200 - First Response

EMIRATES IN-FLIGHT SERVICES CABIN CREW EMERGENCY MANUAL
Effective Date: 15 January 2007

Section: 200 Sub Section: Foreword Page: 01 Issue: 03

FIRST RESPONSE
FOREWORD

This section has been produced as a ready reference for all Emirates Crew.

The contents of this section are intended to be used as a guide to manage in-flight
emergencies. It cannot encompass all in-flight medical situations that may arise and is
not intended to be taken as a complete manual on In-flight Emergency Medical Care.

In the event of uncertainty common sense and good airmanship should prevail.

ACKNOWLEDGEMENT

American Heart Association, 2010, Guidelines for Cardiopulmonary Resuscitation and
Emergency Cardiovascular Care, Circulation, volume 122, issue 18.

St. John Ambulance; St. Andrews Ambulance; The British Red Cross Society, 2002 First
Aid Manual 8th edition, Dorling Kindersley Limited, London

Effective Date:

Section: Sub Section: Page: Issue:

INTENTIONALLY LEFT BLANK



Section: 200 Sub Section: Sub-Index Page: 01 Issue: 08
Sub Index

Content Sec Sub Sec Page

First Response 200

procedures 201
Procedures ................................................................................................................................................... 1
Definition Of First Response......................................................................................................................... 1
The aims of first response are:................................................................................................................. 1
The first responders role.......................................................................................................................... 1
Care management - inflight ...................................................................................................................... 2
Limitations: ............................................................................................................................................... 4
Legal:........................................................................................................................................................ 5
Medlink - Emergency Medical Advice Centre .......................................................................................... 6
Administration Of Medication ................................................................................................................... 8
Standard Operating Procedure ................................................................................................................ 8
Carriage Of Expectant Mothers.............................................................................................................. 14
Documentation ....................................................................................................................................... 15
Medical Incident Report Form: ............................................................................................................... 16
Medical Incident Reporting Procedure (JFK Only):................................................................................ 20
Carriage of Passengers with Disabilities................................................................................................ 21
Carriage Of Passengers With Disabilities (Us Flights)........................................................................... 22

Medical Kits 202
Medical Kits .................................................................................................................................................. 1
First Aid Pouch......................................................................................................................................... 1
Pre-flight check .................................................................................................................................... 1
Procedure for use ................................................................................................................................ 1
Procedure for closing........................................................................................................................... 1
List of contents..................................................................................................................................... 1
First Aid Kit ............................................................................................................................................... 2
Pre-flight check .................................................................................................................................... 2
Procedure for Use................................................................................................................................ 2
Procedure for Closing .......................................................................................................................... 2
List of contents..................................................................................................................................... 3
Emergency Medical Kit............................................................................................................................. 5
Pre-flight check .................................................................................................................................... 5
Procedure for Closing .......................................................................................................................... 6
EMK Supplementary Pouch (SEMK) ..................................................................................................... 27
Pre-flight check .................................................................................................................................. 27
Procedure for use .............................................................................................................................. 27
Procedure for closing......................................................................................................................... 27
Contents............................................................................................................................................. 27
The Hygiene Kit/ Universal Precaution Kit ............................................................................................. 30
Location.............................................................................................................................................. 30
Pre-flight check .................................................................................................................................. 30
Contents............................................................................................................................................. 30
Procedure for Closing ........................................................................................................................ 30

AED 203
The Automatic External Defibrillator (AED) .................................................................................................. 1
Location................................................................................................................................................ 1



Pre-flight checks for the FR2 AED....................................................................................................... 1
Defibrillation safety............................................................................................................................... 3
Defibrillator Troubleshooting................................................................................................................ 5
Documentation..................................................................................................................................... 6

Medical Portable Oxygen Bottles 204
Medical Oxygen............................................................................................................................................ 1
Portable Oxygen Concentrator Units ....................................................................................................... 1
Portable Oxygen Bottles........................................................................................................................... 4
Supplementary Oxygen Bottle ................................................................................................................. 4
Description........................................................................................................................................... 4
Locations.............................................................................................................................................. 4
Procedure for use ................................................................................................................................ 5

Other Equipments 205
Other Equipment........................................................................................................................................... 1
Rescue Breathing Devices....................................................................................................................... 1
Aircraft Wheelchair ................................................................................................................................... 3
Location................................................................................................................................................ 3
Use of the Onboard Wheelchair .......................................................................................................... 3
Sharps Box............................................................................................................................................... 5
Location................................................................................................................................................ 5
Disposal of used syringes and needles ............................................................................................... 5
Crew to crew changeover on board..................................................................................................... 5
At Stations where crews do not hand over face to face ...................................................................... 5
Arrival into Dubai.................................................................................................................................. 6
Bandages And Dressings......................................................................................................................... 7
Bandages ................................................................................................................................................. 7
General rules for bandages ............................................................................................................... 10
Epipen .................................................................................................................................................... 11
How to use the Epipen auto-injector.................................................................................................. 11
Telemedicine.......................................................................................................................................... 12
Tempus 2000..................................................................................................................................... 12
Location.............................................................................................................................................. 12
Pre Flight Check ................................................................................................................................ 12
Criteria for Use................................................................................................................................... 12
Outline of the Tempus........................................................................................................................ 12
Turning on the Tempus...................................................................................................................... 13
Using the Tempus.............................................................................................................................. 13
Telemedicine.......................................................................................................................................... 15
Location.............................................................................................................................................. 15
Outline of the Tempus IC................................................................................................................... 15
Pre Flight Check ................................................................................................................................ 15
Criteria for Use................................................................................................................................... 16
Turning on the Tempus IC................................................................................................................. 16
Using the Tempus IC - Follow the Help Screens............................................................................... 16
Lateral Transfer Devices easy glide and easy belt/ flexibelt ............................................................... 18
Pre- Flight Check ............................................................................................................................... 18

assessing 206
Assessing A Casualty................................................................................................................................... 1
Primary Survey......................................................................................................................................... 1
Secondary Survey.................................................................................................................................... 2
Signs And Symptoms............................................................................................................................... 3
External clues........................................................................................................................................... 3



Assessing Vital Signs............................................................................................................................... 4
Breathing.............................................................................................................................................. 4
Normal Breathing Rates....................................................................................................................... 4
The heart and circulation ..................................................................................................................... 5
Normal Pulse Rates............................................................................................................................. 5
Pulse check for adults and children..................................................................................................... 6
The brain.............................................................................................................................................. 6
Levels of consciousness...................................................................................................................... 7
Temperature ........................................................................................................................................ 7

Basic Life Support Procedures 207
Basic Life Support Procedures..................................................................................................................... 1
Assessment of a collapsed casualty ........................................................................................................ 1
D- Danger............................................................................................................................................. 2
R- Response........................................................................................................................................ 2
S- Shout For Help ................................................................................................................................ 2
A- Airway.............................................................................................................................................. 2
B- Breathing......................................................................................................................................... 3
C- Compressions ................................................................................................................................. 2
D- Defibrillation: ................................................................................................................................... 4
The Unconscious Casualty (Breathing Present) ...................................................................................... 5
Unconsciousness................................................................................................................................. 5
Causes................................................................................................................................................. 5
Management ........................................................................................................................................ 5
The recovery position........................................................................................................................... 5
Rescue Breathing..................................................................................................................................... 8
How to give rescue breaths ................................................................................................................. 8
Special cases....................................................................................................................................... 9
Cardio Pulmonary Rescusitaion (CPR).................................................................................................. 10
How to give chest compressions............................................................................................................ 10
Adults ................................................................................................................................................. 10
Children.............................................................................................................................................. 11
Babies ................................................................................................................................................ 12
Two responder CPR .......................................................................................................................... 13
How chest compressions work .......................................................................................................... 13
CPR, how long do I continue? ........................................................................................................... 13
Presumed Death on Board Policy and Procedures ............................................................................... 16
1. Scenarios .................................................................................................................................. 16
2. Procedure.................................................................................................................................. 16
3. Care of the body........................................................................................................................ 17
5. Other Formalities: General ........................................................................................................ 18
6. Support to Crew......................................................................................................................... 19
7. Breaking Bad News................................................................................................................... 19
The Choking Casualty............................................................................................................................ 21
Definition............................................................................................................................................ 21
Signs and Symptoms......................................................................................................................... 21
Total Blockage ................................................................................................................................... 22
Adult/Obese/Pregnant Unconscious............................................................................................... 23
Children.............................................................................................................................................. 23
Babies (0 1 year) Conscious........................................................................................................ 24
Action For Children And Babies Unconscious................................................................................ 25

Medical Emergencies 208
Medical Emergencies ................................................................................................................................... 1
Air Sickness.............................................................................................................................................. 1
Definition.............................................................................................................................................. 1
Management ........................................................................................................................................ 1



Alcohol Intoxication .................................................................................................................................. 1
Signs and Symptoms ............................................................................................................................... 1
Management ........................................................................................................................................ 1
Anaphylactic Reaction/Allergic Shock...................................................................................................... 2
Definition.............................................................................................................................................. 2
Causes................................................................................................................................................. 2
Triggering factors................................................................................................................................. 2
Signs and symptoms............................................................................................................................ 2
Management ........................................................................................................................................ 2
Appendicitis.............................................................................................................................................. 4
Definition.............................................................................................................................................. 4
Management ........................................................................................................................................ 4
Asthma ..................................................................................................................................................... 4
Definition.............................................................................................................................................. 4
Causes................................................................................................................................................. 4
Management ........................................................................................................................................ 5
Childbirth .................................................................................................................................................. 6
Labour .................................................................................................................................................. 6
First Stage............................................................................................................................................ 6
Management ........................................................................................................................................ 6
Second Stage ...................................................................................................................................... 7
Symptoms ............................................................................................................................................ 7
Management ........................................................................................................................................ 7
Care of baby ........................................................................................................................................ 8
Third Stage .......................................................................................................................................... 8
Symptom.............................................................................................................................................. 8
Management ........................................................................................................................................ 8
Care of mother ..................................................................................................................................... 8
Colds ........................................................................................................................................................ 9
Management ........................................................................................................................................ 9
Deep Vein Thrombosis........................................................................................................................... 10
Management ...................................................................................................................................... 11
Prevention.......................................................................................................................................... 11
Diabetes ................................................................................................................................................. 11
Definition............................................................................................................................................ 11
Hypoglycaemia....................................................................................................................................... 11
Signs and symptoms.......................................................................................................................... 12
Management ...................................................................................................................................... 12
Hyperglycaemia...................................................................................................................................... 12
Management ...................................................................................................................................... 12
Diarrhoea................................................................................................................................................ 13
Management ...................................................................................................................................... 13
Drug Overdose....................................................................................................................................... 13
Management ...................................................................................................................................... 13
Ear Distress ................................................................................................................................................ 14
Definition............................................................................................................................................ 14
Management ...................................................................................................................................... 14
Fainting................................................................................................................................................... 15
Management ...................................................................................................................................... 15



Definition............................................................................................................................................ 16
Types ................................................................................................................................................. 16
Causes............................................................................................................................................... 16
Triggers that can bring on a fit in a person: ....................................................................................... 16
Major seizures.................................................................................................................................... 16
Management ...................................................................................................................................... 17
Food Poisoning ...................................................................................................................................... 17
Management ...................................................................................................................................... 17
Heart Disorders ...................................................................................................................................... 18
Angina .................................................................................................................................................... 18
Management ...................................................................................................................................... 18
Heart Attack............................................................................................................................................ 19
Causes............................................................................................................................................... 19
Management ...................................................................................................................................... 20
Cardiac Arrest ........................................................................................................................................ 21
Signs .................................................................................................................................................. 21
Management ...................................................................................................................................... 21
Heat Related Disorders.......................................................................................................................... 22
Heat Exhaustion..................................................................................................................................... 22
Definition............................................................................................................................................ 22
Management ...................................................................................................................................... 22
Heat Stroke ............................................................................................................................................ 22
Definition............................................................................................................................................ 22
Hyperventilation...................................................................................................................................... 23
Definition............................................................................................................................................ 23
Management ...................................................................................................................................... 23
Hypoxia .................................................................................................................................................. 24
Definition............................................................................................................................................ 24
Causes............................................................................................................................................... 24
Management ...................................................................................................................................... 24
Hysterical Attacks................................................................................................................................... 25
Management ...................................................................................................................................... 25
Indigestion.............................................................................................................................................. 25
Management ...................................................................................................................................... 25
Miscarriage............................................................................................................................................. 26
Management ...................................................................................................................................... 26
Renal Colic............................................................................................................................................. 26
Definition............................................................................................................................................ 26
Management ...................................................................................................................................... 26
Shock...................................................................................................................................................... 27
Definition: ........................................................................................................................................... 27
Causes............................................................................................................................................... 27
Loss of blood or plasma..................................................................................................................... 27
Management ...................................................................................................................................... 28
Smoke Inhalation.................................................................................................................................... 29


Management ...................................................................................................................................... 29
Stroke..................................................................................................................................................... 29
Definition............................................................................................................................................ 29
Management ...................................................................................................................................... 30
Temperature Related Disorders............................................................................................................. 30
Hypothermia........................................................................................................................................... 30
Management ...................................................................................................................................... 30
Fever ...................................................................................................................................................... 31
Management ...................................................................................................................................... 31
Febrile Convulsions................................................................................................................................ 32
Management ...................................................................................................................................... 32

Trauma Emergencies 209
Bleeding........................................................................................................................................................ 1
Definition.............................................................................................................................................. 1
Classification of Bleeding..................................................................................................................... 1
External Bleeding ..................................................................................................................................... 1
Management ........................................................................................................................................ 2
Amputation ............................................................................................................................................... 3
Definition.............................................................................................................................................. 3
Management ........................................................................................................................................ 3
Internal Bleeding ...................................................................................................................................... 4
Signs and Symptoms........................................................................................................................... 4
Management ........................................................................................................................................ 4
Nose Bleeding.......................................................................................................................................... 4
Management ........................................................................................................................................ 4
Burns ........................................................................................................................................................ 5
Definition.............................................................................................................................................. 5
Depth of burns ..................................................................................................................................... 5
Dislocations.............................................................................................................................................. 7
Definition.............................................................................................................................................. 7
Management ........................................................................................................................................ 7
Eye Injury ................................................................................................................................................. 7
Foreign Body in the Eye (Non-Embedded) .............................................................................................. 7
Management ........................................................................................................................................ 7
Foreign Body in the Eye (Embedded) ...................................................................................................... 8
Signs and symptoms:........................................................................................................................... 8
Management ........................................................................................................................................ 8
Fractures .................................................................................................................................................. 8
Definition.............................................................................................................................................. 8
Closed Fractures...................................................................................................................................... 8
Management ........................................................................................................................................ 9
Open Fractures ........................................................................................................................................ 9
Management ........................................................................................................................................ 9
Head Injury............................................................................................................................................. 10
Definition............................................................................................................................................ 10
Management ...................................................................................................................................... 10




Neck And Back Injuries .......................................................................................................................... 11
Management ...................................................................................................................................... 11
Sprains............................................................................................................................................... 12
Definition............................................................................................................................................ 12
Strains .................................................................................................................................................... 12
Definition............................................................................................................................................ 12
Symptoms .......................................................................................................................................... 12
Management of sprains/strains.......................................................................................................... 12
Chest injuries.......................................................................................................................................... 13
Penetrating Chest Injury (Including Pneumothorax) .............................................................................. 13
Management ...................................................................................................................................... 13
Ribcage Injuries...................................................................................................................................... 14
Management ...................................................................................................................................... 14
Abdominal Injuries.................................................................................................................................. 15
Management ...................................................................................................................................... 15

Travel Health 210
Travel Health............................................................................................................................................ 1
Infectious Diseases - Information And Precautions ................................................................................. 1
Immunisation............................................................................................................................................ 3
Key Facts For First Responders .............................................................................................................. 4
What is AIDS?...................................................................................................................................... 4
What is Hepatitis .................................................................................................................................. 4
HIV and Hepatitis B.............................................................................................................................. 4
What are the risks to me as a first responder ...................................................................................... 4
Precautions .......................................................................................................................................... 4
Communicable Diseases: ........................................................................................................................ 5
Guidelines And Administrative Procedures For ....................................................................................... 8
The Prevention Of Cross Infection. .......................................................................................................... 8
3. DEFINITION: ................................................................................................................................. 10
4. POLICY:......................................................................................................................................... 11
5. PROCEDURE................................................................................................................................ 11
10. PERIODIC REVIEW....................................................................................................................... 17
Chickenpox............................................................................................................................................. 20
Symptoms of Chickenpox .................................................................................................................. 20
Treatment........................................................................................................................................... 21

Glossary A - Z 211
Glossary ................................................................................................................................................... 1


Effective Date:



Effective Date: 15 July 2006

Section: 200 Sub Section: 201 Page: 01 Issue: 02
Procedures
Definition Of First Response
The purpose of First Response is to offer assistance or treatment to a casualty for any
injury or sudden illness before the arrival of qualified medical help.

The aims of first response are:
1. Promote a safe environment.
2. Preserve life.
3. Prevent the condition worsening.
4. Promote recovery.

These definitions are accepted by all major Pre hospital care organisations world wide
and they hold good for any one in any walk of life who is trained in First Response. It
does not matter where the incident occurs, whether it be at work, in the home or
socially. People suddenly become ill or have accidents and the First Responder is well
qualified to give life saving assistance and prevent unnecessary loss of life.

These definitions apply equally well to air transport and are especially relevant in the
isolated environment of the aircraft at 30,000 feet. In these situations passengers naturally
will look to Cabin Crew for action and assistance. It is vital that they respond efficiently and
effectively to such a call for help.

All Cabin Crew are given excellent training in In-flight Medical Care and particular attention
is paid to peculiar difficulties that may be experienced in the confined space of the aircraft.
Much of the First Response training received revolves around the need for staff to
improvise and adapt to these restrictions.

The first responders role
The First Responders role is very clear:

1. Assess the situation without endangering one's own life. Pay special attention to:
- Dangers / Hazards
- Level of Responses
- Airway
- Breathing
- Circulation
- Bleeding
- Fractures
- Change in Level of Consciousness

2. Identify the condition or disease from which the casualty is suffering.

3. Give immediate, appropriate and adequate treatment.

4. Arrange for casualty to get expert medical help without delay, through Medlink,
the Captain or the P.A. system.

Effective Date: 30 April 2005

5. The Flight Crew should be updated at all stages so that the Captain is well aware of
the situation at hand. The captain should always be informed of any First
Response Case.

He must be immediately notified of:
- Injuries
- CPR/ Defibrillation
- Serious illness
- Death
- Childbirth

6. Remain with the casualty until he/she can be handed over to Medical Personnel on
the ground.

7. Complete all relevant paper work.

Care management - inflight

Falling ill at 39000 feet can often be a very frightening experience for an individual.
Offering care that instills trust and builds confidence is vitally important. Although your
responsibilities as a First Responder are clearly outlined, remember that a caring
manner during any assessment or casualty handling would be most beneficial to the
casualty's emotional and physical well being. This cannot be over emphasized. It is
vital that the following principles be applied to all situations:

1. Talk to the person, ask relevant questions, those that produce a yes or no answer
are often the best in the initial phase.

2. Act calmly and reassure the person constantly, even after he/she has been given
treatment.

3. Always give a clear explanation of what you intend to do, for example tell the
passenger why you are loosening his/her clothing, or what to expect when receiving
oxygen.

4. Do not leave the passenger until he/she has fully recovered, even if a medical
professional has offered to assist. The responsibility of a medical professional is only
to offer help with areas that cabin crew have not been trained in, for example giving
injections.

5. Never leave a passenger who you suspect may be dying. Hold the passenger's
hand, physical touch can be very reassuring to an unconscious/dying person and this
reminds them that they are not alone.


6. Reassurance is very important, positive information is critical, for example, don't
worry, you will be fine', 'everything is okay'. Avoid words that could cause emotional
distress, for example, 'don't worry, you are not going to die'.

7. Always remember that even the unconscious person may hear you. Be aware of
your own conversation. Where possible do not discuss the casualtys condition over
him/her or in the vicinity of other passengers.

8. The casualty may have family or friends travelling with them and where possible they
should be allowed to stay, unless it interferes with your management or treatment.
This is particularly relevant with the care of children.

9. A designated crew member should be responsible for the care of the relatives with the
passenger that has fallen ill.

Expectations

1. All Cabin Crew have a good basic training in the principles of First Response and the
likely situations when it may be needed in the course of their duties.

2. Very often crew not only apply their knowledge of Emergency In-flight Medical Care,
but also need to improvise and adapt to difficult situations.

3. In any emergency situation, it is the Cabin Crew that passengers automatically turn
to for help and assistance. The training given to Cabin Crew enables them to
respond in a calm and professional manner causing as little disruption and distress
as possible to other passengers.

4. Cabin Crew must never show panic - but allow their training and common sense to
prevail at all times.

5. They must know exactly what is contained in the Emergency Medical Kit (E.M.K.),
the First Aid Kit and the First Aid Pouch. They must be totally familiar with the lay
out of the E.M.K. and also what medication/equipment they have been authorised
to use. They must not use or distribute drugs or any items from the E.M.K. or EMK
supplementary pouch that have been designated for use by qualified medical
practitioners only.

6. The Captain should be informed as soon as possible about the incident and should
be regularly up-dated.



Limitations:

1. Cabin Crew are trained First Responders. They are not considered as nurses or
paramedics and are not expected to have detailed knowledge or experience of all
things medical. They are not expected to give complicated medical assistance.

2. Cabin Crew should not undertake any procedures they have not received official
instructions in or any procedures outside the training manual.

3. They are not expected to give anything else but Emergency In-Flight Medical Care to
a casualty.

4. They are not expected to give passengers medication of any kind even if requested to
do so, except those in the First Aid Pouch /First Aid Kit/ E.M.K. This applies to
both, emergency and routine situations. They are also not expected to give
injections, for example, a diabetic may request a crew member to administer their
insulin injection for them. This is not permitted. However Medlink may instruct the
crew to administer the Epipen injection in the case of anaphylactic shock. See sub-
section 202 page 16 for Epipen dosage and precautions and subsection 208 page 2
for Epipen administration guidelines.

5. Cabin Crew are only to use those medications from the E.M.K. that they have specific
authorisation for and are never to use or distribute medications not supplied in the Kit
or which have not been authorised as safe to use by Cabin Crew. The medication
supplied in the E.M.K. is "strictly" for on-board use.

6. However crew may be ordered by Medlink to give medications that would normally be
given by medical professional.

Note: Cabin Crew should never administer their own personal medication to a
passenger on the aircraft.



Legal:

1. Cabin Crew are considered as competent First Responders. They are not medical
professionals and are therefore not subject to "medical licensing" regulations. In
that respect they are no different to any other member of the general public with
training in First Response. If you act in accordance with what you have been
trained to do, you need not fear any legal implications. No one would ever be
criticized for trying to help another person in distress. What is unforgivable is to
stand back and not use one's skills to save a life in an emergency situation.

