine and First Aid PDF

Chapter 10 Aviation Medicine and First Aid 10 Aviation Medicine and First Aid................................................................... 10-3 10.1 Aviation Physiology............................

Chapter 10 Aviation Medicine and First Aid 10 Aviation Medicine and First Aid................................................................... 10-3 10.1 Aviation Physiology........................................................................................... 10-3 10.2 Effects on Oxygen and Respiration................................................................... 10-3 10.2.1 Administering Oxygen from a Cylinder......................................................... 10-4 10.3 Medical Problems Related to Altitude............................................................... 10-4 10.3.1 Hypoxia....................................................................................................... 10-4 10.3.2 Hyperventilation........................................................................................... 10-6 10.3.3 Gas Expansion............................................................................................ 10-6 10.3.4 The Sinuses and Sinus Barotrauma............................................................ 10-7 10.3.5 Gas Expansion - Other Areas of the Body................................................... 10-8 10.3.6 Decompression Sickness............................................................................ 10-8 10.3.7 Conditions or Activities................................................................................ 10-9 10.3.8 Fatigue...................................................................................................... 10-10 10.4 Aircraft Environment........................................................................................ 10-11 10.4.1 Cabin Air................................................................................................... 10-11 10.4.2 Infection Risk............................................................................................. 10-12 10.4.3 Hearing and Noise Damage...................................................................... 10-12 10.5 Aviation First Aid.............................................................................................. 10-12 10.5.1 The Function of the First Aider................................................................... 10-12 10.5.2 Handling an Unconscious Person in a Seat............................................... 10-12 10.5.3 Neck Breathers.......................................................................................... 10-13 10.6 Medical Procedures in Flight........................................................................... 10-14 10.6.1 DRSABCD................................................................................................. 10-14 10.6.2 First Aid Principles..................................................................................... 10-15 10.6.3 Recovery Position...................................................................................... 10-15 10.6.4 Managing a Medical Incident..................................................................... 10-16 10.6.5 Minor Medical Problem.............................................................................. 10-16 10.6.6 Severe Medical Incident............................................................................ 10-16 10.6.7 When to Stop Cardiopulmonary Resuscitation........................................... 10-17 10.6.8 Death in Flight........................................................................................... 10-18 10.6.9 Chain of Survival....................................................................................... 10-18 10.7 Medical Conditions in Flight............................................................................ 10-18 10.7.1 Loss of Consciousness.............................................................................. 10-18 10.7.2 Heart Conditions........................................................................................ 10-19 10.7.3 Cardiac Arrest........................................................................................... 10-21 10.7.4 Stroke (Cerebral Haemorrhage)................................................................ 10-21 10.7.5 Asthma...................................................................................................... 10-22 10.7.6 Diabetes.................................................................................................... 10-23 10.7.7 Seizures.................................................................................................... 10-24 10.7.8 Febrile Convulsions in Infants.................................................................... 10-25 10.7.9 Choking..................................................................................................... 10-26 10.7.10 Shock........................................................................................................ 10-27 10.7.11 Fainting..................................................................................................... 10-28 10.7.12 Mild to Moderate Allergic Reaction............................................................ 10-29 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-1 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.13 Anaphylaxis............................................................................................... 10-29 10.7.14 Bruises, Strains, Sprains and Fractures..................................................... 10-31 10.7.15 Head and Neck Injuries............................................................................. 10-32 10.7.16 Burns and Scalds...................................................................................... 10-33 10.7.17 Foreign Bodies in Eyes, Ears and Nose.................................................... 10-35 10.7.18 Poisons..................................................................................................... 10-35 10.7.19 Air Sickness............................................................................................... 10-37 10.7.20 Gastrointestinal Disturbances.................................................................... 10-37 10.7.21 Nose Bleed................................................................................................ 10-38 10.7.22 Flu-like Symptoms..................................................................................... 10-38 10.7.23 Childbirth................................................................................................... 10-39 10.7.24 DVT........................................................................................................... 10-40 10.7.25 Mental Illness............................................................................................ 10-40 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-2 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10 Aviation Medicine and First Aid Oxygen is administered to those with medical problems using aircraft portable oxygen bottles. Oxygen should be offered promptly to all distressed people and administered by Cabin Crew. Take advice from the person regarding the position in which breathing is easiest. Always seek professional medical help, if on board. 10.1 Aviation Physiology Human physiology is designed to function best at sea level. Flight at altitude is unnatural to human beings and imposes considerable demands on the body's physiology. For Cabin Crew, the most relevant demands placed upon the body are those caused by changes in gas pressure at different altitudes. Atmospheric Pressure Atmospheric pressure decreases with increasing altitude. The pressure of oxygen also decreases because 20% of air is oxygen. Consequently, the quantity of oxygen in the blood decreases as this is ultimately dependent upon the pressure of oxygen available. Hypoxia occurs as a result of reduced oxygen levels available to supply the body's tissues. Body Gases Atmospheric pressure decreases with increasing altitude. Reduced atmospheric pressure culminates in the expansion of gases within the body. 10.2 Effects on Oxygen and Respiration Respiration Respiration or breathing is the process by which oxygen, absorbed via the lungs, is transported by the blood to every cell in the body, and by which the waste product, carbon dioxide, is expelled from the body through exhalation. The normal adult resting respiration rate is 12 - 18 breaths per minute but this may increase if hypoxia occurs. Oxygen Oxygen (02) is essential for life and must be present in adequate quantities for body cells to function. Lack of oxygen is extremely serious. Brain cells can be permanently damaged if left with no oxygen for 4 - 5 minutes. On ascent, the oxygen pressure decreases. This pressure is the driving force across the lung membranes and increasing the breathing rate does not help the situation but creates another problem - hyperventilation. At sea level, the percentage saturation of oxygen is 97% and at levels above 12 000 ft, normal functioning of the brain is compromised. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-3 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.2.1 Administering Oxygen from a Cylinder NOTE Refer to the ‘Emergency and Survival Equipment’ chapter of the Air Crew Emergency Manual. Oxygen should be offered promptly to all distressed people. Take advice from the person regarding the position in which breathing is easiest. Always seek professional help. NOTE In the event of a depressurisation medical patients should remain on their own oxygen, however the flow rate should be increased to maximum flow. On resuming level flight, they should return to their prescribed flow rate. Passengers who require oxygen to be administered continuously or intermittently will have notified the Company when booking the flight. Such passengers are responsible for; 1. Supplying the oxygen cylinder. 2. Securing the oxygen bottle with Company assistance; and 3. The flow rate at which the oxygen is administered. 10.3 Medical Problems Related to Altitude 10.3.1 Hypoxia Hypoxia is a condition when the supply of oxygen to the body's cells is inadequate (‘Hypo' = under, 'oxia' - oxygenation). Hypoxia is not generally experienced by healthy individuals at commercial flight cabin altitudes unless a depressurisation occurs. Airline aircraft fly most economically at altitudes of 25 000 ft - 45 000 ft. To prevent the fatal effects of hypoxia at these altitudes, aircraft are pressurised. A cabin altitude of between 6000 ft - 8000 ft is maintained as a direct result. Healthy people will travel comfortably at these cabin altitudes, but people with medical conditions may experience difficulties even at these altitudes. This includes people suffering from: 1. Heart and blood vessel disease. 2. Lung disease. 3. Anaemia and other blood disorders; or 4. Intoxication from drugs including alcohol. All of these disorders interfere with the transportation of oxygen at some phase from inspired air to cellular absorption of oxygen. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-4 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.3.1.1 Recognition Mild Persons may present with: 1. Fatigue. 2. Listlessness and vague distress; and 3. Lack of concentration. Moderate Persons may present with: 1. Lack of self-criticism. 2. Mood changes and confusion; and 3. Breathlessness. Severe Persons may present with: 1. Blue tinge to lips and fingers. 2. Loss of consciousness; and 3. Death. 10.3.1.2 Management Manage hypoxia by the following procedure: 1. Give oxygen at 4 L per minute (high flow rate); and 2. Loosen tight clothing around neck, chest and waist. 10.3.1.3 Considerations 1. Conscious persons should be given oxygen sitting upright. 2. Unconscious persons should be given oxygen lying in the recovery position. 3. Excessive oxygen may aggravate some respiratory conditions, give oxygen only until condition is relieved; and 4. Recovery from hypoxia occurs rapidly when adequate oxygen is supplied. A sudden onset of dizziness during recovery is common but should pass immediately. NOTE Recovery is rapid when oxygen is supplied unless the oxygen is administered to a person with severe hypoxia. This is due to the effects of oxygen on the brain blood vessels and is known as the oxygen paradox. Administering oxygen to a person with severe hypoxia may worsen his/her condition for approximately 15 seconds before improving. Oxygen must not be removed if this occurs. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-5 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.3.2 Hyperventilation Hyperventilation ('hyper' = over, 'ventilation' = breathing) is a condition caused by over-breathing to the point where too much carbon dioxide is exhaled, resulting in the disruption of the delicate brain chemistry. Hyperventilation may be caused by: 1. Emotional upset and anxiety, and/or 2. Fear and nervousness. 10.3.2.1 Recognition Patients may present with: 1. Rapid or over-deep breathing. 2. Numbness and tingling of body extremities. 3. Spasms in the hands or feet. 4. Feelings of panic, dizziness and agitation. 5. Vision disturbance; and/or 6. Fainting episodes. 10.3.2.2 Management 1. Manage hyperventilation by the following procedure: 2. Reassure the person. 3. Ask the person to deliberately decrease the speed and depth of respiration. 4. Give oxygen at 4 L per minute (high flow rate). 10.3.3 Gas Expansion Gases contained within the body are affected by reduced atmospheric pressure encountered at altitude. On ascent, the atmospheric pressure decreases and the volume of gas increases. This process affects closed or semi-closed cavities in the body that contain air. These include the middle ear, sinuses, bowel and teeth. The more common problems with trapped gases occur in ears and sinuses. Problems in ears and sinuses are usually due to head colds or hayfever and often occurs on descent. To relieve these difficulties, have passengers: 1. Swallow 2. Yawn 3. Chew on a sweet 4. Blow nose 5. Hold and exhale gently through nose 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-6 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid To relieve these problems in infants, have them: 1. Cry 2. Swallow 3. Suck Otitic Barotrauma Otitic Barotrauma (painful blocked ears) occurs if the Eustachian tube is blocked. Because of this, the pressure cannot be equalised, so causing deflection of the ear drum, pain, deafness, fluid formation and possible rupture of the eardrum. The common cause of eustachian tube obstruction is an upper respiratory tract infection (URTI) - for example, a cold, influenza, sinus or throat infection or hay fever. 10.3.3.1 Recognition 1. Persons who have increasing ear pain on descent. 10.3.3.2 Management 1. Manage otitic barotrauma by the following procedure: 2. Instruct the person to chew, yawn or move the lower jaw around in an attempt to open up the bottom end of the eustachian tubes; and 3. Encourage infants to feed or suck on a dummy, or to cry vigorously. 4. If pain persists after descent: 5. Advise the person to consult a physician. NOTE Placing plastic cups over ears is not permitted. 10.3.4 The Sinuses and Sinus Barotrauma Sinuses are air pockets situated in the bones of the face. They have narrow canals opening into the nose. Pressure is equalised through these openings. Sinus barotrauma occurs if the openings become blocked by infection. 10.3.4.1 Recognition 1. Sinus barotrauma is recognised by people who have severe pain in the sinuses on ascent or descent. 10.3.4.2 Management 1. Manage sinus barotrauma by the following procedure: 2. Instruct the person to blow the nose one side at a time. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-7 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.3.5 Gas Expansion - Other Areas of the Body 10.3.5.1 Bowel The bowel contains air swallowed with food and gas produced during digestion. On ascent, these gases expand. The bowel usually dilates to accommodate the increased volume without discomfort and bowel colic rarely occurs. If there is a cabin depressurisation, bowel gases could expand causing discomfort. Abdominal/intestinal trapped gases are relieved through natural means. 10.3.5.2 Teeth Healthy teeth are not affected by changing altitude, but decay under a dental filling can lead to a hollow cavity with gases of putrification. On ascent, this gas will expand and cannot escape, resulting in severe toothache due to pressure on the nerve ending. On descent the gases compress. 10.3.5.3 Recognition 1. Toothache is recognised by people who have severe tooth pain on ascent and subsiding on descent. 10.3.5.4 Management 1. Manage the toothache by applying an ice pack to the area. 10.3.6 Decompression Sickness Decompression sickness occurs when nitrogen, normally dissolved in body fluids, forms bubbles throughout the body. Decompression sickness is not commonly seen in flight and is most likely to occur after a person goes scuba diving and then flies without waiting an adequate period of time. Scuba diving causes extra nitrogen to be absorbed into the body fluids and flying soon after increases the chance of nitrogen forming bubbles. 