2. If Medlink advise crew to P.A for a Medical Professional, crew should encourage
this person to liaise with Medlink.

3. Cabin crew and Medical professionals on board the aircraft will be covered by
Emirates Indemnity Insurance.

4. A Medical Professional (so long as it falls within the scope of their practice) is
permitted to use his own medication if he wishes but crew should advise the
doctor that we have Medication in the EMK and FAK. The names of any drugs
used by a doctor should be recorded on the Medical Incident Report Form (MIRF).

5. A Medical Professional (so long as it falls within the scope of their practice) can
prescribe (order) the use of any medication, administer any medication (including
injections) and use any equipment in the FAK/EMK.



Medlink - Emergency Medical Advice Centre

Medlink is an Emergency Medical Advice Centre based in the USA, which operates on
a 24-hour basis, from anywhere in the world.
You can contact Medlink through the following methods:

1. Via the EMTEL onboard telephone system through the passenger seat using the
prepaid Medlink calling card and dialing (001 602 239 3627).
2. If Tempus IC if available on the aircraft, you must use the unit to make the
connection
3. If crew cannot contact Medlink from the cabin, advise the Captain as he/she may
be able to make contact via the flight deck.

All phone conversations will be recorded.

In the event of a sick casualty in flight, Cabin Crew should assess the casualty, and
provide suitable First Aid as appropriate in the manner of their training. If Cabin Crew have
any concern over the medical condition of a casualty following assessment and/or First Aid
treatment, or require further medical advice because they are concerned over the
casualtys status, then do not hesitate to contact Medlink for advice. Medlink may well then
ask crew to PA for a medical professional to assist them, ask Ladies and Gentlemen, if
there is a Doctor of Medicine, a registered nurse or paramedic on board, please contact a
Cabin Crew member. Please also have your identification available. (PA should be made
twice if necessary) check identification. Accepted forms of identification includes I.D.
card, business card and check passport.

Only if Medlink is not contactable, then other sources such as Doctors, nurses or
paramedics, who may be on the aircraft should be used as a secondary choice. Even if
a medical professional is called as a secondary means, he/she should be advised of the
Medlink service, and in any event, every effort should be made to establish contact with
Medlink so that the medical professional can discuss the case with them.

The Purser/SFS should advise the Captain that they have an in-flight medical
emergency, inform him whether they have called or need to call Medlink, and give him
details of the casualtys condition as outlined in the Medical Incident Report Form.

The cabin crew should assess/discuss the casualtys condition with Medlink, and using
their assistance attempt to stabilise the casualty. Once the casualty is stabilised, an
agreement should be reached with Medlink as to when/if a follow-up call should be
made. The communication with Medlink should be terminated when crew and Medlink
are satisfied that all of the required action has been taken.


In the event that the casualtys condition cannot be stabilised, Medlink will recommend a
suitable course of action, which may involve a recommendation to divert to the nearest
suitable airport with appropriate medical facilities. Should this occur, the SCCM must
immediately pass this information to the Flight Deck. The Captain will, in liaison with
Medlink, consider the recommendation and take the appropriate action. Medlink will
contact the airport and arrange for local emergency response units to facilitate care.

Medlink should be advised of the action taken by the Captain if different from that
recommended by them (for example: safety, operational or technical reasons). They will
monitor the situation (where needed) until the flight arrives at its destination and the
casualty is disembarked and officially discharged.

The Purser/SFS should complete the relevant paperwork and submit it to the Cabin
Crew briefing office. For advice on documentation, see page 14.

Medlink - On Ground

Medlink has extended their telephone advisory service to our network airports. In a
situation where there may be a concern about a passengers fitness to travel, or simply to
get quick expert medical advice, Medlink services can be utilised whilst on the ground by
airport staff or cabin crew
If a medical emergency arises whilst on the ground e.g. transit / taxiing Medlink can also
be contacted.

Note: The fee to Medlink is paid annually regardless of the number of calls made.



Edition
2
Administration Of Medication
Standard Operating Procedure
Title: Guidelines and Administrative Procedures Of Medication
Administration for Cabin Crew

CONTENTS:

1. PURPOSE AND SCOPE

2. RESPONSIBILITIES

3. DEFINITION

4. POLICY

5. PROCEDURE

INTRODUCTION
LIST OF DRUGS
PREPARATION
STORAGE
ADMINISTRATION
DOCUMENTATION

6. APPLICABILITY

7. NON-COMPLIANCE

8. ADDITIONAL NOTES

9. PERIODIC REVIEW.




Edition
2

ADMINISTRATION OF MEDICATION
STANDARD OPERATING PROCEDURE

1. PURPOSE & SCOPE:
This document is to provide guidelines and direction for Emirates Airlines Cabin
Crew in the administration of medication.

These guidelines apply to all first aid trained cabin crew who are permitted by the
Vice President Aviation and Occupational Medicine to administer medication to
a passenger as part of the first aid treatment they may provide to that sick or
injured passenger.

2. RESPONSIBILITIES:
Cabin Crew within Emirates Airline must follow and adhere to these guidelines.

Group Medical Training will review policies and procedures in terms of
effectiveness and compliance and submit recommendations.

3. DEFINITION:
The following definition of medication shall apply to cabin crew: - A medication is
a substance administered for the cure, treatment or mitigation (relief) of injury or
illness. In the health care context, the words medication and drug are generally
interchangeable. (Adopted from Mallett and Dougherty 2001)

4. POLICY:
This policy is to ensure qualified first aid trained cabin crew are permitted to
administer drugs as part of the treatment service provided to a passenger. In
order that this is carried out safely, the following guidelines are recommended.

Qualified first aid trained cabin crew can administer drugs only as authorised by
the Senior Vice President Medical Services with or without a doctors order,
within the scope of their training and validity of their qualification.

It is the responsibility of each member of cabin crew to ensure that these
procedures are followed and implemented.




Edition
2

ADMINISTRATION OF MEDICATION STANDARD OPERATING
PROCEDURE

5. PROCEDURE:

5.1. INTRODUCTION:
Medications, should be administered only when they are necessary, and in all
cases the benefit of administering the medicine should be considered in relation
to the risk involved.

If misused, they have the potential to cause harm or permanent damage. In
some cases this can even lead to death. It is therefore imperative that those
administering drugs are familiar and well conversed with appropriate policy and
procedures for administration.

Currently cabin crew provide first aid treatment service for passengers who may
fall ill or sustain injury while traveling on Emirates Airlines. Part of this service
includes drug administration. It is the intention of this policy to identify correct
procedure and authorisation in support of this service.

5.2. LIST OF DRUGS:

The following lists of drugs are permitted for use by the cabin crew. No other
drugs other than those that appear on the list should be administered without
authorisation from the Vice President Aviation and Occupational Medicine Dr
Fiona Rennie. These drugs are only to be administered, if required, for the
duration of the flight.

Please refer to, sub section 202, pages 3, 4, 7-10 and 19-27 for the list of
authorised medication available in the Emergency Medical Kit and the First Aid
Kit.




Edition
2

PROCEDURE

5.3. PREPARATION:

Correctly identify the drug name, dosage and route of administration, and take
note of any known allergies that the casualty may have. Similarly, if the
passenger is female, pregnancy must be ruled out before administration. These
details must be recorded.

Expiry dates for drugs must be checked before administration. If unsure about
the dosage please refer to the leaflet inside each medication pack and get
another cabin crew member to double check the dosage.

Under no circumstances should a drug be administered if there is any doubt with
the familiarity of the drugs, drug interaction with other drugs, or other unfamiliar
circumstances. The individual administering is responsible for the accuracy of the
documentation.

Medication containers which are unlabelled or from an illegibly labeled container
must NOT be administered. It should be removed from the medication kit and
sent back to the Emirates Medical Services Pharmacy.

5.4. STORAGE:

All drugs are currently stored in sealed First Aid pouches, First Aid kits and
Emergency Medical Kits on board all Emirates Aircrafts. Under no circumstances
should the First Aid kits and Emergency Medical Kits be left unsealed when not
in use as security is essential. It is important that these medications are not
accessible to personnel NOT authorised to handle medication.

If the drugs have passed their expiry date they are to be sent back to the
Emirates Medical Services Pharmacy for safe disposal and appropriate
documentation should be carried out. No expired drugs should be disposed off in
a normal waste bin provided on board the aircraft.




Edition
2

PROCEDURE

5.5. ADMINISTRATION:

Select the required medication and check for expiry. Inform the passenger of the
medication to be administered. Offer an explanation of the use, action, dose and
potential side effects of the drug where necessary.

Administer the drug through the route prescribed and ensure appropriate
documentation is carried out. Observe passenger for immediate or delayed
adverse reactions to the drug
If the crew member administering the medication is not completely familiar with
the medication and there is any doubt with the medication, then under no
circumstances should the drug be given.

5.6. DOCUMENTATION:

All drugs administered must be properly documented on the appropriate
paperwork- namely the Medical Incident Report Form and the EMK Dug Usage
Form The name of drug and exact dosage needs to clearly document along with
the name, staff number and signature of the crew member administering the
medication.

Known allergies and other medications that the patient is currently taking must be
identified before administration and documented.

An incident report is to be initiated for any adverse reactions. With any adverse
reactions the individual should be referred to a physician immediately for
intervention.

6.0 APPLICABILITY:

These guidelines apply to all Emirates Airlines cabin crew trained in First
Response.




Edition
2

PROCEDURE
Administration for Cabin Crew.

7.0 NON COMPLIANCE:
Group Medical Training will be responsible for addressing and reporting issues
pertaining to non compliance of this policy within their respective areas.

Non compliance of this policy will be immediately addressed and concerned
staff may be subject to training by Group Medical Training or may be liable to
disciplinary action.

8.0 ADDITIONAL NOTES:
A passenger who presents for consultation should be assured of confidentiality
and privacy. In pursuit of identifying pharmaceutical needs, it is imperative that
this be conducted in a professional manner that does not violate the passengers
right to privacy and confidentiality.

9.0 PERIODIC REVIEW:
A review of this policy will be done yearly from the date of issue. However, if a
need is identified for earlier review, this will be undertaken.

REFERENCES:
Mallett, J & Dougherty, L. (2001).
Mims Middle East, 2001, volume 51, number 11.
New Guide to Medicines & Drugs (BMA).
Manufacturers leaflets enclosed inside each medication box.
British National Formulary 42, 2002, British Medical Association, Taristock
Square, London.
British National Formulary 44, 2002, British Medical Association, Taristock
Square, London.

Signature and date: ________________________________________________

Group Medical Training Manager Sheree Hassan




Carriage Of Expectant Mothers

Expectant mothers are normally not regarded as incapacitated, however certain
restrictions apply, which are given below:

Medical Certificate or Letter:

a. No medical certificate or letter is required up to the end of the 28th week of an
uncomplicated single pregnancy.

b. Common complications in pregnancy that require a medical certificate or letter can
include gestational diabetes, pre-eclampsia and eclampsia, placenta praevia, intra-
uterine growth retardation and premature rupture of membranes.

c. When the pregnancy has entered the 29th week, a medical certificate or letter
issued by a qualified doctor or midwife stating fitness to fly and confirming the
expected date of delivery is required.

d. No approval required from Medical Services up to the end of the 36th week

e. The certificate or letter must be returned to the passenger after verification, as it
might be required at down-line stations. If required a photocopy may be retained.

Acceptance:

In addition to the certificate requirement, there are certain limitations as the pregnancy
nears its end. These are:

a. Uncomplicated single pregnancies - accept up to end of the 36th week.

b. Multiple pregnancies such as twins or triplets- accept up to end of the 32nd week.

Note: For travel after these limiting periods, urgent medical or compassionate
reasons, must be approved and cleared by Medical Services. MEDIF procedures
must be used and the passenger will have to travel as a medical case.



Documentation

It is essential that an accurate record is made of the findings at the incident, the
casualtys condition and management. All medications administered and equipment
used should be included. Ideally this should be done at the same time or as soon as
possible after the incident.

It is important to note changes in the casualtys condition in relation to time as this is
useful when liaising with Medlink and when medical services take over on ground. The
identity of all providers (Doctor of medicine, nurse and paramedic) should be noted.

As well as the clinical value these documentations have a medico-legal function.
Records therefore should be as accurate and comprehensive as possible. They should
be retained in case they were required by a Court of Law.

In the event of an in-flight emergency the following paper work should be completed,
when necessary:

Document Location
Birth on Board form Inside EMK
Incident/Accident form Purser folder
Cabin Log FWD video compartment
Medical Incident Report Form Purser folder
Drug Usage Form Inside EMK
The SFS/Purser is required to complete the Drug Usage Form whenever
any medication is administered from the EMK. This form must be completed
in addition to the Medical Incident Report Form (MIRF). If this form is not
available in the EMK, please ensure that a KIS Medical/ EMK Report is
raised listing the medications/dosage that has been used.

For distribution, refer to appropriate form.

Note: For procedure on the use of the Birth on Board Form, refer to Section 614, pages 1-
3 of the Cabin Crew Manual (green).




Medical Incident Report Form:

Effective 17th September 2006, all medical cases/incidents occurring to passengers
and cabin crew are required to be documented on the Medical Incident Report
Form , except suspected cabin crew industrial injuries when it is required to fill up
the existing Accident/ Incident Report. This is for the purpose of SAFE and Group
Safety.
E.g. If a cabin crew develops pain in his/her back following the removal of a container from
a stowage, these details are documented on the existing Accident/Incident Report.
If a crew member develops abdominal pain, chest pain, nausea and vomiting, these
details are documented on the Medical Incident Report Form (see page 18-19 for
sample of the form) as this case is a medical case not an industrial injury.
Please refer to Cabin Crew Manual (Green) Section 600, subsection 612 page 1-6 to
review the policy, procedure and handling of this form. This form has been recently
redesigned to a standard format used for all forms carried in the aircraft.

Each Medical Incident Report Form carries a serial number.

Location: Purser folder

Benefits:

1. It will simplify documentation procedures.

There are a list of questions asked on the form, and where applicable a list of possible
answers/possibilities, which simply require a tick in the appropriate box. Numbers 1-18, full
flight details and the free text section must be filled out for all cases; tick other relevant
boxes as appropriate. Where information is required to be written, print legibly, be specific
and objective. Adhere to the guidelines you learned in training. Bear in mind that any
report could be required for legal reasons.
Note: In the case of Tempus IC, please always indicate if it has been used by ticking
the relevant yes/no box. This also applies if Tempus IC is not on board. This is to
assist in capturing accurate data relating to Tempus use.

It is a compulsory/ legal requirement to document the facts of the case, in the free
text/blank section on page 2 of the Medical Incident Report Form. If the space provided is
not adequate, use an additional MIRF and complete the free text section. In the event of a
passenger injury, it is useful to document the following in this section - cause of injury,
location of incident, was seat belt sign on/off, size of burn, details of witnesses (fellow
crew) etc.

2. Redundant Forms:
There is no requirement to fill up the following existing paperwork, as all required details
are captured on the Medical Incident Report Form.


Medlink Patch Check List. Fill out the Medical Incident Report Form with as much
information as possible, prior to calling Medlink for further advice. The indemnity
clause pertaining to liability, from the Medlink patch check list, is included on the
bottom of page 2 of the new form.
First Aid Kit (FAK)
Supplementary Emergency Medical kit (SEMK)
Automated External Defibrillator Form (AED).
Death On Board Form

Log these kits if opened in the cabin log book, reseal as per the standard procedure and fill
out the Medical Incident Report Form.
If the AED is used remove the data card, place it in a plastic bag clearly labeled with flight
details, serial number of the Medical Incident Report, pax details and staple to the Medical
Incident Report Form. Briefing Assistants will send this data card to Medical Services.

The Medical Incident Report Form must be completed on each flight by the Purser/SFS
(as applicable). A Medical KIS report should be raised also under the appropriate category
giving a brief outline of the incident and the reference number of the MIRF. There is no
need to duplicate information in both reports. All completed reports with other relevant
paperwork e.g. medical professionals business card to be handed over to Crew
Operations Centre at the end of a flight, be it a layover or turnaround. On the outbound
leg for layover flights all reports should be put in the Purser folder and locked in the ships
library. These are then returned to Dubai via the aircraft rotation.
In a case where an incident happens during the later stages of a flight, the Purser/SFS
may not have enough time to write a detailed report. In this case, raise a Medical KIS
report with a brief summary of the incident. A more detailed Medical Incident Report Form
must be completed at a later stage. In serious cases such as death on board, birth on
board, cardiac arrest, medical diversion or cases where passenger/crew require
hospitalisation, an ACARS message can be sent from the Flight Deck also. In the event of
a presumed Death on Board, adhere to the procedures required by the arriving station as
advised per the station manager.

Important: Death must be certified on the ground by the station doctor. Death can not be
certified by an on board medical professional. This is to comply with legal requirements.
Refer to Cabin Crew Emergency Manual, Presumed Death on Board Policy and
Procedures Section 200/Sub Section 207 pages16-20.








Medical Incident Reporting Procedure (JFK Only):

The following procedure must be observed on all flights into JFK if Medical services
are required to meet the aircraft. No passenger is permitted to disembark the aircraft
until the health authorities are satisfied to clear the aircraft.
The following information should be provided to the Airport Station Manager (ASM) in
JFK if Emergency Medical Services (EMS) are required to meet the aircraft:

Seat number of the passenger
Name of the passenger
Gender
Estimated Age
Current medical condition
Pax breathing : Yes/ No
Any medical assistance given

Once the case has been reported to the flight crew by the Purser, the Pilots are
requested to send a message using free text ACARS to the SMNC with the above
bulleted information. The SMNC will pass this information to JFK ASM once this
information is received from the flight crew.
One hour before landing, if there is any change to the passenger condition, an updated
message should be sent to the SMNC.



Carriage of Passengers with Disabilities:

(The below procedure has been agreed on by EK Airport Services and by EK Medical
Services)

WCHC passengers may be accepted for travel without an escort provided it is physically
verified at check-in that the passengers can:
1. Feed themselves and take care of elimination needs on board
2. Perform evacuation procedures during an emergency.
If an unescorted "Go-Show WCHC" passenger (passenger with no previous booking)
reports at the airport for travel on any flight other than the US bound flights, the above
two questions must be asked. If the answer to both questions is "yes" the passenger
can be accepted for travel and the crew must be advised. If the answer to one of the
questions is "no" the passenger must be cleared through Medical Services if time
permits or can be refused travel for the purpose of an on-time departure.

Not all WCHC passengers require medical clearance from Medical Services.
Passengers with permanent stable disabilities e.g. quadriplegics /paraplegics etc may
be accepted without medical clearance.WCHC passengers are encouraged to have
FREMEC cards for their convenience so that medical clearance is not needed each
time they travel. If travel is approved, it will include specific notification regarding escort
requirement.

Aids and Assistive Devices such as canes, crutches, standers and walkers:
In conjunction with In-flight Services/Reservations along with Legal and EK Security it
has been agreed to follow the below procedure with immediate effect.
Passengers who use walking assistive devices that they require for movement in the
aircraft cabin (e.g. to visit the lavatories and/or walk down the aisles) may be allowed to
carry such devices onboard subject to below mentioned conditions:
Such aids must be subjected to thorough X-ray screening examination and
additionally thorough physical check/inspection usually undertaken by trained
security personnel at the last point of security check, before boarding/re-boarding
the aircraft.
These devices will be stowed either in the hat rack above or adjacent to passengers
seat, wherever appropriate. The overhead stowage bins can accommodate aids with
a maximum length of 40 inches.
If a passenger does not require its use onboard, it may be taken away from the
passenger at the aircraft door on departure, loaded into the cargo and returned to
the passenger on arrival.
No medical clearances/certificates are required for passengers to carry their walking
device in the cabin unless passenger is MEDA in which case normal MEDA
procedures to be followed.
Such Walking Aids are allowed free of charge in addition to the normal Free
Baggage Allowances, provided the passenger is dependent on its use.


CARRIAGE OF PASSENGERS WITH DISABILITIES (US FLIGHTS)
Carriage of a passenger with a disability is governed by the Air Carrier Access Act of
1986. US Department of Transportation (US DOT) implemented ACAA through Title 14
of the US Code of Federal Regulations Part 382 which prohibits discrimination by air
carriers on the basis of disability. In compliance with this rule, all flights originating and
terminating in the US must adhere to the following procedures:

Refusal of Transportation
An airline must not refuse transportation to a passenger with a disability on the basis
of their disability or because the individuals disability results in appearance or
involuntary behavior that may offend, annoy, or inconvenience crew members or
other passengers. Emirates must not refuse to provide transportation to a passenger
with a disability by limiting the number of such persons who are permitted to travel
on a particular flight.

Transportation may be refused only for the following reasons:
When acceptance for carriage would violate safety regulations.
For the same reasons as any other customer (i.e. improper transportation
documents, failure to meet check-in deadlines, disorderly behavior, etc.).
When the customers medical condition raises doubt as to whether he/she
could complete the flight safely without requiring extraordinary medical care
during the flight. Please contact MedLink on +1-602-239-3627 for medical
advice.

Note: Always involve the Complaints Resolution Official (CRO) prior to refusing
transportation to a passenger with a disability.

Safety Attendants as per the rule:
An airline cannot require for a personal assistant, who assists persons with
disabilities to the lavatory and in eating. However, the passenger must be
informed that the airline personnel (e.g. Cabin Crew) are not required to
provide any personal assistance during the flight. This means that a passenger
with a disability, who cannot feed themselves or take care of elimination
process, can still travel, given that they are able to follow safety instructions
and are able to evacuate independently from the aircraft during an emergency.
A carrier can only require for a safety assistant which would assist the person
during an evacuation.

A passenger with a disability is only required to travel with a safety assistant in
specific circumstances which are as follows:
A person traveling on a stretcher or in an incubator.
A person who, because of a mental disability, is unable to comprehend/
respond appropriately to safety instructions.
A person with a mobility impairment so severe that the individual is unable to
assist in his or her own evacuation from the aircraft.
A person who has both severe hearing and severe vision impairments, which
prevent him or her from receiving and acting on necessary instructions from
carrier personnel when evacuating the aircraft during an emergency.


If the safety attendant is required and the customer disagrees, immediately contact the
Complaints Resolution Official.

Advance Notice Requirements
Airlines may not require a passenger with a disability to provide advance notice of
their intent to travel or of their disability except as provided below. 48 hours advance
notice is required in the following circumstances:
Medical Oxygen
Carriage of stretcher, incubator, hook-up for a respirator, ventilator, CPAP
machine or Portable Oxygen Concentrator (POC)
Provision by the carrier of hazardous materials packaging for a battery for a
wheelchair or other assistive device.
Accommodation for a group of ten or more qualified individuals with a disability,
who make reservations and travel as a group.
When traveling with a Service Animal in the cabin for flights over 8 hours (only
Seeing-Eye dogs are accepted in the cabin).

Seat Transfer and Assignment
Passenger with a disability should not be required to sit in a particular seat on the
basis of
their disability, except in order to comply with the safety requirements (i.e. exit row-
seating regulations).

Once passenger self identifies his/her disability, crew must ask how may I assist
you?
If the person with a disability cannot self-transfer, cabin crew must use the easy belt
and easy glide for the lateral transfer.

Storage of Customers Personal Equipment
Assistive devices brought into the cabin by a passenger with a disability must
not count toward the customers allowable limit on carry-on items. Customers
using canes and other assistive devices may stow these items on board the
aircraft in close proximity to the customers seat, if consistent with safety
regulations.
If closet space is available Emirates will permit one folding manual personal-
wheelchair to be stowed in the aircraft cabin closet (or other approved priority
storage area) on first come first served basis. Other personal wheelchairs
could be stowed on hold on a priority basis.
Personal wheelchairs are accepted as checked baggage without any charges
when these exceed the free baggage allowances. Powered
wheelchairs/scooters are also carried without any charges. However, these are
classed as Dangerous Goods and procedures for dangerous goods must be
followed.

Acceptance of service animals (Seeing-Eye dogs only)
Seeing Eye dogs are accepted to and from the US, Canada and from EU only.


A Seeing Eye dog may be seated with the passenger with a disability in the
cabin, if the animal can be accommodated without obstructing the main cabin
aisle or emergency exit row.
The Seeing Eye dog must be of a size which will fit at the customers feet. The
customer should bring an absorbent mat for the service dog to lie on but these
can also be supplied by Ground Services staff with the assistance of cabin
crewmembers. The mats are stowed onboard the aircraft. If the dog is too large
to fit in front of one seat, a second seat may be purchased and the seat beside
the passenger blocked. The care and supervision of a Seeing Eye dog is solely
the responsibility of the passenger.
Customer should provide appropriate documentation verifying that the dog is
properly trained in addition to requisite health and entry documents.

Medical Certificates
A disability is not sufficient grounds to request a medical certificate. Carriers shall
not require
passengers to present a medical certificate unless the person:
Is on a stretcher or in an incubator (where such service is offered).
Needs medical oxygen during flight.
Has a medical condition which causes the carrier to have reasonable doubt
that the individual can complete the flight safely, without requiring extraordinary
medical assistance during the flight.
Has a communicable disease or infection that has been determined by public
health authorities to be generally transmittable during flight and to pose a direct
threat.
If the medical certificate is necessitated by a communicable disease, it must
state that the disease/infection will not be communicable to other persons
during the normal course of flight, or it shall state any conditions or precautions
that would have to be observed to prevent transmission of the disease or
infection to others.
Medical certificates must be dated within 10 days of the customers flight.
Emirates may require that a person with a medical certificate undergo
additional medical review by MedLink and/or Medical services at the airport if
there is a legitimate reason for believing that there is a significant change in
his/her condition since the issuance of the medical certificate.

Categories of wheelchair
Passengers who request for wheelchairs are identified according to their needs by
one of the
codes below:
WCHR passengers who can ascend/descend steps and make their own way
to/from their cabin seats but cannot walk long distances.
WCHS passengers who cannot ascend/descend steps but are able to make
own way slowly to/from their cabin seats.
WCHC passengers who are completely immobile and require wheelchairs
to/from the aircraft and to/from their cabin seats.
Extra cabin crew member will be put on roster when necessary, only to satisfy
SAFETY requirements. Cabin crew is not authorized to feed or assist in the


toilet or at the aircraft seat with elimination functions. This function is the
responsibility of the passenger or the personal assistant.
Senior Cabin Crew Member must be advised of the correct number and correct
code of wheelchair customers through the Passenger Information List.

Complaints Resolution Official (CRO)
CROs are experts on ACAA and Trained EK employee available in person at
the airport or via telephone to passengers traveling on flights that begin or ends
at a U.S airport.
The purpose of having a CRO is to resolve the problem of a passenger with
disability as quickly as possible, without resorting to formal DOT enforcement
procedures and ideally before violation to DOT Part 382 regulation.
Passengers having disability related concerns have the right to speak to a
CRO.

In the USA, a CRO is available at all airports and may be contacted during
normal airport operational hours on following numbers. These numbers are for
SFS/Purser use only.

IAH - +1 713 398 6301
JFK - +1 917 325 4295
SFO - +1 650 222 8983
LAX - +1 310 467 6541
DFW - + 1 281 408 6302

For all other outstations or when a US CRO is not available, Manager Airport
Services (Outstations) should be contacted on +971509509416.

For Dubai Airport, Manager Airport Services (MAS-DXB) should be contacted on
+971509508289

Note: For further information regarding the ACAA rule, refer to Green Cabin
Crew Manual, Section 700


Effective Date:




Medical Kits
First Aid Pouch (black colour)
The First Aid Pouch is used for minor injuries
and medical conditions.
All First Aid Pouches will be handled,
replenished, sealed and loaded on board by
Emirates Aviation Catering (DXB).

For location refer to appropriate Aircraft type
safety and emergency procedures sub-
section

Pre-flight check
Available in correct location with two white seals intact.

Procedure for use
The First Aid Pouch contains items for day to day use and is to be used in First aid
situations that are not serious enough to require the opening of the FAK or E.M.K.
No permission is required to open kit.
Follow dosage guide for instruction on drug administration
Procedure for closing
If the Pouch is opened, it should be resealed with 2 Red Seals (into DXB only).
No paperwork to be completed.
List of contents:

Medication/item Uses
Antacid Medication Neogastro+/Maalox Plus/
Moxal Plus
Relief of heart burn and indigestion
Band Aid Strips Water proof dressing for small cuts
Content List List of contents
Disposable Gloves First response procedures
Eye drops e.g. Antistin Privin, Spersallerg For red, sore and slightly infected eyes
Melolin Dressing Sterile dressing for burns or wounds
Micropore Tape Secure dressings/bandages
Nasal spray e.g. Otrivin, Xylolin For nasal congestion
Paracetamol Syrup/Adol Suspension Pain, fever in infants and young children
Paracetamol Tablets (Panadol) For relief of pain and fever
Red Seals For sealing FAP
Sharps Container Disposing of needles/syringe
Silvadiazine Prevention of infection in burns
Sodium chloride 10 ml/ 5ml (Saline Wash) Sterile solution for cuts and wounds
Ventolin inhaler Relief of acute asthma attack
White Bandages Securing dressing

Note
Stethoscope and blood pressure cuff will be loaded in the First Aid Pouch at
the L2 location on all the aircrafts.



First Aid Kit (FAK)

The First Aid Kit provides equipment and medication for
cabin crew to use in addition to the First Aid Pouch (FAP)
when dealing with First Response situations. It meets with
all regulatory requirements.

Location:
Refer to appropriate Aircraft type safety and Emergency Procedures sub section

Pre-flight check:
Available in correct location
Sealed with one blue seal (intact)

When conducting pre-flight checks, missing kits, extra kits or kits with discrepancies e.g.
missing or broken seals or incorrect seal colour must be reported immediately to the
Purser who will advise the Captain.

Procedure for use:
1. Cabin crew should first use items from the First Aid Pouch and if further items are
required to deal with a medical situation, the First Aid Kit may be opened.
2. Follow dosage guide for instruction on drug administration
3. The first kit nearest to the location of the medical incident should be opened and the
Purser/SFS must be informed.
4. Cabin crew can use all the equipment and medications available in the First Aid Kit.
5. The kit should never be left unsealed and unattended.
6. If it is necessary to open another kit for additional items/medications or for another
incident, the Purser/SFS will decide which kit to open.
7. The Captain must be informed if a FAK has been opened.

Procedure after use:
1. Reseal immediately after use with one yellow seal.
2. Return kit to the correct stowage.
3. Complete the following paperwork:
Cabin Defect Log Book entry
Medical Incident Report Form (with supporting KIS report)
The First Aid Kits are maintained on board by Engineering Department.



List of contents

White pouch

Medication Use
Antacid Tablets (Moxal) Relief of heart burn and indigestion
Antibiotic Ointment (Baneocin) For small cuts, wound and burns.
Buscopan Tablets (Antispasmodic) For abdominal pain and renal colic.
Stugeron tablets For motion sickness
Eye drops e.g. Antistin Privin, Spersallerg For red, sore and slightly infected eyes.
Imodium capsules Diarrhoea
Nasal spray e.g. Otrivin, Xylolin For nasal congestion
Paracetamol Drops (Adol Drops) Pain, fever in infants and young children
Paracetamol Tablets (Panadol) For relief of pain and fever
Silvadiazine cream Prevention of infection in burns
Dispiril Soluble Aspirin 300 mg/
Jusprin 300mgs Soluble/Enteric Coated
Suspected heart attack
Ventolin/ Asthavent inhaler Relief of acute asthma attack

Red pouch:

Item Use
Alcohol Swabs Antiseptic Wipes
Band Aid Strips Water proof dressing for small cuts
Burn Dressing (Hydrogel/Waterjel/
Burnshield)
Sterile dressing for burns
Crepe/Cream Bandage Sprains and Strains support
Mask Sterile procedures, baby delivery
Melolin Dressing Sterile dressing for wounds and burns.
Micropore Tape Securing dressing and bandages
Safety Pins Securing bandages
Scissors To cut dressing and bandages
Steri-Strips Paper stitch for wound closure
Surgical Dressing Sterile dressing for wound and burns
Triangular Bandages To use as a support or a tourniquet
White Bandage Securing dressing to wounds



Green pouch

Item Use
Laerdal Pocket Mask Rescue breathing and CPR
Fever scan Thermometer Monitor temperature
Disposable Apron First response procedures, baby delivery
Eye Pad Eye Dressing

Lid pocket
Item Use
Biohazard Bag Disposal of soiled/ blood stained dressing
Content List List of contents
Dosage Guide Dosage guide
Seals For resealing FAK

Perimeter

Item Use
First Aid Handbook First Response Manual
Instant Cold Pack Sprains and Strains
Non Sterile Exam Gloves First Response procedures
Sam Splint Immobilization of fractures and dislocation
Sterile Gloves size 7 Sterile procedures, baby delivery



Emergency Medical Kit (EMK)

Emergency Medical Kits (EMK) are provided on board all
Emirates Aircraft. The EMK provides equipment and
medication for the treatment of serious medical
conditions on board. It contains medication and
equipment for use by Medical Professionals and by
Cabin Crew under the direction of Medlink. It meets with
all regulatory requirements.

Location:

Refer to appropriate Aircraft type Safety and Emergency Procedures sub section.

Pre-flight check

Sealed with two blue seals (intact)

When conducting pre-flight checks, missing kits, extra kits or kits with discrepancies e.g.
missing or broken seals or incorrect seal colour must be reported immediately to the
Purser who will advise the Captain.

Procedure for Use

1. EMK must be opened with the captains permission
2. Cabin Crew can open the EMK in extreme medical emergencies, e.g. use of
Epipen, attend to the situation and inform the Captain as soon as possible.. In any
event, use your discretion in liaison with the Medlink/Medical Professional when
opening the Kit.
3. Follow the dosage guide provided inside the kit for dosage and administration of
medications.
4. In the event of serious illness, Cabin Crew may be ordered by Medlink to give the
following medications that would normally be given by medical professional:

5. If there is any doubt as to the casualty's condition or the crew members familiarity
with a drug, then under no circumstances should a drug be administered.
6. Medlink would not normally instruct cabin crew to administer standard injections
(unless qualified to do so), with the exception of the Epipen which is designed
specifically for non medical professionals.
Isordil Tramal Stemetil
Nitrolingual
Spray/Glytrin
Xanax Glucogel Gel or Instaglucose or Hypostop Gel
Epipen Telfast Chlorohistol


7. Cabin Crew are not permitted to use any medication or injections that are not in on
board kits e.g. medicines offered by passenger themselves or other passengers
on the flight or their own personal medications. .
8. Only Medical PROFESSIONALS may use the medications contained in the sealed
sections of the EMK.
9. Any medications given from the EMK must be properly recorded on the EMK Drug
Usage Form contained inside the kit.
10. Crew must not open the EMK to familiarize themselves with the contents. It is for
emergency use only.


1. Reseal immediately after use with two yellow seals.
2. If the drug compartment or the red controlled drug pouch are opened, they must also
be re-sealed with yellow seals.
3. Opening and closing seal numbers used must be recorded on all relevant documents
4. Return kit to the correct stowage.
EMK Drug Usage Form (refer to page 32 for a sample of the form) It must be
completed each time the EMK is opened regardless whether medication is used or
not. For procedure on the use of the Drug Usage Form, refer to sub section 201
page 15.
Medical Incident Report Form (with Supporting KIS report)
6. The Emergency Medical Kits are maintained on-board by Engineering Department.



EMK Layout and List of Contents

Medications that can be administered by cabin crew

Medication Preparation Location in EMK Uses and actions of medication
Soluble Aspirin 300 mgs
(Dispril/ Jusprin)
Or
Jusprin tablets 300 mg
(enteric coated)
Tablets (12) Lid compartment box 1 Suspected heart attack

Items that can be used by cabin crew

Item Location in EMK Uses
Mortality kit Base compartment
Feverscan Thermometer (1) Lid compartment box 1 Monitor Temperature
Delivery kit Mucous Extractor (1) Lid compartment perimeter To clear airways of new born baby
Sterile Scissors (1) Lid compartment perimeter To cut umbilical cord - delivery.
Umbilical Cord Clamps (4) Lid compartment perimeter Clamp umbilical cord - delivery.
Scissors (1) Lid compartment perimeter To cut dressings/bandages
Sharps Box Lid compartment perimeter For safe disposal of used needles & syringes
Yellow Bio-Hazard Bag (1) Lid flap Disposal of soiled/blood stained dressings



Medications that are to be administered by Medical Professional only
Medication Preparation Location in EMK Uses and actions of medication
Sodium Chloride 0.9% 500 ml (2) I.V. solution Base compartment I.V Fluid
Xanax Tablets
Lid compartment red
pouch.
Short acting sedative - for anxiety , panic attack
Stemetil 5 mg (10) Tablets Lid compartment box 1 Acute Nausea, Vomiting or Vertigo
Glucogel Gel or Instaglucose or
Hypostop Gel (3 doses)
Gel
Lid compartment box 1
Low blood sugar, Hypoglycaemia
Isordil (Isosorbide Dinitrate) (4) Tablets Lid compartment box 1 Angina, congestive heart failure
Nitrolingual Spray (Glyceryl Trinitrate)
(1)
Pocket Aerosol
Lid compartment box 1
Prompt relief of acute Angina Pain
Telfast 180 mg (15) Tablet Lid compartment box 1 Adult Antihistamine for relief of mild allergic reactions
Chlorohistol Syrup Lid compartment
perimeter
Pediatric antihistamine for relief of mild allergic reactions
Delivery kit Syntometrine (2) Amp/Inj
Lid compartment
perimeter
3rd stage of Labour, post partum haemorrhage.
Tramal Capsules
Lid compartment red
pouch
Moderate /Severe Pain
Epipen Adrenaline (Epinephrine) Auto Injector Lid compartment
perimeter
Anaphylactic shock/Allergic reaction
Adrenaline (Epinephrine)1/1000 (2) Amp/Inj 1 ml Tray 1 A Cardiac Arrest, Anaphylactic Shock
Atropine (2) Amp/Inj Tray 1 A Symptomatic Bradycardia, Acute Arrhythmias after Myocardial
Infarction
Benzyl Penicillin (1) Amp/Inj Tray 1 A Suspected cases of Meningococcal Meningitis
Buscopan (Hysocine) (2) Amp/Inj Tray 1 A Acute abdominal pain and renal colic
Decadron (Dexamethasone ) (2) Amp/Inj
Tray 1 A Allergic reactions, Shock, Severe Bronchospasm, Severe
Asthma Attack.
Diazemuls (Diazepam) (2) Amp/Inj Tray 1 A Anxiety, epilepsy, convulsions, sedation
Digoxinn (Lanoxin) (2) Amp/Inj Tray 1 A Atrial Fibrillation, Supraventricular Arrhythmias.
Frusemide (Lasix) (3) Amp/Inj Tray 1 A Severe fluid retention, Heart Failure, Oedema, Oliguria.
Glucagon (1) Powder/solvent Tray 1 A Acute/Severe Hypoglycaemia
Lignocain 2% (1) Vial Inj Tray 1 A Ventricular arrhythmia


Maxalon (Metoclopramide) (2) Amp/Inj Tray 1 A Vomiting, Nausea
Narcan (4) Amp/Inj Tray 1 A Antidote for Opioid overdosage
Tramadol 100mg/2ml (Zydol) (2) Amp/inj Tray 1 A Moderate or severe acute pain e.g. Fracture
Phenergan (Promethazine) (2) Amp/Inj Tray 1 A Allergic reactions, anaphylactic responses
Ventolin (Salbutamol) (1) Amp /Inj Tray 1 A Severe Asthma and Bronchospasm
Water for Injection (2) Amp/inj Tray 1 A Water for injection
Adrenaline (Epinephrine)1/10000
(8)
Pre-filled inj 10ml Tray 2 B Cardiac Arrest, Anaphylactic Shock
Glucose 50% (1) Prefilled Inj Tray 2 B Hypoglycaemia, Fluid Replacement
Lignocaine 2% (2) Prefilled Inj Tray 2 B Ventricular arrhythmia
Sodium Chloride 0.9% 10ml (2) Amp/Inj Tray 2 B Diluent for other I.V. medications

Items that are to be used by Medical Professional only
Item Location in EMK Uses
Catheter Female (2) Base compartment Relief of urinary retention.
Catheter Male (2) Base compartment Relief of urinary retention.
I.V. Solution Giving Set Base compartment To Administer I.V fluids
K Y jelly Base compartment Lubricant
Suture pack (1) Base compartment Closing and suturing deep wounds and lacerations
Urine Drainage Bag (1) Base compartment To collect retained urine
Delivery Kit Spencer Wells Artery Forceps (2) Lid compartment perimeter For professionals to clamp umbilical cord-Delivery
Oropharyngeal Airway adult, child and baby 1 Each Lid compartment perimeter Maintain open airway
Pen Torch (1) Lid compartment perimeter Examination purposes.
Sphygmomanometer (Blood pressure cuff) (1) Lid compartment perimeter To monitor blood pressure.
Stethoscope (1) Lid compartment perimeter Examination purposes.
Tourniquet
Lid compartment perimeter To administer I.V injections, To control life threatening
bleeding.



Can be used by cabin crew in life threatening
bleeding.
Sterile Surgical Gloves (2) Lid flap Sterile procedures, baby delivery.
I.V cannulation pack Tray 1 A Injection, administration of IV fluid
Syringe pack (1) Tray 1 A Giving injections.
Glucometer (1) Lid Compartment Perimeter To measure blood sugar level







BOX 1

Aspirin (Jusprin/ Dispril) tablets
300mg (12)
Feverscan Thermometer
Telfast Tablets 180mg (15)
Glucogel Gel/ Instaglucose or
Hypostop Gel (3 doses)
Isordil Tablets 5mg (4)
Nitrolingual Spray/Glytrin
Stemetil 5 mg (10)




Lid Flap Rev B EMK




Rev B Base Compartment Tray 1A Rev B Base Compartment Tray 2B



Rev B Base compartment

Refer to Sub section 207 page 16 and 17 for procedure on presumed death on board

Mortality Kit
contents:

Body bag

Under pad

Jaw strap

Toe tag (for Medical Professional on the
ground)



LIST OF MEDICATION AND DOSAGE GUIDE

Condition Medication Location Who can use Dose Side
Effects/Precautions
Abdominal pain and
renal colic
Buscopan injection

EMK Medical
Professional
20 mg intramuscular or slow
intravenous injection
Dry mouth, dilated pupils.
Abdominal pain and
renal colic.
Buscopan Tablet FAK Cabin Crew Adults and children over 6
years: One to two tablets
swallowed whole 3-5 times daily

Allergic reactions Adrenaline 1:1,000 EMK Medical
Professional
Intramuscular injection High Blood Pressure
Use with extreme caution
Allergic reactions

Chlorohistol syrup
Antihistamine syrup
EMK

Medical
Professional
Cabin Crew on the
advice of Medlink
Children 6-12 yrs: 1-2 tsp 3
times
a day
children 1-6 yrs: -1 tsp 3 times
a day
infants up to 1 yr: tsp twice
daily or as directed by the doctor
May cause drowsiness
Allergic reactions

Decadron injection EMK Medical
Professional
2ml intramuscular or slow
Short term use, no side
effects.
Allergic reactions Epipen Adrenaline
(Epinephrine)
EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Adults & Children > 30 kg High Blood Pressure




Condition Medication Location Who can use Dose Side Effects/Precautions
Allergic reactions

Phenergan injection EMK Medical
Professional
Deep intramuscular injection
or slow intravenous injection
adults: 25-50mg; max 100 mg
child 5-10 yrs: 6.25-12.5 mg
Drowsiness.
See EMK Medication
Insert
Allergic reactions

Telfast 180 mg
(Fexofeadine HCL)
Antihistmine
EMK

Medical
Professional
Cabin Crew on the
advice of Medlink
For use in adults and children
above 12 yrs only
Take one tablet once daily
Not to be given to children
below 12 yrs of age.
Angina Isordil EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Place one or two tabs under the
tongue. Repeat after 2 hours if
necessary
drop in Blood Pressure,
headache, flushing of face
Angina Nitrolingual/Glytrin Spray

EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Spray one or two doses under
the tongue.
Drop in Blood Pressure,
headache, flushing of
Face
Antidote for opioid
overdosage
Narcan injection 0.4 mg
(nalaxone Hydrochloride)
EMK

Medical
Professional
For IV & IM use
IV Adult: 0.4mg 2mg repeated
at intervals of 2 3 minutes to a
max of 10mg if respiratory
function does not improve.
IV Child: 10mcg/kg. subsequent
dose of 100mcg/kg if no
response.
IM Adult & child dose as for IV
inj. (use as IM inj only if IV route
not possible)
Short acting
Cardiac Irritability



Anxiety, convulsions, Valium (Diazemuls)
injection
EMK Medical
Professional
5-10 mgs intramuscular or slow
intravenous Injection.

Drowsiness, confusion
Anxiety, panic attack Xanax 0.5mg
(Alprazolam)
EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Initially 1 or 2 tablets
(swallowed whole). Repeat after
6 hours if necessary
Not to be given with
alcohol
Not for children under 16
years.
Not to be given if severe
liver disease is known to
be present.
Not to be given during
pregnancy
Arrhythmias Atropine injection EMK Medical
Professional
300mcg Intravenous injection
increase to 1mg if necessary.

Tachycardia
Arrhythmias Lignocaine 2% EMK Medical
Professional
100mgs bolus followed by
infusion 2-4mgs/minute
Heart Block
Arrhythmias. Digoxin
(Lanoxin)
EMK Medical
Professional
Intravenous infusion Preferably
See EMK Medication Insert
Bradycardia, Complete
Heart Block Do not use if
recent myocardial
infarction.