10.3.6.1 Recognition 1. Patients may present with: 2. Joint pains. 3. Tingling, numbness and general discomfort of the skin. 4. Weakness. 5. Chest tightness. 6. Visual impairment 7. Dizziness; and/or 8. An altered conscious state or unconsciousness. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-8 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.3.6.2 Management NOTE Medical advice is required if a person becomes unwell in flight and has recently been scuba diving. Recovery may occur on descent, but usually transfer to a hyperbaric chamber is the appropriate management. 1. Manage decompression sickness by the following procedure: 2. Place the person in a horizontal position. 3. Give oxygen at 4 L per minute (high flow rate). 4. Observe the person. 5. Keep the person warm. 6. Advise the person to keep still. 10.3.7 Conditions or Activities Cabin Crew should be aware that certain conditions or activities can contribute to medical problems related to altitude. 10.3.7.1 Upper Respiratory Tract Infections Upper respiratory tract infections (URTI) may result in Eustachian tube blockage and dysfunction causing middle ear pain, infection and hearing damage, or incapacitation. The ability to 'clear the ear' is essential before returning to flying duties. 10.3.7.2 Medication Some medication may be acceptable for employees performing ground duties but are not considered safe for crew. This applies to prescription and non-prescription medications including homeopathic and herbal medicines. Cabin Crew must observe the following policies on medication and alcohol: 1. Avoid any medication containing codeine, antihistamines and/or alcohol when flying. 2. Sleeping tablets are to be taken only if advised by an aviation physician (DAME) and are not to be taken more than three times per week. 3. Neither alcohol nor sleeping tablets may be taken within eight hours of flying; and 4. Being under the influence of marijuana and hard drugs, including stimulants and hallucinogens, is unacceptable for Cabin Crew. Refer to the Alcohol, Pharmaceutical and Drug Consumption section of the ‘Governance Administration and Policies’ chapter. Before taking a new medication Cabin Crew should use the 'ART' check list before flying: Approved Has an aviation physician (DAME) approved the medication'? 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-9 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid Reason Does the reason for taking the medication make me unfit for flying duties? Trial Have I taken the medication for at least 24 hours to ensure there are no side effects? 10.3.7.3 Blood Donations Blood donations may temporarily affect the medical fitness to fly. The recovery time may not be significant for ground operations but can adversely affect crew members exposed to the lowered oxygen levels at depressurisation or even normal cabin altitudes. In general, crew members should not donate blood. In certain cases, crew members (for example, those in a rare blood group or who donate blood components) may desire to do so. In this case, crew members should: 1. Ensure a 48-hour period free of duty after donation. 2. Not donate more than one standard unit at one time: and 3. Make no more than two donations per year. 10.3.7.4 Scuba Diving The following times apply before crew members may return to flight duties: 1. Non-decompression diving: a. total bottom time of less than two hours wait 12 hours before flying, and b. total bottom time of more than two hours wait 24 hours before flying. 2. Decompression staging diving: a. for any dive wait 24 hours before flying. 10.3.8 Fatigue Individuals vary in their ability to sustain performance over long duty times and cope with sleep disruption as a result of shift work and 'jet lag'. Sleep disruption is usually associated with international tours of duty. Body Clock All humans have a natural 24-hour body 'clock' cycle that is designed to make a person sleepy at night and alert during the day. Most aspects of physical and mental performance are at their peak during late afternoon and at their worst between 0300 and 0500. Many physiological functions such as temperature, blood pressure and hormone levels follow similar cycles. Because of these cycles, 'jet lag' and shift work, crew are involved in trying to work at times when performance is poor. Travelling across time zones means the body 'clock' has to adjust to local time. This process can take several days. Crew rarely have the time to adjust to new time zones. Minimising Fatigue 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-10 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 1. To minimise fatigue crew should adopt the following: 2. Before an international tour of duty, ensure sufficient time is set aside for sleep for at least two or three nights. 3. Before late evening departures, take a nap between 1400-1500 hours. 4. When on another time zone: a. keep on your own time zone if your duty time is less than 48 hours. b. Take naps whenever there is an opportunity to sleep. 5. There are two best times (that crew should make use of according to their body clock) to sleep: a. midnight-0600 hours, and b. 1300-1500 hours. 6. Avoid drinks containing caffeine for four hours before any sleep. 7. Avoid alcohol before sleeping as it causes disrupted sleep. Do not have more than two units of alcohol before sleeping. NOTE One unit is equal to a can of beer, glass of wine or single spirit. 8. Do not exercise within 90 minutes before sleep. 9. Ensure a quiet, darkened room for sleeping. 10. Avoid interruptions to sleep by disabling the phone and activating a 'Do not disturb' sign. Check the alarm clock before sleeping; and 11. You cannot force sleep. Rather than tossing and turning in bed, read a book, watch TV and then retry to sleep in one or two hours. 10.4 Aircraft Environment 10.4.1 Cabin Air Cabin air is purer than air in public buildings and only slightly less pure than air in operating theatres. The total airflow on the aircraft is approximately 20 cubic feet per minute per person, resulting in 20-30 total air changes per hour. Half of the air coming into the cabin is fresh from outside the aircraft and half is re- circulated through high-efficiency particulate air (HEPA) filters that remove micro-organisms and contaminants down to 0.3 microns (0.0003 mm). This results in 99.97% efficiency at removing bacteria and viruses. The filters are replaced every 4000 hours (in which time they become more efficient, not less) due to accumulation of material in the filters. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-11 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.4.2 Infection Risk Cabin air-conditioning systems are not a significant infection risk, although any situation of being in close proximity to large numbers of people involves a risk of contracting an airborne infection. The major airborne infections are viruses that cause the common cold. Dry mucous membranes caused by decreased humidity in the cabin may be a risk factor for contracting upper respiratory tract infections. Cabin Crew are possibly at a greater risk than other employees of contracting colds and 'flu', but they probably develop good immunity levels with time. There have been no documented cases of crew becoming ill with diseases such as tuberculosis (TB) from contact with airline passengers. The risk of contracting other serious transmissible diseases from contact with passengers is low. Blood borne illnesses such as hepatitis B, hepatitis C and HIV are a very low risk to crew. 10.4.3 Hearing and Noise Damage Repeated exposure to high frequency noise can damage hearing leading to permanent damage. This damage initially causes loss of hearing in the high frequencies and then later loss of hearing in the conversational frequencies. Prevention of noise-induced hearing loss is essential. Standards exist on the amount of occupational noise an employee may be exposed to in an eight-hour day, without the requirement for hearing protection. Cabin noise does not exceed the recommended noise dose. Crew are encouraged to wear hearing protectors to protect their hearing when walking across the tarmac to avoid over exposure to high frequency noise from other aircraft. 10.5 Aviation First Aid 10.5.1 The Function of the First Aider A first aider provides immediate and continuing care until a physician (doctor), nurse or ambulance officer (paramedic) is available. 10.5.2 Handling an Unconscious Person in a Seat 10.5.2.1 Finding a Person in an Aircraft Seat Follow First Aid procedures. The person may be assessed while still remaining in the aircraft seat. An unconscious breathing or non-breathing person should be placed in the aisle for further management techniques to be implemented. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-12 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.5.2.2 How to Lift an Unconscious Person from a Seat An unconscious person will be very heavy and difficult to move. Ask other people for help. It is better to have stronger people lift the unconscious person, provided they are available and willing to help. Three people are required to perform the lift. Each person is allocated a position. A three-person lift ensures the weight of the body is shared. If the person is occupying a window seat, it is better to drag that person over to the aisle seat so that the lift is done from the aisle seat to the floor. Position 1 The tallest person should stand behind or to the side of the unconscious person. Reach down under the arms and grip the wrists then crossing the passenger’s arms and placing them on their chest for protection. This will lock the arms in place making the lift manageable. Position 2 This person should bend at the knees and the hips, reach down under the unconscious person's knees and grip one wrist with the other hand. Position 3 This person should position themselves at the unconscious person's waist. If the unconscious person is wearing a belt, grab hold of the belt at the front and back. If a belt is not worn, gather a handful of the person's clothing. The Lift The lift should be performed as a team lift. One person should give a prearranged count (for example, “1, 2, 3 lift!") so the lift is synchronised to avoid unnecessary back strain. Lift the unconscious person into the aisle. 10.5.3 Neck Breathers Some people may have undergone partial or total removal of the larynx (laryngectomy). This operation requires a surgical opening in the neck to permit breathing. A metal or plastic tube may be worn in the opening. NOTE The opening in the neck is called a stoma. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-13 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.5.3.1 Administering First Aid to Neck Breathers Warning If there is a tube in the Stoma (opening in the neck), do not remove the tube. Oxygen to Neck Breathers If first aid oxygen is required by a neck breather, administer it via the stoma (opening in the neck). CPR for Neck Breathers If Cabin Crew are required to perform CPR on a neck breather, it must be administered via the stoma (opening in the neck) using a Laerdal resuscitation face shield™. The Laerdal resuscitation face shield™ is located in the first aid kit. 10.6 Medical Procedures in Flight Warning The Captain is responsible for deciding if first aid management by Cabin Crew can continue during landing. When a person appears distressed, ask if he/she has a medical condition. Early recognition and basic treatment may prevent further problems. NOTE Notify the Captain of any medical problem in flight immediately. 10.6.1 DRSABCD Danger Check for danger, hazards and risks to yourself, the casualty, and bystanders by looking, listening and smelling Response Check for a response from the casualty and assess signs of life. Use COWS acronym: 1. Can you hear me 2. Open your eyes 3. What’s your name? 4. Squeeze my hands Squeeze their shoulder firmly to elicit a response. If they are responsive, place in recovery position and monitor. If no response, Send for help. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-14 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid Send for help Call for assistance of another Cabin Crew member. Airways Check the airway is clear by opening the mouth and removing any foreign material that may be present. Breathing Check for breathing by look, listen and feel method CPR Commence CPR as directed by your first aid institution training. Continue compressions and breaths in a 30:2 ratio until medical aid arrives Defibrillation Apply the defibrillator as soon as possible and follow the voice prompts. An automatic External Defibrillator (AED) should only be used on a casualty who is unconscious, unresponsive and not breathing. 10.6.2 First Aid Principles 5 P’s The five p’s are a useful framework for responding to a medical emergency. 1. Preserve life 2. Prevent further harm 3. Prevent the condition from worsening 4. Promote the unconscious 5. Promote recovery. 10.6.3 Recovery Position The recovery position should be used for an unresponsive person who is breathing and has no other life-threatening injuries. The recovery position keeps the persons airway clear and open. To place a person in the recovery position: With the person on their back, kneel beside them. 1. Place their furthest arm directly out from their body. 2. Place other (nearest) arm across their chest. 3. Bend their nearest leg and place foot on floor. 4. Roll them away from you onto their side, carefully supporting their head and neck. 5. Keep their leg bent with their knee touching the ground to support the body. 6. Place their hand under their chin to stop their head from tilting and to keep their airway open. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-15 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 7. Monitor the person. For pregnant women who need to be placed in the recovery position, they need to be placed on their left side only. This is called the left lateral tilt. 10.6.4 Managing a Medical Incident Managing a medical incident may involve two Cabin Crew members: 1. Primary first aider; and 2. Communicator/assist. NOTE These roles are interchangeable if necessary. 10.6.4.1 Primary First Aider The first person to discover a medical problem is the primary first aider who should assess the situation. 10.6.4.2 Communicator/Assist The second person will be the communicator/assist. The second person makes initial contact with the flight deck, also collects the first aid equipment and assists the primary first aider in assessing the person and performing first aid management. 10.6.5 Minor Medical Problem Cabin Crews’ first aid skills are sufficient to manage a minor medical problem. For minor medical problems, it may be unnecessary to make a cabin announcement for a physician (doctor), a trained nurse or an ambulance officer (paramedic), provided the condition may be easily managed by Cabin Crew. If in doubt about the severity of the condition, a PA should be made for a physician (doctor), a trained nurse or an ambulance officer (paramedic). 10.6.6 Severe Medical Incident If a severe medical incident occurs in flight, Cabin Crew should use the following procedure: 1. Make an announcement. 2. Brief the Captain. 3. Take advice. 4. Follow all first aid procedures; and 5. Complete documentation. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-16 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid Make an announcement Make an announcement asking if there is a MQV on board and request his/her assistance. A Medically Qualified Volunteer (MQV) can be a valuable resource during a severe medical incident on board. MQVs can make a clinical assessment of an ill or injured passenger and provide recommendations firsthand to the crew. A Medically Qualified Volunteer should be a registered doctor, nurse or paramedic. A ‘Request for Medical Assistance’ PA can be made by the crew when an MQV is required. If a Medically Qualified Volunteer is required, crew must verify the credentials of the person assisting by sighting their medical license/registration number. These credentials must also be recorded on any documentation post incident. Brief the Captain Contact the Flight Deck via the interphone as per Chapter 2 ‘Communication’ of the Air Crew Emergency manual. Brief the Captain communicating all available details. Take Advice Take advice from any in-flight medical help, if it is available. Follow all first aid procedures Follow all first aid procedures until medical help takes responsibility. Complete documentation Complete the SHOR (Form CSM099) when time permits and enter details into iQSMS at completion of duty. To avoid multiple calls to the Flight Deck, refer to form FAM015 in Chapter 17 ‘Documentation and Reporting’ of this manual, to collate as much information as possible. Once this information has been ascertained, the Captain is to be informed after Initial contact has been made. 10.6.7 When to Stop Cardiopulmonary Resuscitation CPR may be stopped if: 1. The person recovers with spontaneous breathing and circulation; or 2. A physician (doctor) pronounces the person dead; or NOTE The exception is if a medical patient who is accompanied by a nurse escort collapses. In this instance, Cabin Crew must comply with the nurse's decision regarding the ceasing of CPR for the patient. 