Effects/Precautions
Asthma Ventolin inhaler FAK
FAP
Cabin Crew Adults: 2 puffs every 4-6 hrs
Children: 1-2 puffs. Every 6-8
hrs
Headache, Mild tremor
Only to administer to a
casualty with history of
asthma

Asthma Ventolin injection EMK Medical
Professional
500mcg subcutaneous or
intramuscular every 4 hours if
necessary. Slow Intravenous
Injection 250mcg

Tachycardia,
High Blood Pressure
Burns Silvadiazine FAK
FAP

Cabin Crew Apply as required
Cardiac Arrest

Adrenaline (Epinephrine)
Injection 1:10,000

EMK Medical
Professional
Intravenous injection

High Blood Pressure
Use with extreme caution



Childbirth Syntometrine injection

EMK Medical
Professional
10mgs intramuscular injection. Nausea, vomiting, transient
rise in Blood Pressure
Diarrhoea Imodium FAK Cabin Crew Adult, child >12yrs: 2 caps
initially then 1 caps after each
loose stool
Not more than 8 in 24hrs
child 9-12 yrs: 1 caps every 6 hrs
Drowsiness
Not for children under 9 yrs
Do not administer unless
casualty has more than one
episode of Diarrhoea.
Eye irritation Antistin Privin or
Spersallerg
FAK
FAP

Cabin Crew Put ONE or TWO drops into the
affected eyes. May be repeated
up to 4 times in 24 hours.
Discard after single use. DO
NOT use for bad infection or if
foreign body is present.
Remove contact lenses
before use.
Fluid replacement,
Hypoglycaemia

Glucose 50% EMK Medical
Professional
Intravenous injection N/A
Fluid retention, Lasix (Frusemide) EMK Medical
Professional
20-40mg intramuscular or slow
Nausea, drop in Blood
Pressure, electrolyte
imbalance.

Heart Attack
(Suspected)
Aspirin Tablets 300mgs
(Acetylsalicylic)
(Dispril/Jusprin soluble or
Jusprin enteric coated.
EMK
FAK
Cabin Crew Soluble:One Tablet to be
dissolved in half
glass of water.
Enteric Coated: taken with water
May be repeated after 4-6 hours
if necessary
To be given as a single dose

Not to be given to children
below 12 yrs of age
Not to be given if history of
peptic ulcer, vomiting of blood
or allergy to Aspirin



Effects/Precautions
Heart burn and
indigestion
Antacid Tablets
(Moxal, Maalox,
gastrogel)
FAK
FAP
Cabin Crew Adults and children over 12
years: two tablets to be chewed
20 60 minutes after food. Can
be repeated if necessary

Do not use for patients
with renal failure.
I.V. Fluid Sodium Chloride 0.9%
250 ml I.V. solution.
EMK Medical
Professional
As required

None Known
Low blood sugar
(Hypoglycaemia)
Glucagen injection EMK Medical
Professional
subcutaneous, intramuscular or

Nausea, vomiting
Low blood sugar
(Hypoglycaemia)

Glucogel Gel or
Instaglucose or
Hypostop Gel
EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Administer orally 1 full tube. Vomiting.
Only for use During
Hypoglycaemia



Condition Medication Location Who can
use
Dose Side Effects/Precautions
Meningococcal
meningitis
Benzyl Penicillin1.2 IU
IM injection
(Antibiotic)
EMK
Mark 2
only
Medical
Professional
Intramuscular injection or
slow
IV infusion.
Adult: single dose of 1.2 gm
Children 1-9 yrs: 600mg
Infants under 1 yr 3oo mg
This is the initial dose only and urgent referral
to medical facility is required. Contraindicated if
true penicillin allergy
Moderate/severe
pain
Tramal 50 mg
capsules
(Tramadol
Hydrochloride)
EMK Medical
Professional
Cabin Crew
on the
advice of
Medlink
Initially 1or 2 tablets
(swallowed whole), then 1
tablet after 6 hours if
necessary. Not more than 6
tablets in 24 hours.

Not for children under 12 years.
Not to be given if liver disease or head injuries
known to be present.
Not to be given during pregnancy or if breast
feeding.
Use with care if breathing difficulties present.
Can cause dizziness and nausea
Moderate/severe
pain
Tramadol Injection EMK Medical
Professional
Adults & Children over 12
yrs.
By IM or IV (dilute in 0.9%
sodium chloride & give over
2-3 minutes).
50mg to 100mg every 4 to
6hrs.(to a maximum of
400mg daily)

Not recommended for children under 12 yrs
Caution : hypotension, asthma (avoid during
attack), decreased respiratory reserve,
Pregnancy & Lactation, Enlarged prostrate,
liver or kidney disease, epilepsy or other
convulsive disorders.
Contra-indication: avoid in individuals with
known sensitivity to Tramadol or Opiates. Avoid
use in conjunction with alcohol, hypnotics,
analgesics, opiods or other psychotropic drugs.
Avoid use in people with opoid




use in people with opoid
dependence or who have taken
MAO inhibitors in the last 14 days.
Avoid in acute respiratory
depression, where there is risk of
paralytic ileus, cases where there is
raised intracranial pressure or head
injury, pheochromocytoma.
Side effects: Anaphylaxis, Nausea
& Vomiting, dizziness, constipation,
drowsiness, hypotension,
respiratory depression, dry mouth,
sweating, headache, facial flushing,
vertigo, urinary retention,
palpitations, hallucinations,
confusion.
Nasal congestion Otrivin or Xylolin FAK
FAP

Cabin Crew Spray 1 or 2 puffs into each
nostril. Repeat after 8 hrs if
necessary
Not for children under 12 years,
during pregnancy and if taking
medication for high blood pressure.



pain and fever Paracetamol Tablet
500 mg (Panadol)
FAK
FAP
Cabin Crew Adults: Two tablets up to four
times (not more than 8 tablets
in
24 hours) 6-12 Years: Half to
One tablet up to four times.
(Not more than 4 tablets in 24
hrs).
Should be used with
caution in case of severe
liver or kidney damage. Do
not take if allergic to
Paracetamol.
Pain, fever in infants
and children
Adol Drops
(Paracetamol)
FAK Cabin Crew Follow dosage instructions
provided with the medication

Warning: do not exceed the
stated dose.
Not to be used if known liver
or kidney disease and if
allergic to Paracetamol
Pain/fever in infants
and children
Calpol syrup
(Paracetamol)/Adol
suspension

FAP Cabin Crew Follow dosage instructions
provided with the medication
.
Does not contain aspirin.
Warning: do not exceed the
stated dose.
Not to be used if known liver
or kidney disease. Not to be
used if allergic to
Paracetamol




Small cuts, wounds
and burns
Baneocin (Antibiotic
Ointment)
FAK Cabin Crew Adults and children. Apply two to
three times daily.
Should used with caution
in pregnant and lactating
mothers.
Do not use if allergic to
bacitracin/neomycin
Do not apply to the eyes.
Travel sickness Stugeron (cinnarizine) FAK Cabin Crew Adults: 1 tab every 8 hours
Children 5-12yrs: Half tab every
8 hours if necessary
Drowsiness, dry mouth
Not for children under 5
yrs, pregnant ladies,
passengers
who have consumed
alcohol, flights less than 4
hours,
check for allergies




Vomiting, nausea Stemetil 5 mg EMK Medical
Professional
Cabin Crew on the
advice of Medlink
Adults, children >12 yrs:
One tablet placed high up
along the top gum under the
upper lip and allow it to
dissolve slowly.
May repeat 6 hourly. Do not
exceed 4 tabs in 24 hours
Do not give if history of
cardiac or kidney
conditions.
Do not give during
pregnancy or to children
under 12 yrs
Vomiting, Nausea

Maxalon injection
(Metoclopramide)
EMK Medical
Professional
5-10mg intramuscular or
slow
intravenous
Drowsiness, restlessness
Water for injection WFI (Water for Injection) EMK Medical
Professional
Use as required None known



Supplementary Emergency Medical Kit (SEMK)

The Supplementary Emergency Medical Kit (SEMK) contains
additional equipment which will assist cabin crew and medical
professionals in medical situations for example Cardio Pulmonary
Resuscitation (CPR), respiratory (breathing) disorders and
general medical management

Location:
Refer to appropriate Aircraft type Safety and mergency Procedures sub-section.

Pre-flight check:

1. The Purser/SFS and the Captain must be informed in the SEMK has been opened
2. The SEMK contains 5 items which can be used to assist in the management of on-
board medical situations.

Procedure for closing
2. Return kit to the correct stowage

Contents:
The SEMK contains five items which are described below:

1. Finger Pulse Oximeter for cabin crew and medical professional use when dealing
with medical situations.
There are different types that you may see onboard- example include one of the
following:

On button (should be pressed
prior to use)

Nonin Onyx Nonin GO
2
Zondan



Description:
The oximeter is a portable device for monitoring the oxygen saturation (in percentage)
and pulse rate (in beats per minute) of adults and children. The onyx is not
recommended where motion is expected, or for relatively long term monitoring e.g.
greater than 30 minutes as the onyx has no audible alarms.

Normal Oxygen saturation levels on the ground are between 98-100%. At Cabin
altitude, oxygen saturation levels can be lower than this, particularly if the passenger
is unwell. If it is below 90%, it is advisable to give the casualty supplementary oxygen
on high flow and call Medlink. In any event, where the casualty is experiencing
difficulty with breathing, administer oxygen regardless of the oxygen saturation.

Activating the Onyx
Activate by inserting the patients finger into the oximeter as shown in Figure 1(The
Onyx determines that a finger has been inserted and then automatically activates the
display).

Applying the Onyx (refer to figure 1)
1. Remove paper tab which states Pull to Connect.
2. Insert the patients finger in the onyx as shown above
until the fingertip touches the built-in stop guide.
3. Verify operation.

Note: Zondan finger pulse oximeter must be turned on prior to its use (button is
located in front of the device).

After completing this sequence, the Onyx begins sensing the pulse (indicated by the
blinking perfusion display). Also the oxygen level in the blood will be displayed. O
2
level
should be above 90%. Pulse rate should be within normal limits

Note:
The Onyx performs best when used on fingers other than the thumb. If Onyx does
not turn on, remove finger and wait two seconds before reinserting finger again.
Dark nail polish or acrylic nails may result in inaccurate readings. If possible remove
nail polish; If not, advice Medlink
Do not use the Onyx on infants or babies.
The Pulse Oximeter device is reusable and must be returned to the SEMK after use.
Onyx - Finger Pulse Oximeter
figure1.


2. E-Z Spacer (for cabin crew and medical professional use)

Using the Spacer:
1. Pull up the handle and turn it anti-clockwise to inflate the bag. Push the bar in front of
the handle to extend the mouthpiece.
2. Remove the Ventolin/ Asthavent canister from the inhaler, shake it and insert its nozzle
into hole next to handle.
3. Place your index and middle finger under either sides of the handle and your thumb on
top of the canister. Press the canister down to release one dose of the medication.
4. Instruct the casualty to breathe out, and place his/her lips around the mouth piece.
5. Advise the casualty to breathe in until the bag collapses, and to hold their breath for 5
to 10 seconds before breathing out slowly.
6. P ull down the bag to re-inflate the bag and repeat step 4. This is to make sure that all
medicine has been breathed in from the E-Z Spacer.

Handle
Mouthpiece
Parts of the EZ Spacer
Figure 2
The E-Z spacer is a collapsible drug delivery
system for use with Ventolin/ Asthavent inhaler.

It allows smaller particles of Ventolin/
Asthavent to enter into the lungs.
Bar


3. Oxygen Tubing (for cabin crew and medical professional use)

The oxygen tubing with an attached metal
connector, is used to connect the pocket mask
to the portable oxygen bottle to provide
supplementary oxygen during rescue breathing.

Using the Oxygen Tubing
1. Connect the tubing the oxygen bottle on high
flow.
2. Connect the other end of the tubing to the
pocket mask.
3. Turn on oxygen and adhere to safety
precations with the use of oxygen.

4. Ambu Bag (Adult) (For Medical Professional Use only)

Description:
Only medical professionals can use this for
Rescue Breathing during CPR &
Defibrillation. It should be connected to the
onboard oxygen bottle using the oxygen
tubing to provide supplementary oxygen. All
safety precautions for the administration of
oxygen should be adhered to.

5. Suction Machine (Vitalograph Aspirator) (For Medical Professional Use only)

Only medical professionals use this
aspirator to clear vomit, excessive saliva or
blood, from the mouths and airways of
casualties during resuscitation.

Oxygen Tubing
Figure 3
Application of the Ambu Bag
Figure 4
Suction Machine
Figure 5
Metal connector


The Universal Precaution Kit (UPK)

The Universal Precaution Kit (UPK) contains protective
equipment for use when dealing with cases of suspected
communicable disease on-board. It can also be used when
dealing with blood or any other bodily fluid and when handling
medical waste.
(Medical waste is waste that is generated from sick or ill
customers and should be handled with appropriate precautions
to prevent the spread of disease and infection)

Location:
Next to the EMK on aircraft types-refer to appropriate aircraft type safety and
emergency procedures sub-section.

Pre-flight check:

Procedure for use:
1. The kit is used in any case of suspected communicable disease on-board the aircraft
or when dealing with blood or bodily fluid or excretions, for example vomit, urine or
saliva.
2. Inform Purser/SFS and the Captain if the UPK has been opened
3. For specific information and procedures on how to manage a suspected case of a
communicable disease, please refer to sub section 210 page 5.

2. return kit to the correct stowage
Medical Incident report Form (with supporting KIS report)

Contents:
Instructions
Gloves- 25 pairs
N95 masks-20 sets
Alcohol based disinfectant hand rub- 2 bottles of Dial
Disinfectant antiseptic surface wipes- 10 individual sachets
Biohazard Bag- 1 packed with seal
Disposable thermometer-1 (Fever scan)
Yellow seal - 2
One pair of goggles




Contents Of The Universal Precaution Kit (UPK)



EMERGENCY MEDICAL KIT
DRUG USAGE FORM
QUICK REFERENCE GUIDE
Flight Information
(All fields are mandatory)
Date: 18/02/2012
Sector: DXB-BLR
Flight no.: 566
Aircraft Reg no: A6-
EAD
Captains Authority Name: Cpt.Ahmed Syed
Captains Staff
no: s123456
Purser/SFS Name : G.Greene Staff no: s121346
Medical Incident Report Form reference number: 61532
Passenger Name : Mr. J O Neill
Doctor Name : Dr.M.Branson
EMK Information
(All fields are mandatory)
EMK Case no: 172 Opening seal no: Closing seal
1. G 123541 1. G 128451
EMK Case seal no:
2. G 128452 2. G 129452
Red controlled drugs pouch seal no. 1. G 123521 1. G 129451
Medications/ Equipment Used
All medications/equipment used must be recorded (Please tick appropriately and mention the
quantityused)
Tick Controlled Medications: Quantity Used:
Tramal 50 mg (Tramadol Hcl) Tablets 2 Tablets
Stemitil 5mg (Prochlorperazine) Tablets

Xanax 0.5 mg (Alprazolam ) Tablets
Diazepam 10mg/2ml (Diazemuls) Amps (Medical use only)

Zydol 100mg / 2ml (Tramadol ) Amps (Medical use only) 1 Ampule
Other medication/equipment used: Quantity Used:
Eg: Sharps container 1
Needle and syringe 1

Use block capital letters
when completing the form
Place a line through any lines not
used in the free text area.
Record opening and closing
seal numbers accurately


Effective Date:




The Automatic External Defibrillator (AED)

Emirates aircraft carry forerunner2 (FR2) Defibrillator. The AED will be operated by the
SFS or Purser immediately in the event of a Cardiac Arrest to help revert the abnormal
heart rhythm of ventricular fibrillation. The AED will be operated in conjunction with CPR
to increase the casualtys chances of survival. Research shows that if CPR +
Defibrillation are started within the first 90 seconds of an incident, the chance of survival
can be as high as 90%. CPR alone only carries a 2% survival rate. This highlights the
need for immediate defibrillation. Once CPR is in progress and the AED has been called
for, the Captain should be informed immediately and contact the in-flight medical
emergency assistance Medlink.

The 2010 American Heart resuscitation guidelines now advise that, in the absence of
special paediatric pads, it is acceptable to use the adult pads using the FR2 AED on
children over 1 yr and adults including pregnant ladies.

Location: The AED is located in the same stowage as the E.M.K. on both B777 and
Airbus aircraft.

Pre-flight checks for the FR2 AED

1. Available in the correct location
2. Status indicator flashes from a black
square to a black hour glass
3. Pads and spare pads are loaded with
machine
4. Razor

5. Blunt-tipped scissors

Battery Insertion Test
A battery insertions test (B.I.T) must be done only if status indicator displays red X,
flashing red or a plain black square in the status indicator or if a chirping sound

is audible from the AED.

The B.I.T. is an automatic self-test which tests the entire AED including the battery, to
assess its readiness for use. To perform the B.I.T test, unclick the battery and reinsert
the same battery. The AED will interact with you while the test is running and it only
takes a few minutes. If it fails the test, contact engineering for a replacement. The AED
is not a no go item.

Note: Under no circumstances should a SCCM assign the pre-flight check to a
cabin crew who has not completed the Defibrillation course. This is dangerous
and could have serious consequences for both the casualty and the individual
operator.






Defibrillation safety

The AED is a very easy device to operate, however, in the interest of safety not only to
the casualty, but also to you as the operator, other individuals assisting, and the aircraft,
the following should be observed. The AED delivers each shock at 150 joules and is
biphasic in delivery (delivers shock in both directions through the heart).

1. Avoid spills from tea, coffee, alcohol etc. on the machine.
2. The area surrounding the casualty should be dry.
3. Prepare the chest as quickly as possible:
If the chest is moist or wet from perspiration, quickly wipe with immediately
available material (could even be casualtys clothing) before applying pads.
In males, if excessive hair is present, dry shave the area where the pads will be
applied.
Under wire bra and jewelry must be removed from the casualtys chest area to
avoid burns.
If the casualty has a GTN patch on the chest, remove the patch (with gloves on if
possible). A GTN patch is a medicinal patch for heart conditions like angina.
The AED can be used for a casualty with a pace-maker, which can be felt as a
small box under the casualtys skin. Do not place the pad directly on top of the
pace-maker box. Place this pad to the side of the pace maker.
4. Apply pads firmly to the correct position to prevent any risks of sparking.
5. Ensure that all persons assisting in the incident are clear of the casualty - Visually
and verbally confirm All Clear.
6. Oxygen bottles and pocket masks should be moved away from the casualty during
shock delivery.
7. Do not touch the casualty during defibrillation since you may also receive a shock

Procedure for Use

Conscious casualty
Where a casualty presents with chest pain, either angina or suspected heart attack, and
there are concerns about his/her condition, keep the AED and other medical kits and
pocket masks on standby. Consider the possibility of the casualty going into cardiac arrest,
perhaps move the casualty via wheelchair to a seat which is easily accessible in the event
that he or she collapses.

Medlink and/or an on-board medical professional may advise the crew to use the AED as
a monitor. In this situation it is vital that thorough and calm explanations are provided to
the casualty and accompanying relatives/friends.

Without the advice of Medlink and/or an on board medical professional, SCCMs
trained in the use of the AED are ONLY permitted to apply it to a casualty who is
unconscious.

Note: This above procedure is to reduce the anxiety and risks associated with
applying the AED to a conscious casualty.


Unconscious casualty
1. Turn on the AED by pressing the green ON/OFF button.
2. Listen to the instructions prompted by the AED.
3. Apply pads firmly in the correct position to the casualtys chest. Ensure to adhere
to all the safety measures. Press the pads firmly to the chest to smooth out any air
pocket formation. CPR should not be interrupted for pad placement , but if the
hand of the crew doing CPR is in the way, then crew can be asked to remove their
hands briefly while applying the pads (however, ensure to tell crew to resume CPR
immediately).

4. Plug in co
5. The AED w
6. The AED

If
shock is
advised, give a clear, assertive command STAND CLEAR, ALL CLEAR using hand
signals while visually ensuring everyone is clear. Press the illuminating orange shock
button as prompted by the machine. Following the shock delivery, listen carefully to the
voice prompts from the AED and follow its instructions.

If no shock is advised, listen carefully to the voice prompts from the AED and follow its
instructions.

There is no limit to the amount of shocks delivered. Follow normal guidelines of
diversion or no diversion.

Do not remove the pads even if the casualty regains consciousness, as there is a high
risk of the casualty going into a cardiac arrest.
Adult Pad location

Child Pad location



Defibrillator Troubleshooting

While using the Defibrillator you may experience some minor problems, do not panic,
just follow the prompts as directed by the machine. Listen for verbal prompts and look at
the screen for visual prompts.

Press pads firmly to patients bare chest prompt

Check:
Pads are attached firmly to the chest
Pads are placed in the correct location
Is there excessive moisture or excessive hair on the chest?
Connector and wires
If the problem cannot be solved after doing the checks, replace the pads.

Analysing Interrupted Prompt

Analysing may be interrupted for the following reasons
Passenger Motion? for example - C.P.R
Stop movement, do not touch the patient
Electrical or Radio Interference? For example from the video compartment Keep
radio and cellular phone's 6 feet or 2 metres away.
Transport of the passenger: While transporting the person, for example
transporting the passenger from the aircraft to the lift mobile

The machine will keep reanalysing every 15 seconds until the problem has been
resolved.

Low Battery Prompt
A low battery can be used for 9 shocks or 15 minutes monitoring,
Continue using AED until battery is exhausted
Inform Medlink of AED situation (low battery)
Continue CPR

No Shock Delivered Prompt (after pressing illuminated orange button)

Check pads contact and placement
Check pads and connector for damage
Check wires
If the problem cannot be solved after doing the checks, replace the pads.



Documentation

Documentation for completion should include:

Medical Incident Report Form.
The Blue Data Card
Cabin Log Entry

The Blue Data Card should be removed from the machine after use and sent to EK
clinic with the documentation. Ensure that the AED is switched off before removing the
data card.

Once the Blue Data Card is removed, return the empty tray to the machine.

If the Defibrillator has been used earlier and the blue data card removed, the Defib can
still be used and the incident will be recorded in the Defib machine. In this case the
entire Defib machine would be sent with the documentation, to Senior Vice President
Medical Services.

NOTE: the SCCM should check the defibrillator is in its location before leaving
the aircraft to ensure no theft has occurred.



Medical Oxygen

Portable Oxygen Concentrator Units
The UAE GCAA has approved the carriage of Portable Oxygen Concentrator (POC) Units on all
Emirates aircrafts. These devices address the needs of passengers who must travel with medical
oxygen.
An oxygen concentrator is a device that takes air from the atmosphere, separates the
nitrogen out of the air and delivers 90% - 94% pure oxygen into a product tank that is
then fed through the outlet nozzle to the person needing oxygen.

Effective August 2010, a total of 12 POC models have been approved for use on board
all EK aircrafts. These models are not hazardous materials as a result of meeting the
applicable safety standards:

These units are permitted to be carried and used by passengers, subject to the
following conditions:
1. The passenger must carry a written statement, to be kept in that persons
possession, signed by a physician and made available to the Captain that:
States whether the user of the device has the physical and cognitive ability to
see, hear and understand the devices aural and visual cautions and warnings
States that the passenger is able to take the appropriate action in response to
those cautions without assistance unless accompanied by another passenger
who is able to fulfill those functions.
States whether or not oxygen use is medically necessary for all or portion of
the flight.
Specifies the maximum oxygen flow rate corresponding to the pressure in the
cabin of the aircraft under normal operating conditions.
2. Reservations will advise the passenger of the scheduled flight time and passenger
must carry sufficient number of batteries to power the device for the duration of
oxygen use specified in the physicians statement, including a conservative estimate
of any unanticipated delays.
Any additional batteries carried as carry-on luggage shall be packaged in a
manner that protects them from short circuit and carried in accordance with the
Dangerous Goods Regulations.
3. A portable oxygen concentrator is not permitted to be carried on board as carry-on
luggage if it not intended to be used during the flight.
4. A passenger using the POC is not permitted to sit in an exit row.
5. During taxi, take off and landing, the unit must be stowed under the seat in front of
the user (for Business and Economy class passengers) or in another approved
stowage location. For First class passengers on board the aircrafts that do not have
suites, the crew will secure the unit on a spare seat next to the passenger if the seat
is vacant; if not crew to use an extension seat belt around the unit so that is can be
secured on the floor next to the passenger. The unit must not block the aisle or the
entryway into a row and must not restrict any passengers access to, or use of, any
required emergency or regular exits, or the aisle of the passenger cabin.
6. When the Fasten Seat Belt sign has been turned off, the passenger may move
about the cabin and may operate the device whist doing so.



7. The passenger must be capable of hearing the units alarms, seeing the alarm light
indicators and have the cognitive ability to take appropriate action in response to
various caution and warning alarms, or be travelling with someone who is capable of
performing those functions.
8. The passenger must ensure that the unit is free of oil, grease or other petroleum
products and is in good condition, free from damage or other signs of excessive
wear or abuse.
9. The POC may not meet the passengers oxygen requirement at altitudes greater
than 8000 10000 feet. Therefore, the passenger must be briefed by cabin crew
that in the event of a decompression, he/ she must follow standard procedures and
put on the cabin drop-down oxygen mask.

Note: Cabin Crew are not expected to operate the units in anyway as they have
not received any training on the machines.



The Twelve Approved Portable Oxygen Concentrator Units

AirSep Lifestyle AirSep Freestyle Delphi RS-00400
Central Air
Inogen One

Invacare XP02 Respironics
EverGo
SeQual Eclipse

DeVilbiss Health Care
Inc.s iGo

Intl Biophysics
Corps LifeChoice
Inogen One G2 Oxlife
Independence
Oxygen
Concentrator
Invacare SOLO2




Portable Oxygen Bottles

When there is a need for therapeutic oxygen on the aircraft the Supplementary Oxygen
bottle will be provided. It must be ordered 48 hours prior to the flight.
Supplementary Oxygen Bottle
This unit will only be provided to passengers with
prior medical clearance through the MEDIF
system from Emirates. MEDIF will have
determined the flow rate for the passenger.
This unit can only be used on constant flow.

Description
Discharge: 2 to 4 LPM Through one standard cabin bottle and a face mask
Capacity/Weight/Duration:
Oxygen
capacity
Duration (hrs) Weight full load (kg)
2/L/min 4L/min
Type 1 P/N MO3048 820 6.8 3.4 9.5
Type 2 P/N MO3048-01 820 6.8 3.4 9.5
Type 3 P/N MO3048-02 720 6.0 3.0 5.15

Gauge:
1) flow gauge
2) Pressure gauge indicator, - - Full
Knob: Black control knob, ON/OFF and provides flow control which
could be checked in the flow rate gauge.
Locations:
A340-500 overhead bin 40DE and 40FG
B777-300 ER : 2 bottles in stowage AS 201 or A401 or L503 (L5 door)
6-8 bottles in overhead bin 46AB and 46JK
B777-200 2 bottles in stowage A401 (L4 door)
6 bottles in overhead bin 37AB and 37 JK
B777-200LR

2 bottles in overhead bin 39JK (R4 together with EMK,
AED) 6 bottles in overhead bin 37AB and 37 JK

P/N Number
Oxygen mask

Flow Gauge
Pressure Gauge



Bins are labeled accordingly with Provisions for Therapeutic Oxygen as shown
below:

Procedure for use

1. Cabin crew must check the weight/model of the oxygen prior to lifting from
stowage area.
2. Position container on the floor between seats.
3. Lift flap cover of the container and thread mask connector through the opening
and plug it onto oxygen outlet.
4. Open black control knob and adjust it until flow gauge indicates the desired flow
rate.
5. Listen for the hissing sound to ensure oxygen is flowing.
6. Fit the oxygen mask on passenger
7. Monitor the passenger and oxygen bottles pressure gauge.

Note: when the needle in the pressure gauge reaches full, turn off the oxygen
and replace with another bottle.

After use
1. Turn black control knob fully to the OFF position and disconnect mask
2. Discard of the mask in a yellow biohazard bag.
3. Ensure to keep the metal connector inside the bottle container


Effective Date:




Other Equipment

Rescue Breathing Devices

Face Shields and Pocket masks enable the first responder to give Rescue Breathing
and minimize the risk of infection.

Face Shield
The Face shield consists of a plastic sheet with an air filter which can be used on adult,
children and babies. It can also be used for Rescue Breathing for neck breathers.

Using a Face Shield
Tilt the casualtys head back to open the airway.
1. Unfold the face shield; place it on casualtys face with the air filter over the
mouth.
2. Pinch the nose and put your mouth over the air filter and blow into the mouth until
the chest rises.

Figure No. 1 Figure No. 2

Pocket Mask on Adult and Children
The Pocket mask is designed for mouth to mask Rescue Breathing of a non-breathing
adult, child and baby. It minimizes the risk of infection and gives additional oxygen
during Rescue Breathing.

Using a Pocket Mask

Figure 1
Take the
mask out of its
case.
Figure 2
Push out mask to a
dome shape; attach the
mouthpiece to the hole
in the centre of the
mask.
Kneel behind the casualtys head. Tilt the casualtys
head back to open the airway.

Figure 3 - Apply the rim of the mask to the area
between the casualtys lower lip and chin, to keep the
mouth open under the mask. Position end marked
nose over the casualtys nose. Press the mask
firmly against the casualtys face to form an airtight
seal.


To give rescue breathing with the pocket mask, secure the mask and press with both
thumbs on either side of the mask, and with fingers wide open hold the jaw and pull the
head towards you to maintain an open airway. Seal your mouth over the mouthpiece.
Blow slowly until chest rises. Remove your mouth. Allow casualty to exhale. See
diagram 4.
Additional oxygen can be given during rescue breathing as shown in diagram 5.

Alternatively, if you are a lone rescuer, you need to place yourself beside the casualty in
a location that facilitates both rescue breathing and chest compressions.
To give rescue breathing, secure the pocket mask by placing your index and thumb of
one hand on the top part of the mask, performing a head tilt at the same time. Use the
other hand to secure the mask along the lower margin and blow slowly. Observe for
chest rise. See diagram 6.

Note: If casualty vomits, remove mask and clear casualtys airway.
Replace with new pocket mask. After use, dispose of the items in a biohazard
bag. (Vomiting is not a sign of circulation).

Use on Babies

For a baby, follow procedures given for adults and children except turn the mask upside
down so that the nose part is under the chin.
Then apply mask gently against the face to form a tight seal. Open airway. Blow slowly
until chest rises. Then, remove your mouth to allow baby to exhale.

Use with Oxygen
Always use oxygen with the pocket mask. Connect to high flow outlet as soon as
oxygen and oxygen tubing arrives at the scene.




To attach additional oxygen, connect oxygen tubing to mask (see above diagrams). This
tubing can be found in the EMK supplementary pouch. One end will have a metal
connector to be attached to the high flow outlet on the oxygen bottle. (This connector is
identical to the one used on all oxygen masks).
Place mask on face and continue giving rescue breathing, as oxygen flowing from the
oxygen bottle has to be blown down into the lungs through the mask.
Note: Head strap can be placed around the head to keep mask in place.

Aircraft Wheelchair

All Emirates aircrafts carry one onboard wheelchair that has been specifically designed
to fit the aircraft aisles. This may be used by cabin crew to assist in the transfer of
customers with restricted mobility between their seats and the lavatory.
The wheelchair must be stowed during taxi, takeoff and landing and should not be used
during turbulence.

Location: as per the following chart.

Aircraft Classes Location
A330-200 2 lower compt stowage aft door R2
A330-200 3 lower compt stowage aft of lav C aft door R2
A340/300 lower compt of stowage C3 fwd of door L2
A340/500 Door R4 Center stowage FWD of BCRC Compt 834
B777-200 2 Door 2 CTR stowage LH side lower compt M118.
B777-200 3 Door R3 RH stowage fwd of lav H inside doghouse.
B777-200 LR Door 1 VCC lower compt
B777-300 2 RH doghouse forward of lavatory H.
B777-300 3 Door 4 CTR Closet RH side lower compt C406.
B777-300 ER/
ULR
Door 1 VCC lwr compt or door 3 RH stowage fwd Lav H
inside dog house

Pre-flight check: Available in the correct location.

Use of the Onboard Wheelchair
1. Set up the wheelchair prior to use by following these steps:
Hold the seat with the left hand on the footrest.
Take the back rest with the right hand, then pull and raise the seat.
Push the locking lever forward to secure assembly of the seat.
Check that all the wheels are moving smoothly.
Ensure that the brakes are working properly by pushing the red indication pins on
the aft wheels.
2. Bring the wheelchair in line with the seat of the customer.
3. Push the brakes and ensure that the wheelchair is locked in place.



4. Ensure that the arm rests are folded up for easier transfer of the customer.
5. Explain all the steps regarding the transfer to your customer before proceeding
6. Assist customer either in self-transfer or with the use of the EasyGlide/ Easybelt.
7. Once the customer is in the wheelchair:
Bring the arm rests down.
Place the feet on the footrest.
Secure the customer to the seat using the shoulder, thigh and ankle belts.
8. Inform the customer that you are now about to move the wheelchair. Release the
brakes and push wheelchair slowly forward.

Folding back the wheelchair
1. After use, release the locking lever by pulling the lever.
2. Hold the seat at the backrest; push the backrest forward into the collapsed position.
3. Return wheelchair to its stowage.

Figure 1. Parts of the onboard wheelchair

Figure 2. Wheelchair in the collapsed position

NOTE: Never leave a customer unattended in the wheelchair. Always put on the
brakes while the wheelchair is not in motion.
Movable arm rests
wheels footrest
3 Seat belts for the:
Shoulder, thighs and
ankles
Locking lever
Aft wheel breaks
handles
seat
Back rest
Locking lever (red color)
Aft wheel brakes


Sharps Box
The sharps box is used to safely dispose of sharp items such as used needles, syringes
or lancets. If not handed correctly, they can cause puncture wounds to you or another
person which may lead to infections such as HIV or Hepatitis.

Location: FAP and the EMK

There are 2 types of sharps boxes available on board
Type 1
This container
has a blue lid
that
opens/closes by
pulling/pushing
action

Type 2
Type 2 is
operated by
twisting the lid to
open and close.
There is a plastic
guard inside to
prevent the
sharps from
coming out of the
box.

Procedure for use:
The sharps box must be used to dispose of all sharps on board. In a situation where
an onboard medic is assisting and using medication from the EMK, it is your role to
offer the sharps container to him/her and ensure that all the needles are disposed off
appropriately.
To use both types, follow the general principles for use below:

1. Always wear gloves when handling used
sharps.
2. Bring the sharps box from the FAP/EMK to the
scene and place it on a secure surface in an
upright position. Never walk through the cabin
with a sharp item.

3. Open the lid of the sharps box

4. To dispose of the sharp, drop it into the box
with the needle facing downwards as
demonstrated in the picture. If a passenger
requests the use of the sharps box, give them
the container and ask them to place the item in
the container themselves.

5. Secure the sharps box by closing the lid and
ensuring it is locked.

6. Record the flight details on the sharps box.

Plastic guard


If the sharps box from the FAP has been used:
Hand over the sharps box to the Purser
The Purser must complete a KIS report to document its use.
The Purser is responsible for returning the sharps box to the Arrivals Desk at
the Crew Operations in Dubai. (If on a layover, it can be handed over to the in
bound Purser).
At stations where crew do not hand over face to face, the sharps box is to be
left inside the Purser folder which must be locked inside the Ships Library.
Inform the Ground staff to brief the new operating Purser on the location of the
Purser folder. Include this information in the Crew Handover form.

If the sharps box from the EMK has been used:
Ensure that all needles/sharps have been disposed of and not left in the EMK.
The crew member should encourage assisting medical professional to dispose
of any needles they have used.
An orange sticker must be attached to the top of the box to show it has been
used (see picture below). The stickers can be found in the documents section
of the EMK. This indicates to Pharmacy personnel that the container has been
used.
The sharps box should be returned to the EMK for disposal.

Complete the following paperwork:
Cabin Defect Log Book Entry if EMK has been opened.
Complete the Drug Usage Form located inside the EMK if any injection is
administered from this kit.

Complete the Medical Incident Report form if required.



Bandages And Dressings

Bandages
Bandages have a variety of purposes. They can be used to secure dressings over
wounds, to control bleeding, to support and immobilise injuries such as fractures and to
reduce swelling.

White bandages:
Available in the FAP, FAK

White bandages are used to secure dressing in place and can be used with dressings like
Hydrogel and Melolin to treat burns, control bleeding and cover wounds.

Crepe/Cream bandages
Available in the FAK

Crepe/cream bandages are used to offer support and reduce swelling to muscle and
soft tissue injuries i.e. sprains and strains.

Both cream and white bandages may be used as Roller Bandages which could be
placed on either sides of an embedded object or protruding bone (open fracture) for
indirect pressure.



Triangular Bandages

Available in the FAK

A Triangular shaped material can be used to make:

1. An immobilization sling which offers support and immobilizes fractures and
dislocations.

Ask the casualty to
support their own
arm. Slide the
bandage under arm
so that the longest
side is parallel to the
body on the
uninjured side.

Fold the lower part of
the bandage up over
the forearm and bring
it to meet the upper
end at the shoulder.

Tie the bandage at
the injured side, at
the hollow above
the casualtys
collar bone.

Fold over the
pointed end of the
bandage at he
elbow an pin with
a safety pin.

2. An elevation sling for hands and fingers injuries

As k the casualty to
support his injured
arm across his
chest with his
fingers resting on
the opposite
shoulder

Place the bandage
over so that the
longest side is
parallel to the
injured arm.




Tuck the base of the
bandage under his hand,
forearm and elbow.

Bring the lower and the
upper ends of the bandage
diagonally across his back
and tie anywhere at the
back

Regularly check the circulatio
in the thumb. If necessary
loosen the bandage
and sling.

3. Tourniquet

Rules for the use of tourniquet

Used only by Cabin Crew as a last resort, e.g. crash injuries.

1. Apply above the wound.
2. Record time of applying tourniquet.
3. Place T mark on casualtys
forehead.
4. Release for 15 seconds every 15
minutes.
5. Never cover a tourniquet.
6. Never leave casualty unattended.
7. apply to limbs only

Dressings
Dressings are used to cover wounds, burns and can help to control bleeding. They are
used to prevent infection and contamination to the injured site.
Dressings provided on board are:
1. Melolin
2. Surgical dressing
3. Hydrogel
4. Bandaid




General rules for bandages
Explain to the casualty what you are going to do and reassure him/her throughout
the procedure.
Make sure the casualty is as comfortable as possible either in a sitting or lying
position.
Keep the injured part supported.
Work directly in front of the casualty and on the injured side.
Apply the bandage firmly enough to control bleeding (if any) and to hold the dressing
in place, but not too tight that it could reduce circulation to the injured part.
Leave fingers and toes exposed.
Ensure that knots do not cause discomfort to the casualty i.e. Sling tied at back of
the neck.
Check circulation to the area every 10 minutes.
If the circulation has been affected, remove and reapply the bandage.

Checking circulation after applying a bandage

The Circulation to any injured part should always be checked to ensure that a dressing
or bandage has not been applied too tightly. Swelling can also affect the tightness of the
bandage; therefore, checks must be at regular intervals (every 10 minutes).
Observations should include any abnormal colour, movement, sensation and
temperature.

Colour
Press the casualtys finger or toe on the affected part firmly, it will become pale. Upon
releasing the pressure, normal colour should return promptly. If colour does not return
or returns slowly, the bandage may be too tight.

Movement
The casualty must be able to wriggle the toes or fingers of the affected limb (arm or
foot). If movement is restricted, release the bandage.

Sensation
Look out for any numbness, tingling (pins and needles) or any unusual sensation which
may indicate that the bandage is too tight.

Temperature
Fingers and toes should be warm to the touch, coldness could suggest that circulation
has been affected. Check temperature in the unaffected limb also, for comparison.

If any of the above factors are present the bandage should be removed and
reapplied.



Epipen

Epinephrine/Adrenaline is a drug used for a casualty suffering anaphylactic shock/severe
allergic reaction (see subsection 208 page 2)

How to use the Epipen auto-injector

Prepare:
Disposable gloves (FAP, FAK)
Epipen auto-injector (EMK)
Sharps box (EMK)

1. Remove Epipen and sharps box from EMK.
2. Open sharps box and place on floor near casualty.
3. Hold the auto-injector around the middle, keeping your fingers away from both
ends.
4. Place the black tip on the casualtys outer thigh, at right angle to the leg. (Only
apply to thigh). Epipen can be applied through normal clothing or on bare skin
5. Pull off the grey safety cap.
6. Press hard into thigh until the auto-injector mechanism works and hold in place for
10 seconds.
7. The Epipen can then be removed.
8. Dispose of the Epipen in the sharps box. Close the sharps box
9. Advise casualty to massage the injection site for 10 seconds.

Area of injection

Note: keep your fingers away from both ends to avoid injecting yourself.

Grey safety
Black tip
(Needle not visible prior to



Tempus IC

The Tempus IC is a monitoring device designed for use in a remote
environment such as the aircraft. It allows a trained user to take the
passenger vital signs and transmit the data to Medlink through the
aircraft communication system. Medlink can then review this data,
make a more informed decision on the treatment of the passenger
and whether a medical diversion is required or not.

The Tempus IC can measure the following parameters:
Blood pressure and pulse rate
Blood oxygenation level
Respiration rate
Capnometry (exhaled carbon dioxide)
Temperature
Blood glucose level
12 lead electrocardiogram (ECG)
Tempus IC can take photo of the customer and in case of Ethernet
and WiFi connections live video streaming is possible. There is a
Bluetooth headset to communicate with the Medlink Doctor. In
addition, a wired headset is also available.

Location:
A340-500: Compartment 831 in galley G8a
B777-300 ER/LR: Compartment A111 in the aft galley

Pre Flight Check: (to be conducted by the SFS)
Available in the correct location with a spare battery.
Battery checks to be completed on the Tempus IC and on the spare battery. If either
battery is showing orange or red, document this in the cabin defect log and inform
the engineer as soon as possible. If possible a replacement will be issued. The
aircraft should not be delayed for a replacement.

Criteria for Use:
Tempus IC may be used only on adults or children over 10 years and over 20 kg. if
the passenger does not match these criteria or is an unaccompanied minor, use the
Tempus IC to connect to Medlink, but consult with Medlink before attaching any of
the medical parameters. If a passenger is unconscious, you may use the Tempus IC
as this is considered legally as consent.

Procedure for use:
The Tempus IC (if available) must be used on all medical cases that require the
assistance of Medlink, The Tempus IC must be used to make the initial connection.
Gain consent from the passenger before use.
Inform the Captain that Tempus IC will be used.
Use the machine following the steps below:

Switch on the machine at the stowage by pressing the on/off button for 2
seconds until the green light flashes.


Follow the IAssist help screens at all times they will provide you with detailed
instructions.
Initially the Tempus IC will ask you to attach the Blood Pressure cuff and Pulse
Oxymeter. This will ensure that the data will be available for Medlink as soon
as you are connected.
The next step is the connection process. Follow the IAssist help screens at all
times. The unit should be configured to the aircraft you are flying on. In the
event that this is not the case, you can change the connection mode by
pressing the Change Aircraft Type button on the screen. Please refer to the
table below for the types of connections that may be available on your aircraft.

Connection types overview:

A/C Type Connection Type
All A340-500

B777-300
(registration numbers:
EBQ to EBY only)
Dual Pot Connection (RJ11).
2 cables are connected to the sockets
located behind the handset in the seat back.

B777-300 and B777-
200

( All Registration
numbers except EBQ to
EBY and EGP onward)

Ethernet Connection (RJ45).
1 cable is connected to the socket in the
seat back or at the L2 door area. This will be
labelled Tempus/Medlink station.



B777-300
( All registrations
starting with EGP
onward)

Ethernet Connection (RJ45).
There is no connection point available in the
seat back. Connection sockets are located
only at L2/L3/L4 doors and the PSU panel
above seat 49JK.

Once you are connected, Medlink must be advised of the following information
This is a Tempus IC call and I have received consent to use the unit.
Pass on relevant data from Medical Incident Report Form (MIRF), including
your name, aircraft registration and flight details (Route, ATD, ETA).
Once connected, Medlink have control of the unit, therefore you can ask for
guidance on the IAssist screens if you need it. All you need to do is ask.

Offline Monitoring:

You can still use the machine to monitor the casualty offline if you are on aircraft
where the Tempus IC cannot connect to Medlink. In this situation, attach the
machine and proceed to take the parameters. Use your Medlink card to make a
connection to Medlink. The data can be verbally relayed to the Doctor. If there is a
medical professional assisting you, they can also interpret the data. The vital signs
can be recorded on the Medical Incident Report Form.
The crew member is not expected to interpret any of the medical data. This will be
done by the Medlink physician or a medical professional on board.

Note: if you have not received Tempus IC classroom training, do not use the machine.
Use the Medlink call card to contact Medlink .


Remember to disconnect the call to Medlink after every incident. Follow the steps
below:
Ensure Medlink have advised you to end the call.
Disconnect the Voice and Data link.
Disconnect Voice and Data connection cables if they have been used.

Clean and Repack by following the steps below:
Press the ? button to display the Cleaning and Repacking IAssist help screen
Follow the help screens to clean and repack the Tempus IC. A final check has
to be done to ensure that the process is complete. This option is given on the
screen. It is very important to repack the machine for the next user.


Turn off the machine. Press and hold the On/Off button on the front panel for about
two seconds until the lamp in the top left corner of the button starts flashing orange
(the Tempus IC will switch off after approximately 10 seconds.)
Return the machine to its stowage.
Complete the following paperwork:
Cabin Defect Log Book entry should include the following information:
1. Serial number of the Tempus IC (can be found on the back of the machine
see picture below)
2. Battery charged below 25%
3. Glucometer was used
4. Capnometer cannula was used. The machine will prompt if any other



Lateral Transfer Devices easy glide and easy belt/ flexibelt

To support and assist the transfer of passengers with special needs, the Easy Glide
and Easy Belt (Flexibelt) have been loaded on all Emirates aircrafts. They can be used
to transfer passengers in the seated position between on board wheelchair and aircraft
seat or vise versa.

The Easy Glide is made of flexible polyethylene. The smooth
top makes it easy move and the double anti-slip tape on the
underside prevents the board from sliding during transfer.
Location: beside the onboard wheelchair.