3. Medical help takes over; or 4. The operators are exhausted and cannot continue doing CPR; or 5. The Captain advises the Cabin Crew to be seated for landing because of safety reasons. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-17 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.6.8 Death in Flight NOTE A person can be pronounced dead only by a physician (doctor), or an escorting nurse (who ceases resuscitation on their patient). If a person is pronounced dead in flight or CPR has ceased due to exhaustion by the operators. Refer to the When to Stop Cardiopulmonary Resuscitation section of the ‘Aviation Medicine and First Aid’ chapter; Cabin Crew should use the following procedure: 1. Place the body in a seat and fasten the seatbelt. 2. Move other people from the immediate vicinity, if possible. 3. Cover the body with a blanket. 4. Pass the person's particulars to the captain for transmission to the destination airport; and 5. Record the time and location of the aircraft when death occurred. NOTE Details should be recorded by the Cabin Manager and the Captain. 10.6.9 Chain of Survival The Chain or Survival is a series of actions that can be taken to increase the chance of survival for someone suffering a cardiac arrest. This can be achieved by: 1. Early recognition by the rescuer that the casualty has a problem. 2. Early call for help: 3. On the aircraft: Notify cabin crew and flight crew and make the “Request for Medical Assistance” PA. 4. On the ground – Australia: call 000 5. Other countries – applicable emergency contact numbers. 6. Early CPR to keep the brain and heart alive by pumping oxygenated blood around the body long enough for a defibrillator to arrive. 7. Early defibrillation (AED). 8. Early advanced care by ambulance and hospital personnel. 10.7 Medical Conditions in Flight 10.7.1 Loss of Consciousness The common causes of loss of consciousness are: 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-18 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 1. Head injury - damage to the brain and its blood vessels. 2. Stroke - burst or blocked brain arteries. 3. Fainting - body's blood vessels widen causing a drop in blood pressure. 4. Drunkenness. 5. Seizures. 6. Diabetes. 7. Heart attack. 8. Asphyxia; and 9. Poisons. 10.7.1.1 Recognition The person is unable to respond to people or activities despite attempts to arouse them. 10.7.1.2 Management Manage a person that has lost consciousness by the following procedure: 1. Place in the recovery position. 2. Loosen tight clothing around the neck, chest and waist. 3. Give oxygen at 4 l per minute (high flow rate). 4. Stay with the person, maintaining close observation; and 5. Seek medical aid immediately using the severe medical incident procedure. 10.7.2 Heart Conditions 10.7.2.1 Angina Angina is a condition caused by a narrowing or spasm of the coronary arteries supplying blood to the heart muscle. Angina is often brought on by anxiety, excitement or even exertion. 10.7.2.2 Recognition Persons may present with: 1. Pain and discomfort in the chest, sometimes radiating into the neck and down the left arm, and/or 2. A pale appearance and skin that is clammy to the touch. 10.7.2.3 Management Manage angina by the following procedure if carrying own medication or no medication: 1. Ask if the person has a medical condition. 2. Ask if the person is carrying any medication for that condition. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-19 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 3. Loosen tight clothing around the neck, chest and waist. 4. Give oxygen at 4 L per minute (high flow rate). 5. Stay with the person, maintaining close observation; and 6. Seek medical aid immediately using the severe medical incident procedure. Manage angina by the following procedure if requesting Nitrolingual Pumpsray from Physicians Kit: 1. Ask if the person has a medical condition. 2. Prime the pump by holding spray upright and press nozzle 5 times (quickly and completely) spraying in the air. 3. Ask passenger to open mouth, put tongue on top of mouth and aim pump under the tongue. 4. Get passenger to press the nozzle firmly once with forefinger to release the spray under tongue. Do not inhale the spray. 5. Release the nozzle and close mouth. Avoid swallowing after taking the dose. 6. Only if pain persists after 5 minutes, repeat with a second dose. 7. Loosen tight clothing around the neck, chest and waist. 8. Give oxygen at 4 l per minute (high flow rate). 9. Stay with the person, maintaining close observation; and 10. Seek medical aid immediately using the severe medical incident procedure. 10.7.2.4 Precautions 1. Ask passenger if they have used Viagra or a similar drug in the last 3-5 days. 2. Do not use more than three sprays during an attack. After use: 1. Wipe nozzle clean after use. 2. Place used pumpspray in D1 Bag. 10.7.2.5 Heart Attack A heart attack is experienced when a sudden blockage of a coronary artery occurs. 10.7.2.6 Recognition Persons may present with symptoms that are similar to, but more severe than those relating to angina and may include loss of consciousness. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-20 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.2.7 Management Conscious 1. Manage a conscious person who has had a heart attack as a person who has angina. Refer to text under the heading 'Angina' in this chapter for further information. Unconscious 1. Manage an unconscious person who has had a heart attack as a person who has lost consciousness. 10.7.3 Cardiac Arrest A sudden cardiac arrest is when the heart ceases to function. A cardiac arrest is usually caused by an electrical malfunction in the hearts electrical system ad is either at a complete standstill or vibrating rapidly in a chaotic rhythm. This may be due to a heart attack, drowning, electrocution, heart failure, allergic reaction or trauma. 10.7.3.1 Recognition 1. Not breathing, or not breathing normally. 2. Unresponsive. 10.7.3.2 Management 1. Follow DRSABCD. 2. Commence CPR. 3. Defibrillate as soon as possible. 4. If consciousness regained, place in recovery position and give oxygen at 4 l per minute (high flow rate). 5. Seek medical aid immediately using the severe medical incident procedure. 10.7.4 Stroke (Cerebral Haemorrhage) A stroke is induced by the rupture of a blood vessel in the brain, or by a blockage of a blood vessel due to the presence of a blood clot. This is most common amongst middle aged or elderly people who have a history of blood pressure problems. 10.7.4.1 Recognition Persons may present with: 1. Paralysis and loss of feeling on one side of the face or body. 2. Loss of normal speech. 3. Loss of balance; and/or 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-21 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 4. Loss of normal vision. 10.7.4.2 Management Manage a person who has had a stroke by the following procedure: 1. Support in a semi-reclined comfortable position and support the paralysed side with soft articles to protect from injury. 2. Loosen tight clothing around the neck, chest and waist. 3. Give oxygen at 4 l per minute (high flow rate). 4. Stay with the person, maintaining close observation; and 5. Seek medical aid immediately using the severe medical incident procedure. 10.7.5 Asthma Asthma is a spasm of the small air tubes in the lungs, causing wheezing and breathing difficulties. Asthmatics may use two types of medications (inhalers). These are preventers or relievers. Preventers assist in the prevention of asthma attacks. Relievers are used to relieve the symptoms of an asthma attack. Relievers are used in acute asthma attacks. 10.7.5.1 Recognition Persons may present with: 1. Obvious respiratory distress; and/or 2. An audible wheeze. NOTE In a severe asthma attack, there may be no audible wheeze. 10.7.5.2 Management Manage asthma by the following procedure if carrying own medication or no medication: 1. Ask if the person has been diagnosed with a medical condition. 2. Ask the person if they are carrying any medication for the condition. 3. Loosen tight clothing around neck, chest and waist. 4. Give oxygen at 4 l per minute (high flow rate). 5. Stay with the person, maintaining close observation; and 6. Seek medical aid if there is no response to the management or the person's condition is worsening. NOTE Asthmatics should implement their management plan as decided by their physician. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-22 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid Manage asthma by the following procedure if requesting Asthma puffer from Physicians Kit: 1. Ask if the person has been diagnosed with a medical condition. 2. Shake inhaler before giving. 3. Give one puff of medication through a spacer if available, if not then directly to mouth. 4. Ask passenger to take four breaths from the spacer device. 5. Repeat steps (3) and (4) three more times. 6. Wait for minutes from the last puff. 7. If there is little to no improvement, repeat steps (3) to (6) and ask for an MQV. 8. Give oxygen at 4 l per minute (high flow rate). 9. Stay with the person, maintaining close observation; and 10. Seek medical aid if there is no response to the management or the persons condition is worsening. After use: 1. Dispose of red cap. 2. Place used spacer in H Bag. 3. Place used salbutamol inhaler in D1 Bag. 10.7.6 Diabetes Diabetes is a metabolic disease characterised by an imbalance between levels of glucose and insulin a hormone responsible for the regulation of blood sugar levels in the body and is caused by a failure of the pancreas to produce adequate insulin. Diabetics are usually on medication and they often require a special diet to help regulate blood sugar levels. NOTE Do not accept insulin for storage in the galley ice drawer. Insulin need not be chilled and it may get lost or contaminated, causing considerable difficulties for the person. Diabetics on treatment may suffer with a too high or too low blood sugar reaction. The most common reaction is a low blood sugar reaction. 10.7.6.1 Recognition - Low Blood Sugar Reaction Persons may present with: 1. Dizziness. 2. Confusion. 3. Sweating. 4. Shaking. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-23 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 5. Hunger; and/or 6. Weakness. 10.7.6.2 Management - Low Blood Sugar Reaction Manage a low blood sugar diabetic by the following procedure: 1. Ask if the person has been diagnosed with medical condition. 2. Ask the person if they are carrying any medication for the condition. 3. Stay with the person, maintaining close observation; and 4. Seek medical aid if the person's condition is worsening. Warning Urgent medical help is required if a diabetic becomes unconscious. This is a severe medical problem. 10.7.6.3 Recognition - High Blood Sugar Reaction Persons may present with: 1. Thirst. 2. The need to urinate frequently. 3. Hot dry skin; and/or 4. Smell of acetone on their breath. 10.7.6.4 Management - High Blood Sugar Reaction Manage a high blood sugar diabetic by the following procedure: 1. Ask if the person has been diagnosed with medical condition. 2. Ask the person if they are carrying any medication for the condition. 3. Stay with the person, maintaining close observation; and 4. Seek medical aid immediately using the severe medical incident procedure. 10.7.7 Seizures A seizure is caused by a disturbance of the electrical activity within the brain. 10.7.7.1 Recognition Persons may present with: 1. A loss of consciousness and strong rhythmic body movements. 2. Seizures that may last several minutes. 3. A blue tinge to the face and foaming at the mouth. 4. A loss of bladder and bowel control; and/or 5. An altered conscious state and possible confusion after the seizure. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-24 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.7.2 Management – during the seizure Manage the person during a seizure by the following procedure: 1. Recline the seat and loosen the seatbelt (if the person is in a seat). 2. Protect from injury, provide soft articles to 'pad' the person. 3. Place the person in the recovery position if the person is having the seizure on the floor. If this is not achievable due to danger or difficulty leave the person and continue to protect as above; and 4. Time the seizure. NOTE If a person is having a seizure, do not force anything into their mouth or restrain the person. 10.7.7.3 Management – after the seizure Manage the person after a seizure by the following procedure: 1. Place the person in the recovery position. 2. Loosen tight clothing around the neck, chest and waist. 3. Give oxygen at 4 l per minute (high flow rate). 4. Reassure and gently orientate the person back to normal surroundings when he/she regains consciousness. 5. Make the person comfortable if he/she feels the need to sleep; and 6. Stay with the person, maintaining close observation. NOTE An ambulance must meet the aircraft if: - the seizure lasts longer than 5 minutes, - the person remains unconscious, - it is possibly their first seizure, or - one seizure is followed by another seizure. 10.7.8 Febrile Convulsions in Infants Febrile convulsions are a common medical condition in children aged between 6 months to 6 years when they are suffering from a high fever. 10.7.8.1 Recognition Children may present with: 1. Fever. 2. Stiffness or floppiness. 3. Jerking or twitching movements; and/or 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-25 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 4. Unconscious or unaware of their surroundings. 10.7.8.2 Management – during the convulsion 1. Place the child in the recovery position or on the floor. 2. Protect from injury, provide soft articles to 'pad' the person; and 3. Time the seizure. 10.7.8.3 Management – after the convulsion 1. Remove excess clothing or wrapping (ie; sweaters, jackets); and 2. Seek medical aid immediately using the severe medical incident procedure. DO NOT COOL BY SPONGING OR BATHING BUT REMOVE EXCESSIVE CLOTHING OR WRAPPING. 10.7.9 Choking Warning Choking is a life-threatening emergency Choking is an obstruction of the upper airway by impacted foreign material. It is important at an early stage to differentiate between partial or complete airway obstructions following the accidental inhalation of a foreign material. If the person can breathe, speak, cry or cough, it is an indication that some movement of air can occur, and that the obstruction is partial. 10.7.9.1 Recognition Partial Obstruction Persons may present with: 1. Wheezing or noisy breathing. 2. Difficulty in breathing. 3. Violent coughing. 4. Blue tinge to the skin; and/or 5. Flaring nostrils (in infants, children and young adults). Total Obstruction Persons may present with: 1. Inability to breathe, speak, cry or cough. 2. Agitation, with the possibility that the person may grip his/her throat. 3. A blueness of the face and bulging neck veins. 4. Rapid deterioration; and/or 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-26 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 5. A loss of consciousness. 10.7.9.2 Management 1. Encourage the person to relax and cough to remove the object. 2. Bend person forward and give 5 back blows. 3. Have oxygen available (if required) at 4 l per minute (high flow rate); and 4. if no improvement, seek medical aid immediately using the severe medical incident procedure. 10.7.10 Shock Warning Shock is a state of collapse which, if not controlled, may result in death. Shock is a loss of effective circulating blood volume and may be caused by: 1. Pain. 2. Trauma. 3. Infections. 4. Allergic reactions. 5. Poisoning. 6. Inadequate supply of oxygen to the brain (due to a heart attack or asphyxia). 7. Severe burns or injury. 8. Severe haemorrhage (internal or external); and/or 9. Severe dehydration. 10.7.10.1 Recognition Persons may present with: 1. Giddiness, faintness and anxiety. 2. Thirst, nausea or vomiting. 3. A pale appearance and clammy skin to touch. 4. A rapid or weak pulse. 5. Rapid, shallow respiration; and/or 6. An altered conscious state or unconsciousness. 10.7.10.2 Management Manage shock by the following procedure; 1. Place the person in a horizontal position if conscious. Elevate legs (if injuries permit); 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-27 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 2. Cover with a blanket, but do not overheat. 3. Loosen tight clothing around the neck, chest or waist. 4. Give oxygen at 4 l per minute (high flow rate). 5. Stay with the person, maintaining close observation; and 6. Seek medical aid immediately using the severe medical incident procedure. 10.7.11 Fainting Fainting is a temporary disturbance of consciousness due to inadequate blood pressure supply to the brain. This fall in blood pressure may be attributed to the enlargement, and consequent pooling of, blood in the body's blood vessels. Fainting can be brought on by any emotional or physical upset including nervous shock, pain and/or from sitting and standing still for long periods. Most fainting will pass quickly and will not be serious. It may make the person feel unwell and recovery may take several minutes. 