The Easy Belt/ Flexibelt is made of moisture and soiling
resistant nylon with a confortable polyester surface against
the body. It has vertical and horizontal handles to provide the
best possible grip.
Location: inside the pocket of the onboard wheelchair

Pre- Flight Check: Availability of the equipments in correct location. For location of the
wheelchair, go to page 4.

Procedure for use:
1. Check the functionality of the equipment before use. If any signs of damage are
found, do not use the equipment. Enter any defects on the cabin log.
Easy Belt: Apply pressure to buckles and handles to verify they will not break
under heavy loads.
Easy Glide: carefully bend to check for strength and durability.

2.

3.

4. Elevate the armrests of the wheelchair and passengers seat.
Place the belt around the passengers waist or
hips;
Fasten the clasp and tighten firmly.
Position the wheelchair adjacent to the aircraft
seat;
Ensure wheelchair breaks are on.


5.

6.

7.

8. Unclasp the belt to remove it and adjust passengers clothing for comfort.
Lean the passenger to one side and place the
Easy Glide under the hip of the passenger which is
nearest to the aircraft seat. Ensure the bend of the
board is towards the rear.
When transfer is complete, bend the board
upwards and remove the board gently.
Hold the board secure with one knee as shown in
the picture. Grasp the handles of the belt securely
and glide the passenger across the board towards
the aircraft seat. Another crew member should
assist in pushing the passenger towards the seat,
using the belt handles.


Effective Date:




Assessing A Casualty

It is important to have a well-practised method of assessment when faced with any
medical emergency situation. Your first duty when attending a casualty is to assess
them for life threatening conditions that need emergency First Aid. This initial
assessment is called the primary survey.

Primary Survey

Yes

No

Yes

Note: Refer to Sub Section 207 page 2-16 for further explanation of the steps.
Danger
(See Subsection 207 page 2)

Put your safety first and deal
with any danger
When it is safe:
Response

Shout for help

Open Airway

Check for signs of breathing

(See Subsection 207 page 2&3)
Assess for other conditions
Carry out a secondary
survey
Treat any conditions found if
possible
Contact Medlink if necessary
Bring all equipment required
Inform SCCM and Captain
Place in recovery position
(see sub section 207 page 5)
Assess for other conditions
Breathing present
Start CPR
(See subsection 207
page10)

Not Breathing
No
No


Secondary Survey

Once the casualty is out of immediate danger, you should carry a secondary survey in
order to identify any other conditions.
While conducting the secondary survey crew can fill out the Medlink Incident Report
Form which will assist them to communicate with the Medlink physician.

In all situations cabin crew should:

1. Gain a history from the casualty/traveling companion and assess the signs and
symptoms (see next page)
2. Look for external clues
3. Reassure the casualty
4. Loosen tight clothing, open air vent
5. Monitor vital signs (see page 4)
6. Give Oxygen high flow
7. Let the casualty assume the most comfortable position for themselves
8. Keep casualty warm
9. Inform SCCM and Captain

If necessary

10. Contact Medlink
11. Make PA for Medical Professional on board
12. Request Medical Assistance on arrival

History of the incident
A useful method of obtaining a history is to use the S.A.M.P.L.E. method.

S = signs and symptoms

A = Allergies is the casualty allergic to anything?

M = Medications is the casualty taking any medications?

P = Past medical history does the casualty have a significant history of any
medical condition?

L = Time of Last meal

E = Events that lead up to the incident. What happened? What was the casualty
doing? What is the environment in which the problem occurred?



Signs And Symptoms

To help you identify a medical problem, look out for the following:

1. Breathing: deep, shallow, rapid, noisy, wheezing, distressed.

2. Pulse: Regular, Irregular, Rapid, Slow, Strong, Weak

3. Skin Appearance: pale, blue, flushed, dry, sweating, clammy (for darker skin,
color change can be noted inside lips and at nail beds).

4. Pain: type ( sharp, dull, burning, crushing) and location ( ask casualty to point to
area of pain)

5. Bleeding: wounds, bruising

6. Broken bones: deformity, loss of function, swelling, bruising

7. Nausea, vomiting

8. Body temperature: see vital signs below

External clues

A Medic Alert Emblem or any other identification in the form of a bracelet or necklace
contains information on the backside about the casualtys medical condition. E.g.
Epileptic, Diabetic (this is very useful when the casualty is unable to speak for
themselves e.g. Unconscious).

In addition the casualty may carry medication which gives valuable information about an
incident. Such as tablets, inhalers, needles/syringes



Assessing Vital Signs

Breathing

Breathing consists of three phases:

Breathing in (inspiration)
Breathing out (expiration)
A pause

When we breathe in, air is drawn in at the nose and mouth, and passes down the main
airway to the lungs. Within the lungs, it travels along a broadening (widening) network of
air passages that finally open into tiny air sacs (alveoli). Here, the blood absorbs the
oxygen. Air containing carbon dioxide is then expelled as we breathe out, enabling fresh
air containing oxygen to be drawn in with the next breath.

Air contains 21% oxygen, only 5% of this oxygen is used by respiration. Therefore,
there is 16% oxygen in exhaled air, which is more than adequate to resuscitate another
person.

Oxygen is essential for life. To live and function properly, every cell, tissue and organ
of our body requires a continuous oxygen supply. If the supply of oxygen in the body
decreases for reasons such as suffocation, choking or lung infections, the tissues start
to deteriorate very rapidly - brain cells start to die if their oxygen supply is interrupted for
as little as three minutes.

Without Oxygen 3-5 minutes Irreversible Brain Damage May Occur
7-8 minutes Brain Death

Normal Breathing Rates:

Count the number of breaths/minute to see whether the breathing rate is abnormally
fast or slow

Adults: 10 20 Breaths per minute
Children: 20 30 Breaths per minute
Babies: 30 50 Breaths per minute



The heart and circulation

The purpose of the circulatory system is to move the blood around the body, supplying
oxygen and nutrients to the cells and removing their waste products.

Blood circulates around the body in a continuous cycle, pumped by the rhythmic
contraction / relaxation of the heart muscle. The blood circulates within a network of
flexible tubes, known as blood vessels. The force with which the heart pumps the blood
through the vessels and around the body is known as the blood pressure.

In brief:
The heart is located in the centre of the chest, approximately the size of the owners fist.
It is made of strong muscle layers and divided into four chambers. The left side of the
heart contains thicker, stronger muscle than the right, so it is the left side of the heart
that is responsible for pumping the oxygenated blood to the rest of the body.

The deoxygenated blood (blood that no longer contains oxygen as it has been given to
the rest of the body) returns to the right side of the heart where it goes to the lungs and
picks up oxygen again when we breathe. The oxygenated blood returns from the lungs
to the left side of the heart where it is then pumped to the rest of the body. This cycle
continuously repeats itself.

This pumping (beating) of the heart can be felt as the pulse and is controlled by an
electrical impulse.
The pulse is the wave of pressure that passes along the arteries, (blood vessel
containing oxygenated blood), created by each beat of the heart. It can normally be felt
where an artery passes close to the surface of the body.

The heart has its own blood supply provided by the coronary arteries which are
susceptible to narrowing (angina) and blockage (heart attack). In severe cases of
blockage or if the electrical impulses are disrupted, the heart may stop (cardiac arrest).
See subsection 208 page 18

The pulse rate may increase with exertion, fear, fever, blood loss and some illnesses.
Fainting, and certain heart disorders, may slow it down.

Normal Pulse Rates:

Count the number of beats/minute to see whether the pulse rate is abnormally fast or
slow

Adults: 60 80 Beats per minute
Children: 80 100 Beats per minute
Babies: 100 120 Beats per minute



Pulse check for adults and children

First, check radial pulse at patients wrist (thumb side). If difficult to feel, check carotid
pulse at either side of patients neck.

Pulse check for babies

Check brachial pulse at the babys inner upper arm.

Radial Pulse Carotid Pulse

Brachial Pulse

Always use 2 fingers (NOT THUMB) to check for a pulse

Note: ONLY check the pulse on conscious/semi-conscious casualty

The brain

The brain is a vital organ which lies in a hard protective shell the skull. Often
considered the central processing unit of the entire body as it receives information from
inside the body by means of nerve impulses and chemical substances circulating in the
blood. The brain collects this information and responds by stimulating, regulating and
coordinating activities within the body.

The brain requires a constant supply of oxygen for normal functioning and is extremely
sensitive to any chemical imbalances within the body, particularly that of oxygen and
glucose such as caused by hypoxia, hyperglycaemia, hypoglycaemia, bleeding and
fractures.

Its base is attached to the spinal cord which controls sensation through the nervous
system. Much like the heart the brain has electrical activity present within it which if
disturbed can result in certain disorders. It also has its own arteries supplying it with
oxygen and nutrients called cerebral arteries.



Levels of consciousness Appearance

Conscious Awake, orientated and alert.
Eyes are opened, follows commands, responds relevantly to
questions.
Semi-conscious Drowsy, confused, arousable.
Eyes may be open, responds verbally to voice and non-painful
stimulation, makes meaningful movement.
Unconscious Eyes closed, no verbal response to stimulation, no meaningful
movement. Breathing may or may not be present.

AVPU: is one method that can be used to assess the casualtys level of consciousness.

A Alert Is the casualty alert and awake?
Does the casualty open his/ her eyes and respond to
questions?
Does the casualty respond to your questions?
V Responsive to
Voice
Does the casualty respond to voice?
Does the casualty answer simple questions and obey
commands?
P Responsive to
Pain
Does the casualty respond to pain?
Does the casualty open his/ her eyes or flinch if shoulders
are tapped firmly?
U Unresponsive Is the casualty unresponsive (does not respond to voice or
pain)?
If so, then assume he/ she is unconscious.

Using this mode of assessment, you can continually check the casualtys condition to
monitor any change.

Temperature

Normal body temperature is around 36 37c (97-99F)
An abnormally low temperature (below 35c-95F) could be an indication of Hypothermia.
See sub-section 208 page 30.
An abnormally high temperature (above 40c-104F) is known as a fever and could be
due to a bacterial or viral infection. See sub-section 208 page 31.

The body temperature of a casualty can be checked using the:

Fever scan Thermometer, in FAK and EMK

Ensure the forehead is dry.
Press fever scan strip against fore head.
The colored bar will indicate the casualtys temperature after 15 seconds. (Read
indicator while still pressed against forehead).


Effective Date:





Basic Life Support Procedures

Assessment of a collapsed casualty

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

Refer to section 207 pages 2-16 for further explanation of each step of the action plan
and CPR.

D Dangers
Check for dangers to you and casualty
R Response
Firmly tap the shoulders and shout in both ears
S Shout for help
Help me: get the SFS/Purser and Defib
A Airway
Quickly open airway using head tilt chin lift
technique
B Breathing
Check for signs of normal breathing (Minimum
5 seconds Maximum 10 seconds)
C CPR
Im starting CPR-Start Defib
C 30 compressions
A Open Airway
B Give 2 effective breaths
D - Defibrillator

Response is
present
Elevate legs.
Give O2
Monitor ABC
Breathing
is present
Recovery Position
Give O2,
Monitor ABC
No response
No Breathing


D- Danger
Assess the area for dangers or hazards, which could cause you or the casualty an injury
look up, down, all around the area.

When it is safe:

R- Response
Assess for responses to establish if the casualty is conscious, semi conscious or
unconscious.

Adults and Children - Tap gently and firmly on shoulders and call into both ears.
Babies- Gently tap or flick the soles of the feet.

Note: If casualty is Responsive, refer to fainting section, subsection 208, page 15.

If the casualty is unresponsive:

S- Shout For Help

Help me, get the SFS/Purser and Defib

A Airway and B Breathing
Opening of Airway and checking for signs of normal Breathing must only take a
minimum of 5 seconds and maximum 10 seconds.

A- Airway (Head Tilt, Chin Lift Technique)

Before checking for breathing, open the airway following these steps:
Put one hand on the forehead and the fingers of your other hand on the bony part of
the chin (see next page). Tilt the head back and lift the chin.
Avoid pressing on the soft part of the neck or under the chin.

For Children and Babies, caution should be given not to over extend/tilt head as this
could block or kink the airway. Avoid pressing the soft part of the neck or under the
chin. The head should be tilted so as the nose is pointing at the ceiling.

Note:
The muscles at the back of the throat relax in a person who does not respond.
When the muscles relax, the tongue may fall back and block the airway. A person
with a blocked airway can not breathe.

Check the mouth and clear the airway only when there is evidence of choking



Head tilt/chin lift method

Tongue Tongue

Blocked Airway
In an unconscious casualty the tongue will
fall back and block the throat and airway
Open Airway
In the head tilt/chin lift position, the tongue
is lifted from the back of the throat

B- Breathing:

If the person does not respond, check his breathing. If the person is not breathing at all
or if he is only gasping then he needs CPR.

A person who is gasping usually appears to be drawing air in very quickly. He may
open his mouth and move the jaw, head or neck. Gasps may appear forceful or weak
and sometimes may pass between gasps because they usually happen at a slow rate.
The gasp may sounds like a snort, snore or groan. Gasping is not regular or normal
breathing. It is a sign of cardiac arrest in someone who does not respond. In this case,
do not delay CPR.

If the casualty is breathing, refer to the unconscious casualty management page 5.



C- CPR:

The command Im starting CPR, SFS/ Purser start Defib should be assertively
stated. Expose fully the casualtys chest. Starting with 30 compressions Push Hard
and Push Fast followed by 2 rescue breathes..

For technique of Rescue Breathing, refer to Sub section 207 page 8.

For compressions technique, refer to Sub section 207 page 10.

D- Defibrillation:
Defib must be operated as quickly as possible to increase the chances of survival.
Emirates trained and authorised On duty Cabin Crew only to operate

Refer to Sub section 203 pages 1-5 for Defib procedure and use.



The Unconscious Casualty (Breathing Present)

Unconsciousness
Prolonged state of collapse

Causes
Heart attack, Stroke, Diabetic coma, Head injury, drug or alcohol intoxication

Management

1. Follow the DRSABCD action plan.
2. Place the casualty in recovery position if normal breathing is present.
3. Give oxygen, high flow.
4. Keep casualty warm, cover with a blanket.
5. Inform captain.
6. Contact MedLink.
7. Continue to monitor Airway and breathing every 1 minute.

The recovery position

An unconscious, breathing casualty should be placed in the recovery position. This
position prevents the tongue from blocking the airway. It allows fluid to drain from
the mouth, reducing the risk of the casualty inhaling stomach contents. The head,
neck and back are kept in a straight line, while the bent limbs keep the body propped in a
secure and comfortable position. Before turning a casualty, remove his or her eye glasses,
if worn, and any bulky/sharp objects from pockets.



Method of placing a casualty in the recovery position

Adults
1. Kneeling beside the casualty; open the airway by tilting the head and lifting the chin.
Straighten the legs. Place the arm nearest you at right-angles to the body, elbow
bent in a right angle to the body and with the hand palm uppermost.

Open the airway first using head
tilt/chin lift method

Elbow bent Leg straight

2. Bring the arm furthest from you across the chest, and hold the hand, palm outwards,
against the casualty's nearer cheek.

Place the back of the hand against the
cheek, and hold it there.

3. With your other hand, grasp the leg furthest from you and pull the knee up, so that
the foot is flat on the floor.

Use your knees to stop the casualty rolling
too far over.



4. Keeping the hand pressed against the cheek, grasp the leg above the knee and roll
the casualty towards you and on to the side.

Bent leg Props the body up and prevents
the casualty rolling forward.

Hand under cheek helps to keep the airway
open

5. Tilt the head back to make sure the airway remains open. Adjust the hand under the
cheek, if necessary, so that the head stays in a tilted position.

6. Adjust the upper leg, if necessary, so that both the hip and the knee are bent at right
angles.

Note: If the casualty has to be kept in the recovery position for more than 30
minutes he should be turned to the opposite side.

Children

Use the same technique as for the adult.

Babies

Hold the baby on their side, supporting the babys head and neck, tilting the babys head
slightly downwards to prevent inhalation of vomit and stop the tongue blocking the airway.


Rescue Breathing

Rescue breathing is used to breathe air into the casualty to inflate the lungs and give
oxygen needed for survival.

How to give rescue breaths

Adults/children

1. Lay casualty on hard flat surface.
2. Open the airway. Use head tilt/ chin lift.
3. Pinch the soft part of the casualtys nose.
4. Take a breath and place your lips around the casualtys mouth, making sure that
you have a good seal.
5. Blow air slowly into the casualty until the chest rises (about 1 second).
6. Release the nose and remove your mouth of the casualtys mouth, maintaining an
open airway, and check chest falling.

Babies (0-1yr)

Same as above except
1. Seal the babys nose and mouth with your mouth.

If you have difficulty achieving an effective breath

Check the casualtys mouth and remove any obstruction.
Caution should be given not to over extend / tilt the head as this could block or
kink the airway. It is best to use the nose pointing at the ceiling technique, with
slight movement of the head until an effective airway is achieved. Avoid pressing
on the soft part of the neck or under the chin.

When available a face shield or pocket mask can be used. See subsection 205 page 1

Note: Blowing too hard or too fast creates increased resistance and less air to reach the
lungs, leading to over inflation of the stomach which can cause vomiting
When giving breaths, it maybe necessary to adjust the casualtys head through a range
of positions to achieve effective rescue breathing.


Special cases

Neck breathers

Have an airway from the throat directly into the wind pipe and can be total or partial
neck breathers.

Total Neck Breather: Breathes only through a neck opening.
Partial Neck Breather: Breathes through a neck opening and through the nose and
mouth.

Rescue Breathing for Neck Breathers

When a neck breather stops breathing, Rescue Breathing should be given through the
casualtys stoma (hole) in the neck, i.e. mouth-to-neck breathing.

Rescue Breathing technique for neck breathers:

Total Neck Breather: Seal your mouth around the tube in the neck. Inflate
slowly.

Partial Neck Breather: Seal the casualty's nose and mouth and inflate through
the tube in the neck and inflate slowly.

Only a face shield can be used when administering Rescue Breathing to a neck
breather.



Cardio Pulmonary Rescusitaion (CPR)

CPR is the combination of Rescue Breathing to provide oxygen and chest
compressions to circulate oxygenated blood around the body.

How to give chest compressions

Adults (8 yrs and above)
1. Lay casualty on their back on hard/flat surface.
2. Kneel beside the casualty; knees shoulder width apart and close to the casualty.
3. Place the heel of your hand in the centre of the chest between nipples.

4. Place the other hand on top of the first hand and interlock fingers.




5. Keeping shoulders directly over your hand press the chest downwards at a depth
of at least 5 cm (2 inches). (Keep elbows locked).

6. Release the pressure on the chest without removing your hands.
7. Compress the chest 30 times, aiming for a speed of at least 100 compressions per
minute.
8. Follow the 30 compressions with 2 effective breaths of Rescue Breathing.
9. Continue to give compressions and breaths at a ratio of 30:2.

Children (1-7 yrs)

1. Lay child on their back on hard/flat surface.
2. Kneel beside the casualty; knees shoulder width apart and close to the casualty.
3. Place the heel of your hand in the centre of the chest between nipples.

4. Place the other hand on top of the first hand and interlock fingers.

5. Press down the chest at a depth of about 5 cm (2 inches); compress the chest 30
times, aiming for a speed of at least 100 compressions per minute.
6. Follow the 30 compressions with 2 effective breaths of Rescue Breathing.
7. Continue to give compressions and breaths at a ratio of 30:2.



Babies (0-1 yr)

1. Locate the nipple line (imagine a line joining the nipples).

2. Place two fingers just below this line.

3. Press down the chest at a depth of about 4 cm (1.5 inches); compress the chest
30 times at a speed of at least 100 compressions per minute.

4. Follow the 30 compressions with 2 effective breath of Rescue Breathing (Mouth to
Nose and Mouth). Continue compressions and Breaths at a ratio of 30:2.

Note: There is no need to check for circulation/pulse at any time. Only stop CPR and
recheck for breathing if the casualty shows signs of life (movement, coughing, or
breathing).

Tips about compressions

1. It is essential to combine Rescue Breathing with Chest Compressions in order to
circulate oxygenated blood around the body.
2. At all times the compressions should be given in a controlled manner and applied
vertically. Erratic or violent action could cause injuries to the internal organs and
bones, complicating the resuscitation process.


Two responder CPR:

If there are two responders, then two responders CPR can be performed. One person
delivers chest compressions and the other person maintains an open airway and
delivers the effective breaths.

There is no difference between the ratio of breaths to compression for one or two
responders.

How chest compressions work:

Pushing down vertically on the breastbone
squeezes the heart against the backbone,
forcing the blood out into the blood vessels
to circulate around the body. As pressure
is released, the chest rises and
replacement blood is sucked in to refill the
heart; this blood is then forced out of the
heart with the next compression.

CPR, how long do I continue?

Continue CPR until:

1. The casualty shows signs of life e.g. movement, coughing, or breathing
2. The defibrillator is applied and commands do not touch the patient or check ABC
or signs of circulation.
3. Advised by MedLink to stop. Or, until advised by a doctor of medicine only in the
absence of Medlink. However, ensure that efforts to contact Medlink still
continue.
4. Diversion destination is reached and medical assistance takes over, or if no
diversion - 45 minutes.
5. A colleague takes over from you if you are exhausted.

See CPR differences on next page.



COLLAPSED CASUALTY DIFFERENCES

ADULTS
8 years and above
CHILDREN
1-7 years
BABIES/INFANTS
0-1 year
Rescue Breathing
technique
Mouth to Mouth Mouth to Mouth Mouth to Nose and Mouth
Chest Compressions
location
In the centre of the chest
Between the nipples
Between the nipples

Just below the nipple line
Chest Compressions
technique and depth
Two hands
at least 5 cm (2 inches)
Two hands
about 5 cm (2 inches)
Two fingers
about 4 cm (1.5 inches)
Chest Compressions
Speed
At least 100 per min At least 100 per min

At least 100 per min
Compression/breaths
Ratio
All rescuers
30:2 30:2

30:2




CARE OF THE COLLAPSED CASUALTY SUMMARY

ASSESSMENT ACTION FOLLOW UP
CASE FOR
DIVERSION
Responsive,
with breathing
Lay flat, elevate legs
Give oxygen,
Monitor ABC
Keep Warm
No
Unresponsive,
Breathing
Recovery position
Check for breathing
every minute
Give Oxygen
No
Unresponsive,
No Breathing,

Start Cardio-Pulmonary Resuscitation CPR

All cases ratio of compression to rescue breaths is 30:2

Defibrillation is a
Priority

Yes,
only at
Captains
discretion, via
MedLink



Presumed Death on Board Policy and Procedures

Applicability/Aim:

Emirates Cabin crew are expected to carry out Cardio Pulmonary Resuscitation (CPR)
on a casualty in the event of a sudden cardiac arrest on board. The aim of this policy is
to provide cabin crew with clear guidelines on when it is appropriate to stop the
resuscitation effort and how to handle a presumed death on board situation.