10.7.11.1 Recognition Persons may present with: 1. Dizziness and light headedness. 2. Anxiety and restless. 3. A pale appearance or clammy skin to touch. 4. Nausea; and/or 5. Unconsciousness for a few seconds. 10.7.11.2 Management Warning Brain damage or death may occur if a person who has fainted is left in an upright position or sitting with their head between their knees. Manage a conscious person who has fainted by the following procedure: 1. Place the person in a horizontal position with legs elevated. 2. Loosen tight clothing around the neck, chest and waist. 3. Give oxygen at 4 l per minute (high flow rate); and/or 4. Stay with the person, maintaining close observation. NOTE By laying the person down, the brain blood pressure is restored and the person recovers quickly. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-28 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.12 Mild to Moderate Allergic Reaction An allergy occurs when a person reacts to a substance in the environment known as an allergen. These are found in pollen, insects, mites, moulds, foods and some drugs (medications). 10.7.12.1 Recognition Persons may present with: 1. Swelling of lips, face, eyes 2. Hives or welts 3. Tingling mouth 4. Abdominal pain, vomiting. 10.7.12.2 Management Manage the allergic reaction by the following procedure if carrying own medication or no medication: 1. Ask if the person has been diagnosed with a medical condition. 2. Ask the person of they are carrying any medication for the condition. 3. Loosen tight clothing around neck, chest and waist. 4. Give oxygen at 4 l per minute (high flow rate). Stay with the person, maintaining close observation; and Seek medical aid even if condition is improving. Manage the allergic reaction by the following procedure if requesting Loratadine (antihistamine) from Physicians Kit: 1. Ask if the person has been diagnosed with a medical condition. 2. Locate medications sleeve in Physicians Kit. 3. Break security seal and place one tablet in passenger’s hand. 4. Reseal medications sleeve and place back in Physicians Kit. 5. Stay with the person, maintaining close observation; and 6. Seek medical aid even if condition is improving. Precautions 1. Not for pregnant tor breastfeeding mothers. 2. Ensure the passenger has used the medication before and confirm they are not allergic to the medication. 3. For use by adults and children over 12 years old. 10.7.13 Anaphylaxis Anaphylaxis is a severe allergic reaction which often involves more than one body system. Common triggers of anaphylaxis include food, bites, and medication. Those 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-29 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid suffering anaphylaxis should administer an adrenaline auto injector which should not be delayed. The adrenaline auto injectors are intramuscular injections that contain a single, premeasured dose of adrenaline that is given for the emergency treatment of anaphylaxis reactions. 10.7.13.1 Recognition Persons may present with: 1. Difficulty/noisy breathing. 2. Swelling of the face/tongue. 3. Swelling/tightness of the throat. 4. Difficulty talking or hoarse voice. 5. Wheeze of persistent cough. 6. Abdominal pain and vomiting. 7. Hives, welts, and body redness. 8. Persistent dizziness or collapse. 9. Pale and floppy (young children). 10.7.13.2 Management Manage anaphylaxis by the following procedure if carrying own medication or no medication: 1. Ask if the person has been diagnosed with a medical condition. 2. Ask the person of they are carrying any medication for the condition. 3. Loosen tight clothing around neck, chest and waist. 4. Give oxygen at 4 l per minute (high flow rate). 5. Stay with the person, maintaining close observation; and 6. Seek medical aid even if condition is improving. NOTE Passengers who suffer anaphylaxis should implement their management plan as decided by their physician. Manage anaphylaxis by the following procedure if requesting Adrenaline Auto Injector (EpiPen) from Physicians Kit: 1. Ask if the person has been diagnosed with a medical condition. 2. Sit passenger in their seat, passenger cannot walk around 3. Administer Adrenaline Auto Injector (EpiPen). 4. Form fist around Adrenaline Auto Injector (EpiPen) and pull off blue safety release. 5. Hold leg still and place orange end against outer mid-thigh (with or without clothing). 6. Push down hard until click is heard and hold in place for 3 seconds. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-30 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 7. Note time administered on passenger’s hand. 8. Loosen tight clothing around neck, chest and waist. 9. Give oxygen at 4 l per minute (high flow rate). 10. Further adrenaline may be given if no response after 5 minutes. 11. Stay with the person maintaining close observation; and 12. Seek medical aid even if condition is improving. Warning Commence CPR if person is unresponsive and not breathing normally. This is a severe medical problem. 10.7.13.3 Precautions Check passenger’s thigh pockets for phone, keys etc as auto injector will not penetrate. Auto injector can be administered through most clothing materials. Adrenaline auto injector (EpiPen) comes in two different doses. Junior Pen – Green – 150 micrograms of adrenaline for children 7.5 kilograms to 20 kilograms. Adult Pen – Yellow – 300 micrograms of adrenaline for children and adults over 20 kilograms. After use The used Adrenaline auto injector (EpiPen) shall be placed in a sick back and taken off with passenger to hospital. 10.7.14 Bruises, Strains, Sprains and Fractures Injuries due to turbulence may vary from minor injuries such as small bruises to more severe injuries such as extensive bruising, strains, sprains and fractures. A bruise occurs when an injury causes bleeding into the body tissues of the injured part. A strain is a pulled muscle. A sprain is a torn ligament. A fracture is a bone that is either broken or cracked. The fracture may be an open fracture where a wound lead from the skin surface to the broken bone or a broken bone protrudes through the skin. A closed fracture is when the skin surface around the fracture is not broken. 10.7.14.1 Recognition Persons may present with: 1. A recent obvious injury. 2. Pain (particularly when moving). 3. Difficulty in moving, or inability to move the injured part. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-31 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 4. Tenderness at or near the affected area. 5. Some deformity of the injured part; and/or 6. Swelling at the site or injury. 10.7.14.2 Management Manage bruises, strains and sprains by applying the principles of RICE: 1. Rest to keep weight off the injury. 2. Ice to minimise swelling, pain and stiffness. 3. Compression from bandaging, to reduce swelling; and 4. Elevation to prevent excessive swelling through gravity. NOTE Strains and sprains may be associated with dislocations and fractures. Handle limbs carefully and do not forcibly move parts. Slings are available to assist in immobilising injuries, particularly fractures. WARNING Cabin Crew must not: - put pressure directly on the protruding bone, - attempt to straighten the fractured limb, or - use force. Manage open or closed fractures by the following procedure: 1. Control any bleeding by placing dressings around the protruding bone. 2. Immobilise and support the fracture in the position it is found, using rigid items such as magazines or newspapers and bandages. 3. Observe the circulation of the injured limb (colour, warmth, movement and sensation) every 15 minutes. 4. Treat as for shock. Refer to the Shock section in this chapter. 5. Seek medical aid immediately using the severe medical incident procedure. 10.7.15 Head and Neck Injuries Injuries to the head and neck are always regarded as serious because they can inflict damage to the brain and spinal cord, as well as damaging the bone and soft tissue. Head injuries can be classified as: Open – a bleeding or open wound to the face or head. Closed – no obvious injury to the face or head. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-32 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.15.1 Recognition 1. Blurred or double vision. 2. Nausea and/or vomiting. 3. Headache, mild or severe. 4. Open wounds. 5. Bruising around the eyes and/or ears. 6. Restlessness and irritability, confusion. 7. May have uneven pupils. 8. Evidence of fluid leaking from ears and/or nose. 9. Deformation of the skull. 10. Altered/deteriorating level of consciousness. 