CPR can be stopped in any of the following scenarios:

1. Scenarios

1. A doctor is on board and willing to oversee resuscitation procedures carried out by
the crew, in consultation with MedLink. The doctor is qualified to pronounce death
and will do so when appropriate. The doctor should not certify death as this will
be done by the relevant medical authority at the destination (regardless of whether
there is a diversion or not).
2. There is no doctor on board, but the cabin crew is in contact with MedLink. The
decision to stop resuscitation would normally be taken in consultation with
MedLink. The MedLink physician will advise at what point resuscitation efforts
should stop.
3. There is no doctor on board and MedLink cannot be contacted. The cabin crew
may stop the resuscitation effort in accordance with paragraph 2 below:

2. Procedure

Cabin crew should carry out CPR until one of the following occurs:

1. The scene becomes unsafe The captain will advise of any adverse conditions or
limitations which would threaten flight safety.
2. Signs of life are obvious e.g. coughing, breathing, movement.
3. CPR has been given for 45 minutes with a no shock advised command on the
defibrillator and no signs of life.
4. Cabin crew become tired and (in which case a colleague needs to take over).
5. The aircraft lands and care is transferred to the emergency medical services on
the ground.

Cabin crew should carry out CPR for 45 minutes, including the operation of the
defibrillator. If after that time there are no signs of life, the resuscitation effort can be
stopped after discussion with the captain and family members/traveling companions
(see guidelines below on breaking bad news)

Crew should look for the following signs that are suggestive of death:
1. Complete absence of movement and/or responses
2. Absence of breathing and signs of circulation.
3. Body looks pale and gradually becomes bluish and cool to the touch



4. Pupils may become dilated and not respond to light.

If the cabin crew member is satisfied that all resuscitation efforts have failed and the
passenger has not responded they should implement the presumed death on board
protocol.

Note: In the event of a diversion, CPR and defibrillation should be continued until arrival
at the destination airport where emergency medical assistance takes over on the
ground.

In the event of no diversion CPR and defibrillation should be continued for 45 minutes or
on the advice of Medlink.

3. Care of the body:

This is a challenging situation for crew and it can be a very emotional event. Despite
any feelings of emotion or anxiety, the role of the cabin crew is clear - to care for the
body with respect and dignity, bearing in mind differing cultural and religious beliefs.
Family members may also have specific requests concerning the body. With this in
mind the following should be carried out:

1. Note the time when all active treatment has stopped.
2. A crew member should collect the mortality kit from the Emergency Medical Kit, if
available.
3. The body should be moved to an area of privacy e.g. Galley, where it can be
stowed for the remainder of the flight. This may require the use of the on-board
wheelchair. It is advisable that an oxygen mask is placed over the passengers
face, and the wheelchair should be moved backward down the aisle in order to
minimize viewing of the body by other passengers.
4. The body should be laid flat close to the mortality kit.
5. Close the eyelids gently.
6. Secure the jaw in a closed position with the chin strap from the mortality kit.
7. Position the body as you would when placing a passenger in the recovery position.
Do not place the passenger fully into the recovery position, just support the body
on its side until the body bag is in place.
8. Open the zipper on the bag and position along side the body with the zipper
fastener at the foot.
9. Slide the body bag under the body, tucking the zipper side closest to the body as
far as possible to the back.
10. Place the under pad on the inside of the body bag and level to the buttocks with
the white side facing up. The longest part of the under pad should be placed
across the inside of the bag.
11. Gently maneuver the bag around the body until it is fully inside the bag.
12. The body should be laid out flat with arms down and legs straight.
13. The zipper should be secured to chest level with the head and shoulders exposed.

Important: The zipper must not be completely closed, the head must be exposed. The
head may be covered with a light blanket.


4. Stowage of the body:

Considering the confinements of the aircraft cabin, it is often difficult to find a suitable
place in which to stow the body. The objective is to minimize emotional distress to
family members, traveling companions, and other passengers on board. With this in
mind the following location options are recommended. However, in selecting a location
to stow the body, bear in mind factors such as aircraft load, type, configuration, and the
location of the passenger during CPR.

1. Ideally, resuscitation attempts should have been carried out in the galley area. The
body may remain there provided that it does not compromise flight safety i.e.
obstruction of an exit or aisle. It may be more convenient to stow the body near an
exit during the cruise phase of flight given the confinements of the galley and
allowing for service flows, and then moved for the landing phase of the flight.
2. Where the body obstructs an exit or an aisle, then place the body in a seat. The
body should be secured with the seat belt or other available equipment.
Consideration may also be given to laying the body across several vacant seats or
in a First Class suite, where available (maximum discretion must be used)
3. Do not place the body in the lavatory.
4. Do not place the body in the Bulk Crew Rest Compartment.

Note: The relatives/traveling companions may wish to remain with the passenger, and
provided that this does not compromise flight safety they should be allowed to do so.

5. Other Formalities: General

1. The Emirates Airport Services Manager or his/her deputy at the airfield of landing
should be informed via the Ground Handling Agent that there is a presumed death
on board case, who in turn, will notify the authorities.
2. Cabin crew should ask for contact details from those who have assisted e.g.
traveling companion, Doctor or other medical professional. Use discretion when
replying to other passengers inquiries.
3. All formalities such as immigration and customs documentation should be filled out
as per the requirements of that country. Station staff can advise on this if
necessary.
4. The cabin crew should fill out the relevant paperwork and record when all active
resuscitation ceased. Similarly, the Captain should also document the incident on
the Captain Special Report Form.
5. A District Doctor or Airfield Medical Officer should be available on arrival to certify
death. The body should remain on board until all passengers have de-planned.
Where passengers are required to remain on board, use discretion. Station staff
will advise.
6. The Airport Services Manager is responsible for checking that the Death
Certificate requirements are complied with.



6. Support to Crew

Support will be given to all crewmembers that are likely to be distressed by a presumed
death on board incident. Crew will find it helpful to discuss the incident and its effects on
them with the peer support group.

7. Breaking Bad News:

Breaking bad news is never easy and should be given by a crew member who feels
able to handle the situation. Though the Purser or the SFS would often be the most
appropriate person to carry out this task, any crew member can perform this.

Breaking bad news is never an easy task and can be a very emotional situation. The
objective here is to have a basic plan that will help to make this task easier, and one which
is applicable to the difficulties of the on board medical emergency situation.

In a medical setting it is generally accepted that only about 20% of information given
verbally to a patient is retained (Royal College of Surgeons of Edinburgh, 2004). In
contrast, in a situation of sudden and great distress everything that is said and done is
likely to be remembered. The resuscitation attempt may seem the most import thing at the
time, however, the way in which information about the incident is relayed to the
relatives/traveling companion will have a deep and long lasting effect.

There are many challenges that the cabin crew are likely to face when breaking bad news,
mainly due to the following:

Lack of privacy
Confinement of the aircraft cabin/galley
Lack of any proper designated space for the body
Additional stress due to unfamiliar surroundings and fear of the unknown e.g.
foreign destination/diversion/customs and immigration procedures

On board, all efforts should be made to ensure optimum privacy whilst breaking bad news
to relatives/traveling companions. A galley area is always the most appropriate place as it
is away from direct passenger view.

Before briefing the family/relatives:
Be Prepared, although time may be brief, think about what is to be said before
telling the relatives/traveling companions.
Consider a second person to assist if a professional has been involved in the
situation on board they may be called upon.
Check that the names and relationships of those involved are correct.



The Task of breaking bad news:

Make a proper introduction e.g. my names is ... I am the Purser today etc.
Look at those to whom bad news is to be given with eye contact, or touch if eye
contact is avoided (only if appropriate)
Begin leading into the situation by describing it as serious incident. Go on to say
that all that could have been done was done, but it was sadly not successful.
This will often lead to questions to which more straight forward answers and
explanations can be given.
Remember that the person receiving the bad news will recall every detail which
will be imprinted on their mind for the future.
Take your time, dont rush, and allow the person time to absorb what has been
said.
Use straightforward language to explain what has happened; avoid jargon or
abbreviations that may have no meaning to the person e.g. CPR
Allow silence though the situation may be uncomfortable for you and the
concerned individuals, unnecessary talk should be avoided.
It is essential to assure relatives that the airport of destination will make all
necessary arrangements and assist with any relevant formalities for that country.



The Choking Casualty

Definition
Total or partial blockage of the airway caused by a foreign object, e.g. food, peanuts, a
small toy, etc

Signs and Symptoms

Partial Blockage Total Blockage
1. Coughing 1. Unable to cough
2. Panic and Distress 2. Unable to speak/Wheezing sound
3. Difficulty talking 3. May grasp throat
4. Difficulty with breathing 4. Blueness of lips
5. May become unconscious
6. May stop breathing

If blockage of the airway is only partial, the casualty will usually be able to dislodge the
foreign body by coughing, but if obstruction is complete, urgent action is required.

PARTIAL BLOCKAGE

Casualty is coughing and is conscious and breathing, despite evidence of obstruction:

Adults
Encourage casualty to continue coughing, as this will help to dislodge the obstruction.
Reassure do not leave casualty unattended.

Children
Encourage child to cough if he/she demonstrates the ability to cough.

Babies
Do not interfere allow baby to clear airway by coughing. Do not leave unattended.



Total Blockage

Adult Conscious

If the adult becomes weak or stops coughing

Give Abdominal thrusts

Continue giving Abdominal Thrusts until foreign object is removed.

Abdominal Thrust technique
1. Stand behind the casualty.
2. Pass your arms around the casualtys
abdomen under the armpits.
3. Clench your fist and place it between
the breastbone and the navel with
thumb side to the abdomen. Grasp it
with your other hand.
4. Pull both hands towards you with
quick inward and upward thrusts.

ADULT OBESE/PREGNANT CONSCIOUS

Give Chest thrusts

Continue giving Chest Thrusts until foreign object is removed.

Chest Thrusts technique
1. Stand behind the casualty.
2. Pass your arms around the casualtys chest under the armpits.
3. Clench your fist and Place it with thumb side in the centre of the chest. Grasp it
with your other hand.
4. Pull both hands towards you with quick inward thrusts.



Adult/Obese/Pregnant Unconscious

1. Check clear and open the airway.
2. Check for signs of normal breathing.

If the casualty is breathing, place into the recovery position.

If the casualty is not breathing, start CPR.

Note: each time the airway is opened to administer rescue breaths during CPR;
you should check the mouth for foreign object and remove it.

Children (1 - 7 Years) Conscious

If the child becomes weak or stops coughing stand behind the child, lean the child forward.

1. Give abdominal thrusts.

Continue giving abdominal thrusts until the object is cleared or the child becomes
unconscious.

Abdominal Thrusts Technique
1. Kneel behind the child.
2. Lean the child forward with the head down as far as possible.
3. Pass your arms around the childs abdomen.
4. Clench your fist and place it between the breastbone and the navel.
5. Grasp the fist with your other hand.
6. Pull sharply inwards and upwards.



Babies (0 1 year) Conscious

If the baby becomes weak or stops coughing lay him face down along your forearm, with
his head low and support his head and back

1. Give 5 back slaps in between the shoulder blades
2. Give 5 chest thrusts.

Continue the sequence of backslaps and chest thrusts until the object is cleared
or the baby becomes unconscious

Back slaps technique
1. Lay the baby along your forearm, head down, and support his chin with your hand.
2. Give 5 backslaps in between the shoulder blades.

Chest thrusts technique
1. Turn the baby on his back
2. Place two fingers on the babys breast bone (same location as per chest
compressions technique)
3. Give up to five chest thrusts, push inwards and towards the head.

Note: Do not use the abdominal thrust method on a baby as it may cause damage
to internal organs.




Action For Children And Babies Unconscious

1. Check, clear and open the airway.
2. Check for signs of normal breathing.

If the child/baby is breathing, place into the recovery position.

If the child/baby is not breathing, start CPR.

Note: each time the airway is opened to administer rescue breaths during CPR;
you should check the mouth for foreign object and remove it.


Effective Date:





Medical Emergencies

Air Sickness

Definition

Sickness caused by motion.

Management

1. Recline seat.
2. Loosen clothing at the neck and waist.
3. Open air vent for fresh air.
4. Advise the casualty to breathe deeply and slowly and to look at a fixed object.
5. Have an air sickness bag available.
6. Stugeron can be given on flights over 4 hours. See sub-section 202 page 25 for
administration and precautions

Alcohol Intoxication

Signs and Symptoms

1. Odour of alcohol.
2. Face flushed.
3. Breathing slow and deep.
4. Possible vomiting.
5. Slurred speech.
6. Eyes bloodshot.
7. Partial or complete unconsciousness.

Management

1. Offer non-alcoholic drinks i.e. water, soft drinks, etc.
2. Delay and dilute alcoholic drinks.
3. Distract by conversation.
4. Omit alcohol if possible.
5. If casualty becomes unconscious, maintain airway opened and place in the recovery
position check A.B.C.



Anaphylactic Reaction/Allergic Shock

Definition

It is a severe allergic reaction affecting the whole body, resulting in a drop in blood
pressure and difficulty in breathing. It can be gradual or sudden in onset and potentially
fatal.

Causes

It is caused by the body being exposed to a substance which it is allergic to. The bodys
immune system recognises the substance as a threat.

Triggering factors

1. Certain drugs
2. Insect bites/Stings/Venom
3. Certain foods e.g. Peanuts, shellfish, food preservatives or additives

Signs and symptoms

1. Anxiety.
2. Swelling of face, tongue and airway.
3. Difficulty in breathing
4. wheezing

5. Itchy rash, hives.
6. Signs and Symptoms of Shock.
7. May become unconscious.

Management

Aim

To provide immediate Management, in order to relieve symptoms and prevent the
condition from getting worse.

1. Gain a history from the casualty.
2. Ask casualty if he has his own medication (Epipen), if so encourage him to
administer it
3. If the casualty has a history of Anaphylactic reaction but does not have his Epipen
with him he can be given the Epipen from the EMK and administer it himself (or a
family member or friend trained to do so). Permission will not be required for this.
4. Inform the SCCM and Captain.
5. Contact Medlink.
6. Monitor ABC.
7. Sit casualty upright.
8. Administer oxygen.
9. Treat for Shock.
10. Advise the casualty to consult a physician at the end of the flight.




If the casualty cannot self-administer the Epipen or has no previous history:

1st choice: Medlink may instruct a crew member to administer Epipen to the casualty.
They are not obliged to do so if they have not received the necessary training. However
if they choose to assist, a Medlink physician will talk them through the steps necessary
to give the medication.

If unable to contact Medlink
2
nd
choice: PA for Medical Professional on board. The Medical Professional can then
administer the Epipen to the casualty.

If no medical professional comes forward
3
rd
choice: Cabin crew who are trained and competent will be covered to administer
Epipen to the casualty.

For directions on how to administer the Epipen auto-injector refer to sub-section 205,
page 11.

Note: The Epipen in the EMK is generally intended for adults and children above
30 kg body weight. However Medlink may advise it for children of a body weight
less than this.


Appendicitis

Definition

Inflammation of the appendix due to infection

Signs and symptoms
1. Right sided lower abdominal pain.
2. Nausea and vomiting
3. Raised temperature - flushed face.
4. Rapid pulse
5. Constipation
6. Possible shock as condition worsens.

Management
1. Give nothing to eat or drink and no medicine.
2. Let casualty assume most comfortable position.
3. Keep casualty warm.
4. Contact Medlink-Case for Diversion at Captains discretion.

Asthma

Definition

A condition in which the air passages of the lungs go into spasm and constrict, due to
irritation and allergic reactions, making breathing difficult (especially breathing out causing
a wheezing sound). Severe asthma is potentially life threatening.

Causes

1. -Infections such as: cold or flu.
2. -Exercise.
3. -Emotional stress.
4. -Allergic reactions to substances such as: dust, pollen, animal hair.
5. -Changes in weather condition.



Signs and symptoms

1. Difficulty in breathing, especially breathing out.
2. Tight wheezy chest when breathing out
3. Dry cough.
4. Very anxious.
5. Difficulty in speaking.
6. Casualty may develop hypoxia (grey/blue lips and face).
7. Possible loss of consciousness.

Management

Aim

To ease breathing

1. Ask casualty if they have a history of Asthma.
2. Ask casualty to take their own prescribed medication/inhaler.
3. Give Ventolin inhaler (FAP, FAK) if own medication is not available. Allow the
casualty to self-administer as many puffs as he/she require as necessary.
4. Use E-Z spacer (Supplementary EMK). Sub-section 202 page 28.
5. Reassure and calm casualty constantly.
6. Advise casualty to sit upright leaning slightly forward to assist breathing.
7. Administer oxygen (high flow).
8. Loosen tight/restrictive clothing.
9. Monitor pulse and breathing rate.
10. If the casualty becomes unconscious, follow DRSABCD plan and treat as necessary.

Contact Medlink if:

1. Casualty has no previous history of asthma.
2. No improvement after 2 puffs of Ventolin inhaler.
3. Casualty cannot complete a sentence.



Childbirth

For regulations of carriage of expectant mothers on board, refer to sub-section 201
page 14.

Labour

The process of giving birth is known as labour and will last several hours. So there is
plenty of time to prepare for the delivery and contact Medlink. Most expectant mothers
will be well prepared for what will happen during labour. However, a woman who goes
into labour unexpectedly may become very anxious, and you will need to reassure her.

Labour consists of three stages, beginning with the first contraction and ending when
the placenta is delivered after childbirth.
First stage: Full dilation of cervix, the mothers body is preparing to give birth.
Second stage: Delivery of the baby.
Third stage: Delivery of the placenta (after birth).

First Stage
Approximately 4 - 18 hours.

Symptoms
1. Low backache.
2. Regular contractions (moderate/severe cramp like pains).
3. Blood-stained mucus (cervical plug).
4. Rupture of membrane surrounding the baby will give way to flow of blood-stained fluid.
5. Full dilation of cervix.

Management
1. Contact Medlink.
2. Take the lady to the lavatory to evacuate bowels and bladder and ask her to wash
thoroughly between the legs.
3. Select a place of maximum space and privacy. i.e. Galley.
4. Reassure the lady.
5. Collect and prepare:
Blankets and plastic bags to place under mother.
Oxygen.
Emergency Medical Kit.
Delivery Kit:
Mucous extractor
Cord clamps For cabin crew use (sub-section 202, p7 for usage)
Sterile scissors
Spencer Wells artery forceps
Syntometrine injection For medical professionals only

Cool 2 bowls of boiled water - one to clean the mother, the second to clean the
baby's eyes.
One biohazard bag for soiled dressings; another biohazard bag for the placenta.


Note: At this stage decide who will deliver the baby- no colds, sore throats,
infection.
6. Prepare mother with knees parted and drawn back.
7. Wash hands thoroughly and apply sterile gloves.
8. Time how frequently the contractions are occurring.

Second Stage
This stage starts once the cervix is fully dilated. Approximately 10 minutes to 1 hour.

Symptoms
1. Stronger, frequent contractions (every 2-3 minutes).
2. Skin between rectum and vagina will bulge (birth imminent).
3. Mother will feel the urge to push.
4. Emergence of babys head. This is called crowning.

Management
1. Protect rectum with sterile pads.
2. To prevent rapid delivery apply gentle pressure with palm of
hand over baby's head.
3. Ask mother to push with each contraction and to rest in
between contractions.
4. As head appears ask mother to pant.
5. Always support baby's head to prevent it "shooting" out.
6. Once head is delivered check for cord around the neck.

Note: if cord is around babys neck
Attempt to remove cord by gently lifting it over the baby's head. If not possible, place cord
clamps 3 inches (7.5 cms) apart and cut cord when it turns white in between clamps using
the sterile scissors.

7. The baby will now turn and the front shoulder is born with the next contraction.
Continue to support the head while the rest of the body is being delivered.
8. The rest of the baby will now come out.
9. Lift baby onto mother's abdomen by holding under the armpits.
10. Clear mucus from baby's mouth and nose using a mucus extractor. See
diagram below.
11. The baby now starts to breathe and may cry.
12. Take a note of time of delivery.

Use the wider end to suck out the mucous from
the newborns mouth and nose.
Take care when inserting the thinner end
into the newborns mouth and nose.
Mucous will be collected in
this container.
Use of the mucous extractor


Dealing with the cord

Do not stretch the cord.
1. As soon as pulsation has ceased, apply one cord clamp firmly on the umbilical
cord 6 inches (15 cms) from the baby's abdomen. Apply the second cord
clamp 9 inches (23 cms) from the baby's abdomen.
2. Cut the cord, using sterile scissors, when it turns white between the two
clamps.

3. Cover end of baby's cord with sterile gauze pad. Check regularly for signs of
bleeding.

NOTE: Do not remove cord clamps at any time.

Care of baby

1. Dry baby with a towel
2. Clean eyes with cooled boiled water.
3. Wrap baby in a blanket and give to mother.

Third Stage
Approximately 15-30 minutes after the birth of the baby.

Symptom
1. Mother may experience further contractions.

Management:
1. Encourage her to push - do not pull the cord.
2. Keep placenta for Doctor's inspection by placing in a biohazard bag.
3. Monitor mother for excessive bleeding.

Care of mother

1. Clean mother.
2. Apply sanitary pad.
3. Make comfortable and offer warm drinks.
4. Record and monitor pulse regularly.

BABYS
ABDOMEN



Note: Observe for bleeding. Encourage mother to cross legs at the ankle and to breast
feed the baby.

Always arrange for a Doctor and ambulance to meet the flight upon arrival.
Birth on Board Form must be completed before mother and baby leave the aircraft.

If baby fails to breathe adequately after delivery:

1. Clear mouth and nose with mucus extractor
2. Perform gentle mouth to nose and mouth resuscitation.

Colds

Signs and symptoms

1. Runny nose.
2. Chills.
3. Headache/fever

Management

1. Keep casualty warm.
2. Give Panadol tablets for adults, Calpol/Adol for babies and children. See Sub-
Section 202 page 24 for dosage and administration.
3. Give plenty of fluids to drink.
4. Use otrivin if necessary.



Deep Vein Thrombosis

What is Deep Vein Thrombosis?

Is a condition in which a small blood clot or clots develop in the deep veins, usually
in the lower leg. The condition itself is not dangerous, but the complication of
pulmonary embolism can be life threatening. A pulmonary embolism is a blood clot
that travels to the lung. It often cuts off blood circulation making it difficult for the
heart to pump blood and decrease the amount of oxygen available to the body.
About 90% of pulmonary embolisms start in the legs as DVTs.

DVTs may develop during long distance travel because of long periods of
immobility. This immobility may cause a reduction of blood flow and may promote
the formation of a blood clot. This clot reduces or blocks the flow of blood in the
deeper veins and causes swelling and inflammation to the affected limb.

Who is more at risk?

1. More common in the elderly
2. Previous history of DVT
3. Recent major surgery
4. Female passengers who take the Oral Contraceptive Pill(OCP)
5. Pregnant passengers
6. Passengers with coronary artery diseases and certain blood conditions. Many
theories have been proposed for risk factors associating DVT with flying. These
include dehydration, excessive alcohol, poor air quality, changes in circadian
rhythm, and hypoxia.