10.7.15.2 Management Manage head and neck injuries by the following procedure: 1. Immobilise the persons head and spine and place them in a horizontal position. 2. Treat any wounds. 3. If unconscious or drowsy, put the person in the recovery position while supporting the head and neck. 4. Allow any fluid to drain from the ears freely – if in the recovery position, put the injured side down with a pad under the ear to collect the fluid. 5. Cover with a blanket, but do not overheat. 6. Loosen tight clothing around the neck, chest or waist. 7. Give oxygen at 4 l per minute (high flow rate). 8. Stay with the person, maintaining close observation; and 9. Seek medical aid immediately using the sever medical incident procedure. Warning Commence CPR if person is unresponsive and not breathing normally. This is a severe medical problem. 10.7.16 Burns and Scalds Generally, burns and scalds may be classified as: 1. Superficial is where the top layer of skin and underlying tissue is injured or destroyed; or 2. Deep is where the full thickness of the skin and underlying tissue is destroyed. Any burns or scalds that occur in flight are most likely to be superficial. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-33 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.16.1 Recognition Warning Burns and scalds to 10% of the body surface is considered dangerous, burns to 50% of the body are often fatal. Superficial Burns Superficial burns are recognised by people who have: 1. A reddened area of the skin. 2. Blisters. 3. Swelling, and/or 4. Pain. Deep Burns Deep burns are recognised by people who have: 1. Pale, brown or charred (black) skin, and/or 2. Red skin around the outer area of the burn (superficial burn). NOTE The burn may be painful or painless depending on whether nerve endings in the skin have been destroyed. 10.7.16.2 Management Warning Do not use ice or burn cream on burns as creams retain heat under the skin and can cause further pain or damage. Do not break any blisters or remove anything sticking to the burn such as clothing. Manage burns by the following procedure: 1. Saturate the burn in cool water for up to 20 minutes. 2. Remove clothing, rings or bracelets, if possible. 3. Apply Burn-aid gel from the aircraft first aid kit (if necessary) 4. Cover the burnt area with a loose and light sterile dressing; and 5. Stay with the person, maintaining close observation. NOTE Tap water without ice is usually a satisfactory temperature. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-34 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.17 Foreign Bodies in Eyes, Ears and Nose Foreign bodies are not commonly seen in flight. They may be painful and distressing. 10.7.17.1 Recognition A foreign body in the eyes, ears or nose is recognised by people who have embedded material in these body parts causing discomfort or pain. 10.7.17.2 Management NOTE Attempt to remove the foreign body only if it can be easily removed. Otherwise leave the foreign body and advise the person to seek medical aid. Eye Manage a foreign body in the eye by the following procedure: 1. Do not allow the person to rub their eye. 2. Flush a foreign body out of the eye using an eye irrigating solution (located in the first aid kit) if necessary. 3. Cover the eye with a sterile bandage; and 4. Advise the person to seek medical aid as soon as possible after disembarkation if the foreign body cannot be removed. Nose Manage a foreign body in the nose by the following procedure: 1. Instruct the person to breathe through their mouth rather than his/her nose. 2. Advise the person to blow his/her nose in an attempt to remove the foreign body; and 3. Advise the person to seek medical aid as soon as possible after disembarkation if the foreign body cannot be removed. Ear Manage a foreign body in the ear by the following procedure: 1. Turn the person’s head so the affected side is facing down, allowing the foreign body to fall out; and 2. Advise the person to seek medical aid as soon as possible after disembarkation if the foreign body cannot be removed. 10.7.18 Poisons Poisoning in flight is rare, it may be accidental or deliberate. If poisoning is suspected, urgent medical advice is required. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-35 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.18.1 Recognition NOTE A wide range of signs and symptoms may occur that can be confused with other medical conditions. Confirmation of poisoning is by the person admitting he/she has taken a substance. Persons may present with: 1. Nausea or vomiting. 2. Burning pain in the mouth or throat. 3. Headache. 4. Disturbed vision. 5. Seizure; and/or 6. Loss of consciousness. 10.7.18.2 Management Warning Do not induce vomiting unless advised by a medical professional. Manage a conscious person who is poisoned by the following procedure: 1. Stay with the person, maintaining close observation. 2. Give reassurance, determine type of substance if possible and keep a record; and 3. Seek medical aid immediately using the severe medical incident procedure. NOTE Obtain the following information if possible for emergency services. Name and age of persons, substance taken, retaining a sample if possible if they have vomited into an airsickness bag. Amount and time it was taken, what route it was taken such as orally, inhaled, injected or skin contact. Pass the above information to the Captain for transmission to ground services meeting the aircraft on arrival. Wipe any obvious contamination from around the mouth before commencing resuscitation. Ensure the Laerdal pocket mask™ is used for CPR. 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-36 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 10.7.19 Air Sickness Air sickness can be related to turbulence, anxiety, fear or overindulgence in food and alcohol. 10.7.19.1 Recognition Persons may present with: 1. Nausea or vomiting. 2. A pale appearance and skin that is clammy to touch; and/or 3. Excessive salivation and swallowing. 10.7.19.2 Management Manage air sickness by the following procedure: 1. Advise the person to hold his/her head still. 2. Apply cool pack to forehead; and 3. Give sips of iced water. 10.7.19.3 Post management procedures Use the Body Fluid Clean Up Kit to clean affected surfaces and make sure disposable gloves are worn. Ensure the seat is blocked out and not used by any passengers. The affected seat must be notated in the Cabin Condition Report booklet and request seat cover to be changed. Properly dispose of contaminated items that have been used by the ill passenger, as well as materials used to clean up, into a plastic bag and tie it securely to avoid leakage. Wash your hands with soap and water or with an alcohol-based hand cleaner after removing gloves. Ground Handling Agents and/or cleaners must be notified upon arrival, and of areas that have been contaminated. 10.7.20 Gastrointestinal Disturbances Gastrointestinal Disturbances can be associated with infectious diseases, anxiety, fear, turbulence or overindulgence in food and alcohol. 10.7.20.1 Recognition Persons may present with: 1. Pale 2. Abdominal pain 3. Vomiting 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-37 Uncontrolled if Printed or Downloaded  Chapter 10 Aviation Medicine and First Aid 4. Sweating 5. Nausea 6. Fainting 7. Diarrhoea 10.7.20.2 Management Manage gastrointestinal disturbances by the following procedure: 1. Advise the person to hold his/her head still. 2. Apply cool pack to forehead. 3. Loosen tight clothing; and 4. Give sips of iced water. 10.7.21 Nose Bleed Nose bleeds are common in flight. 10.7.21.1 Recognition Nose bleeds are recognised by people who have obvious bleeding from the nose. 10.7.21.2 Management Manage nose bleeds by the following procedure: 1. Sit the person upright. 2. Incline his/her head forward. 3. Instruct the person to breathe through his/her mouth. 4. Apply finger pressure to the soft end of the nose for 10 minutes, using protective gloves; and 5. Seek medical advice if bleeding continues. 10.7.22 Flu-like Symptoms If possible, ill passengers (and their close personal contacts including family members) or crew experiencing cough, fever, sore throat, sweats or chills should: 1. Be separated from other traveller as a precaution, with at least one spare seat on either side or a window seat with a spare seat next to them. Ideally the row should be kept empty. 2. Be given a face mask to wear 3. Cabin Crew should spray Netbiokem in and around the toilet area after use by the ill passenger. In addition, Cabin Crew should; 1. Wear gloves when handling and receiving items from affected passengers 01 Sep 2024 Cabin Crew Policy and Procedures Manual v1.8 10-38