Signs and Symptoms

1. Pain, swelling, redness at the affected area
2. Affected area feels warm or hot to touch
3. Raised body temperature
4. Joint pain and swelling

Remember the link between DVT and pulmonary embolism. If the passenger suddenly
complains of:

5. Chest pain and or shortness of breath as condition worsens
6. Nausea and Sweating
7. Coughing up blood
8. Becomes unconscious the clot is likely to have traveled and lodged in the lung



Management

1. Monitor ABC.
2. Give Oxygen.
3. Rest and elevate affected leg.
4. Contact Medlink.
5. Medical Professional may prescribe medications to prevent more clots from
forming.
6. Case for Diversion at Captains Discretion.

Prevention
1. To reduce the risk of developing DVT, it is recommended that passengers carry
out frequent and regular stretching exercises, particularly of the lower limbs, during
flight.

2. Encourage passenger to drink plenty of water during the flight and avoid alcohol,
to ensure casualty doesnt become dehydrated.

3. Passengers who have risk factors for DVT should seek medical advice from their
own medical practitioner.

Diabetes

Definition

Lack or absence of insulin in the blood

Insulin regulates blood sugar. Blood sugar may become too high from missing Insulin
Injections, or too low after taking Insulin and missing or not eating enough food.
Hypoglycaemia is sudden in onset, while Hyperglycaemia develops gradually over a
period of days or weeks.

Hypoglycaemia

Low blood sugar
Hypoglycaemia is an in-flight emergency, since the main risk is unconsciousness.



Signs and symptoms
1. Weak, faint, dizzy and light-headed.
2. Tremor/ Shakes
3. Pale, sweaty skin.
4. Possible rapid pulse.
5. Intense hunger.
6. Confused, disorientated - may appear to be drunk.
7. May become aggressive.
8. Limbs may tremble.
9. Possible unconsciousness.

Note: Some or all of these symptoms may be present.

Management

Aim
Raise blood sugar levels as quickly as possible.

1. Give sweet drinks or sugar, honey.
2. Give more substantial food, e.g. a meal, sandwich.
3. If unconscious, treat as the unconscious casualty.
4. Contact Medlink

Hyperglycaemia

High blood sugar
Rare in-flight as it takes 24-48 hours for symptoms to develop. Hyperglycaemia is not an
in-flight emergency since signs/symptoms develop over time.

Signs and symptoms
1. Excessive thirst.
2. High urine output.
3. Dry, warm skin.
4. Acetone breath (nail varnish smell).
5. Loss of appetite.
6. Drowsy& lethargic
7. Restlessness
8. Possible rapid pulse
9. Possible abdominal pain.

Management
1. Encourage casualty to take own Insulin.
2. Encourage the casualty to drink plenty of water.
3. If unconscious, treat as unconscious casualty.
4. Contact Medlink.



Diarrhoea

Signs and symptoms

1. Abdominal pain
2. Runny bowels

Management

1. Give Imodium (see subsection 202 page 20 for dosage and precautions).
2. Offer constipating food e.g. rice.
3. Offer fluids.

Drug Overdose

This may result from an accidental or deliberate overdose, or from drug abuse. Signs
and symptoms vary, depending on the type of drug.

Signs and Symptoms

1. Abnormal Behavior
2. Abnormal Sized Pupils
3. Drowsiness
4. Nausea/Vomiting
5. Sweating
6. Unconsciousness

Management

Conscious casualty

1. Place in a comfortable position.
2. Monitor ABC.
3. Ask casualty about drug taken, quantity.
4. Contact Medlink.

Unconscious casualty
If unconscious treat as an unconscious casualty. Monitor and give oxygen. Contact
Medlink and inform captain.



Ear Distress

Definition

An unequal pressure between outer and middle ear, particularly on descent, this occurs
due to a blockage in the Eustachian tubes from colds, allergies or infection. See sub-
section 210 page 8.

Signs and symptoms

1. Mild to sever pain
2. Partial or total hearing loss
3. Bursting of eardrums causing, initially sharp pain, then relief of pain
4. Possible bleeding from ear
5. In babies and children, crying due to pain

Management

Aim

To relieve the pain

1. Yawning.
2. Swallowing.
3. "Popping" - hold nose, close lips and force air gently out (also known as the
Valsalva Maneuver).
4. Move the jaw out and from side to side.
5. Infants crying/feeding will help to relieve pain.
6. Contact Medlink if necessary.

Note: Do not cover ears with a cup filled with a hot towel, as this may make the
condition worse.



Fainting

Fainting is a brief loss of consciousness due to a sudden drop in blood pressure. It is a
temporary and harmless condition causing a lack of blood supply to the brain. Unlike
shock, the pulse rate becomes slow and gradually will return to normal.

Reasons for fainting

1. Pain.
2. Emotional upset.
3. Excessive hunger.
4. Prolonged standing or sitting which causes the blood supply to pool in the lower
extremities.
5. Low sugar levels.
The casualty usually will come around quickly and recovery is complete.

Signs and symptoms

1. Dizziness and Weakness.
2. Pale face.
3. Sweating.
4. Possible nausea.
5. Casualty may collapse.
6. Brief loss of consciousness.

Management

Aim

Increase blood flow to the brain and make the person comfortable

1. Immediately check D.R.S.A.B.C.D.
2. If the casualty is responsive and has breathing and signs of circulation present,
elevate legs
3. Should you find the casualty is unresponsive with breathing and signs of
circulation present, place in recovery position
4. Sometimes a casualty may feel faint'; the correct position for this casualty is to lay
flat and elevate legs.
5. Give oxygen.

NOTE:
Do not let the casualty stand up until they have recovered completely.
If unconsciousness persists, treat as the unconscious casualty.



Fits And Seizures

Definition
A seizure (sometimes referred to as a fit or convulsion) occurs when there is a brief
electrical disruption in the normal working of the brain. This can cause an involuntary
contraction of many of the bodys muscles.

Types
There are many different types, varying from what looks like a daydream to convulsions
where the body stiffens, falls and shakes and the person may lose consciousness.
1. Tonic / Clonic seizure (Major/Grand mal)
2. Absence (Minor/Petit mal)

Causes
1. Epilepsy
2. Increased blood pressure in
pregnancy
3. Head injury
4. Drug overdose
5. Brain Tumor
6. Imbalance in certain chemicals in
the body
7. Infection in the brain
8. Heat stroke
9. Hypoglycaemia
10. High fever, mainly in children and
infants (see page 32)
11. Poisoning

Triggers that can bring on a fit in a person:
1. Lack of sleep
2. Lack of food
3. Stress

4. Flickering lights
5. Too much alcohol

Major seizures
A tonic clonic seizure or fit is quite obvious and usually follows a pattern. It is divided
into 4 stages:

1. AURA Before a fit, casualty may alert you to certain warning signs, such as
abnormal taste, smell, sound, or sight.
2. TONIC The casualty may give out a loud, sharp cry, become stiff and rigid.
May stop breathing for 30-60 seconds, face flushed or pale. Eyes staring.
3. CLONIC The casualty displays jerky, vigorous movements. Twitching /thrashing
of arms and legs. Clenched jaw - may bite the tongue. Possible foaming at the
mouth. Possible loss of bladder/bowel control. May injure himself/herself at this
time.
4. COMA - Fit is over. Possible unconsciousness for a few minutes after the fit.
Once conscious, they may be confused, dazed or sleepy.

Note: People with epilepsy often carry a Medic alert ID card, bracelet or necklace
giving details or medication.



Management

Aim:

To protect casualty from injury to himself or other passengers

1. Protect from injury, i.e. remove sharp objects, and pad with pillows and
blankets.
2. If possible protect the head. Make space around the casualty.
3. Once fit is over, immediately check A.B.C, place in Recovery position if breathing is
present and allow casualty to awaken naturally.
4. Stay with casualty and monitor condition until fully recovered.
5. Give Oxygen.

Do not:
1. Put anything into casualtys mouth.
2. Restrain the casualty.

Contact Medlink if
1. There is no past history of fitting.
2. Repeated fits occurs.
3. The fit lasts longer than 5 minutes.
4. A child has a fit for the first time.

5. The casualty is pregnant.
6. The fit occur post head injury.
7. Casualty does not regain
consciousness after 10 minutes.

Food Poisoning

Signs and symptoms

1. Nausea
2. Vomiting
3. Diarrhoea
4. Abdominal pain

Management

1. Give fluids. (If the passenger can tolerate them)
2. Have an air sickness bag available.
3. Buscopan can be given for abdominal cramps. Imodium can be given for diarrhoea if
necessary. See subsection 202 page 16 for dosage and precautions.



Heart Disorders

Angina
The name means Chest pain of a crushing nature, experienced when narrowed coronary
arteries are unable to deliver sufficient oxygenated blood to the heart muscle. The heart is
unable to meet the demands of physical exertion, stress, or excitement. This is
particularly so as a result of mild Hypoxia associated with cabin altitude.

Reasons why coronary arteries become narrow:

1. High animal fat intake
2. High cholesterol levels
3. Alcohol and Smoking
4. Lack of exercise
5. Stress ( The modern day illness )

Signs and symptoms

1. Gripping central chest pain can spread to the jaw and down the left arm.
2. Shortness of breath.
3. Skin pale or blue.
4. Pulse weak.
5. May be sweaty.
6. Anxious.
7. Weakness.
8. Nausea and vomiting.
9. Possible shock.

Management

Aim

To ease the strain on the heart, and increase oxygen supply to the heart.

1. Ask casualty for medical history.
2. Give oxygen. (High flow).
3. Encourage casualty to take his/her own medication. If pain is not relieved by
medication, rest and oxygen after 15 minutes, treat as suspected heart attack.
4. Reassure.
5. Monitor closely and encourage casualty to sit upright.
6. Keep casualty at rest, minimize exertion.
7. Contact Medlink. Medlink may advise another tablet to be administered.
8. Inform Captain and SCCM.



A casualty with a history of a heart condition will carry his own medication. Should the
casualty not have his medication, Nitrolingual Spray is carried and Isordil tablet in the
Emergency Medical Kit. Nitrolingual Spray and the Isordil tablet has the effect of
widening the coronary arteries to allow oxygenated blood to get to the heart muscle.
This results in the heart muscle receiving more oxygenated blood and the pain should
then ease. Medlink may order cabin crew to give Nitrolingual Spray or Isordil to a
casualty. See subsection 202 page 17 for dosage and precautions.

Note: Most Angina sufferers respond to their medication and remain well for the
rest of the flight

Heart Attack
A Heart Attack occurs when the blood supply to the heart muscle, is suddenly cut off.
This can be as a result of a blood clot, or a Build Upon the artery wall that completely
blocks the artery. The damage depends largely on how much of the heart muscle is
affected, as the muscle has been starved of oxygenated blood and therefore will die.
Research shows that many people recover well from a heart attack if they are treated
correctly from the beginning; however the main risk during heart attack is that the heart
may stop (Cardiac Arrest).

Causes
Blood clot, fatty deposits.

Signs and symptoms

1. Persistent, central chest pain can spread to the jaw and down the left arm.
2. Very short of breath.
3. Discomfort high in the abdomen (often similar to severe indigestion).
4. Skin pale, blue, sweaty and clammy.
5. Pulse weak and rapid.
6. Nausea/vomiting.
7. Very anxious/frightened.
8. Severe shock.



Management

Aim

To reduce the workload on the heart and reduce pain and shock

1. Ask Casualty for Medical History.
2. If the casualty is conscious, help the casualty into an up right comfortable position
with head and shoulders supported.
3. Ask casualty to take own
medication.
4. Reassure casualty.
5. Give Oxygen (High Flow).
6. Treat for Shock.
7. Contact Medlink.
8. Give aspirin from the FAK or EMK.
See sub-section 202 page 20 for
dosage and precautions
10. Monitor ABC very closely.

Note: If casualty becomes unconscious assess D.R.S.A.B.C.D. (Be prepared to
perform C.P.R. as casualty may go into cardiac arrest) and ask for the Defibrillator
and the SCCM.

Do not move the casualty unnecessarily (This will increase the work load on the heart)
Do not lay casualty flat, as it is more difficult for them to breathe in this position.
On disembarking use the "On Board" wheelchair to move casualty.
Could be a case for diversion At Captain's discretion

Always treat chest pain as a heart attack. If

1. The casualty has never had chest pain before.
2. The chest pain does not ease once the casualty is at rest and with medication and
oxygen.



Cardiac Arrest

This term describes a sudden stoppage of the Heart. Cardiac Arrest is characterised by
the absence of responses, no breathing, no circulation, with dilated pupils.
Remember that the brain is very sensitive to lack of oxygen therefore your response
should be fast and automatic. Immediately commence CP.R.

Causes

As a result of a heart attack, abnormal electrical activity, underlying heart disease

Signs

1. Unconsciousness.
2. Unresponsive.
3. No breathing.
4. No signs of circulation.
5. Dilated pupils.

Management

1. Start C.P.R.
2. Start defibrillation.
3. Perform rescue breaths with the oxygen attached to the pocket mask.
See Sub-Section 205 page 1
4. Contact Medlink.



Heat Related Disorders

Heat Exhaustion

Definition

This condition occurs due to loss of fluid and salts from excessive sweating, caused by
exposure to excessive heat and humidity. It is gradual in onset

Signs and Symptoms

1. The person looks exhausted.
2. Pale, cold, clammy skin.
3. Rapid breathing and pulse.
4. May complain of headache, dizziness and nausea.
5. Muscular cramps due to salt deficiency.
6. Person may suddenly faint.

Management

Aim
Move the casualty to a cool place and replace lost fluids.

1. Lay person flat in a cool place, elevate the legs.
2. If the casualty is 'fully conscious' give small sips of fluids to re-hydrate him/her.
3. If the casualty falls unconscious, check A.B.C. and place in recovery position if
breathing is present.
4. Careful attention should be given to the casualty with heat exhaustion, since this can
develop into a 'heat stroke' - a more critical condition.

Heat Stroke

Definition
A condition caused by exposure to high ambient temperature/humidity and is sudden in
onset.

Signs and symptoms

1. May complain of headache and feeling hot.
2. Weakness, dizziness.
3. Nausea.
4. Hot flushed dry skin.
5. High body temperature - over 41oC.
6. Rapid pulse and breathing rate.




This casualty requires immediate rapid cooling.

1. Use cool compresses e.g. wet towels.
2. Keep head cool.
3. Give cool drinks.
4. Open air vent.
5. Remove excess clothing.
6. If the casualty is conscious, place in a half sitting position with head and shoulders
supported.
7. If the casualty becomes unconscious, check A.B.C. and place in recovery position if
breathing is present.
8. Give oxygen.
9. Contact Medlink.

Hyperventilation

Definition:

Over breathing, causing decreased level of Carbon Dioxide in the blood.
It is most commonly produced by emotional stress, particularly anxiety, apprehension or
fear. It can also be induced by pain or motion sickness. At altitude, hyperventilation might
also rarely be induced by hypoxia. (See Hypoxia Subsection 208 p 24)

It should be noted that the symptoms of hypoxia and hyperventilation are virtually
indistinguishable. Crew must treat both simultaneously.
(USAF Flight Surgeons manual, Chap. 2)

Signs and symptoms:

1. Visible over-breathing, deep and heavy.
2. Dizziness and blurred vision.
3. Tingling at the surface of the skin, followed by muscle spasms in the hands, the feet
and/or the face.
4. Loss of balance and fainting.

Management:

1. Ask casualty to breathe slowly in and out to control breathing rate.
2. Reassurance plays a big part in the management of hyperventilation since the
casualty may be very anxious, which in turn, increases the hyperventilation.
3. Administer oxygen if the casualty complains of tingling and spasm in the hands and
feet and is still hyperventilating, as prolonged hyperventilation maybe a sign of
hypoxia.
4. If the symptoms persist and hypoxia is suspected, contact the captain
immediately and inform him of the situation.



Oxygen is only administered in the aircraft environment. Prolonged
hyperventilation maybe a sign of hypoxia therefore the captain will need to be
notified as soon as possible.

REF: USAF School of Aerospace Medicine, FLIGHT SURGEON'S GUIDE
Viewed on http://wwwsam.brooks.af.mil/af/files/fsguide/CHAP02R.DOC 29/07/06

Hypoxia

Definition
Lack of oxygen in the body cells and tissues.

Causes

This can be due to a wide variety of causes

1. Insufficient oxygen in inspired air (e.g. decompression, smoke inhalation).
2. Airway obstruction (e.g. choking, anaphylactic reaction).
3. Respiratory disorders (e.g. asthma, chest injury).
4. Loss of blood.
5. Spinal injury.

Signs and symptoms

1. Headache and dizziness.
2. Difficulty in breathing.
3. Blue skin, lips, ears and finger nails.
4. Tiredness/fatigue.
5. Loss of co-ordination/concentration.
6. Loss of normal vision.
7. Euphoria.

Management

1. Maintain an open Airway.
2. Treat the cause if possible.
4. Contact Medlink.



Hysterical Attacks

Seldom occurs unless someone is present.

Signs and symptoms
1. Laughing/crying.
2. Eyelids tremor.

Management
1. Monitor situation.
2. Do not give more attention than necessary.

Indigestion

Signs and symptoms

1. Wind pain in the abdomen.
2. Discomfort in the stomach and the chest.

Management

Offer Maalox, Gastro gel tablets. See subsection 202 page 21 for dosage and precautions.



Miscarriage

The term miscarriage refers to the spontaneous loss of pregnancy before the 20th week
of gestation. Most miscarriages occur between 8th to 12th weeks.

Contributory factors of miscarriage in-flight
1. Lack of oxygen in the aircraft cabin.
2. Pressurization.

Signs and symptoms
1. Most commonly vaginal bleeding.
2. Mild to moderate slight lower abdominal pain and backache.
3. Signs of shock.
4. Anxiety.

Management

1. Contact Medlink.
2. Give oxygen.
3. Give reassurance and support.
4. Treat for shock.
5. Pain relief.
6. Counseling at a later stage.

Renal Colic

Definition
Severe pain caused by a urinary stone passing down from the kidney to the bladder and
out.

Signs and symptoms

1. Severe pain - may radiate to one side.
2. Possible rapid pulse.
3. May be burning/urgency on urination.
4. Casualty restless and agitated.

Management

1. Encourage fluids.
2. Warm compress to act as a comfort to casualty
3. Give Buscopan. See subsection 202 page 16 for dosage and precautions



Shock

Definition:

Described as a reduction in the amount of circulating blood volume. This can be the result
of a sudden fall in blood pressure or loss of blood and bodily fluids. When the blood supply
is reduced, especially to the brain, the person can become unconscious.

Shock is found to some degree in nearly all casualties. It should never be
underestimated and always given a high priority when considering the care of an
injured or ill person.

Causes
1. Loss of blood e.g. Internal or External.
2. Loss of body fluids e.g. vomiting, bleeding.
3. Heart disorders i.e. heart attack, angina.
4. Severe burns.
5. Head injuries.

Loss of blood or plasma

Severe bleeding

Will reduce the amount of circulating blood from the circulatory system.

Burns

Severe burns will cause loss of plasma (water content of the blood), resulting in a
reduction in the amount of circulating blood.

Fluids

Fluids are also lost from the body in the form of vomiting, sweating, diarrhoea, urine.

Heart disorders

When the normal working action of the heart is reduced, this will cause a drop in the
blood pressure e.g. Heart attack or Angina.

Dilation of the blood vessels
This can be the result of anaphylactic shock, spinal injury or shock due to severe
infection. When the blood vessel becomes larger, the space inside the vessel becomes
larger and this will cause a drop in the blood pressure.



As there is a reduced amount of circulating blood, the bodys own defense mechanism
must take compensatory action to maintain adequate blood flow to the vital organs.

Signs and symptoms
1. Weakness/dizziness.
2. Rapid/weak pulse.
3. Skin very pale/blue, cold clammy.
4. Severe chill/body shakes.
5. Nausea/vomiting.

6. Slow, verbal response.
7. Restless/agitated.
8. May complain of thirst.
9. Fast/shallow breathing.

Management

Aim
Increase blood supply to the vital organs and treat any specific cause

1. Reassure the casualty, Speak quietly and act calmly.
2. Lay casualty flat and elevate the legs to assist blood flow to the vital organs
especially the brain.
3. Prevent further loss of blood volume by:
Controlling any bleeding.
Cooling burns.
4. The casualty may feel cold, cover with a blanket, do not artificially heat or overheat
the casualty.
5. Monitor closely.
6. Contact Medlink.
7. Give nothing to eat or drink.
8. If the casualty is unconscious and they are breathing, monitor ABC and give
oxygen place in the recovery position.
Some exceptions

If the casualty is displaying signs and symptoms of shock and has difficulty with
breathing or is complaining of chest pain e.g. Angina attack or Heart attack, then
the appropriate position for this casualty is sitting upright supported with pillows, do
not lay this casualty flat since this position will further complicate the breathing and
increase anxiety.



Smoke Inhalation

Any person who has been enclosed in a confined space during a fire should be
assumed to have inhaled smoke.

Source

Fire/Carriage of Dangerous Goods/Cabin contamination (See SEP)

Smoke is a bigger killer than fire itself. Smoke is low in oxygen (which is used up by the
burning of the fire) and may contain toxic fumes from burning materials.

Signs and symptoms

1. Irritation of the air passages causing spasm and swelling, resulting in rapid, noisy,
distressed breathing with coughing and wheezing.
2. Burning in or around the nose or mouth.
3. Soot around the mouth and nose.

Management

1. Do not enter a smoked filled room without proper safety equipment. (See SEP)
2. If possible remove casualty from the source of the smoke.
3. If the casualty is unconscious, open the airway and check breathing be ready to
resuscitate if needed. Place casualty in the recovery position and monitor.
4. Give oxygen.

Stroke

Definition
A bleeding artery or blood clot in the brain. Usually affects middle-aged or elderly.

Signs and symptoms
1. Headache.
2. Flushed face.
3. Strong pulse.
4. Weakness/paralysis down one side of the body.
5. Disorientated /weepy.
6. Slurred/absence of speech.
7. Possible loss of bowel/bladder control.
8. Possible unconsciousness (with noisy breathing).



Management

1. Reassure.
2. Nothing to be given by mouth
3. Lay casualty flat and raise head slightly if possible.
5. Monitor closely.
6. Contact Medlink.

If unconscious
Treat as the unconscious casualty. See sub-section 207 page 5

Temperature Related Disorders

Hypothermia

The effects of a low body temperature vary depending on the speed of onset and the
level to which the body temperature falls. Babies, the elderly and those who are thin
and frail are particularly vulnerable.
Lack of activity, chronic illness and fatigue can increase the risk. Alcohol and drugs can
make the condition worse. See assessing temperature, subsection 206 page 7

Signs and symptoms

1. Shivering.
2. Cold, Pale, Dry skin.
3. Disorientated or irrational behaviour.
4. Lethargy or impaired consciousness.
5. Slow and shallow breathing.
6. Slow and weakening pulse.

Management

1. Prevent the casualty losing more body heat.
2. Re-warm the casualty slowly by covering with blankets (cover head for additional
warmth).
3. Offer warm drinks.
4. Contact Medlink if necessary.
5. Administer Oxygen.
6. Do not over heat.



Fever

An elevated body temperature is usually an indication of a bacterial or viral infection
and may be associated with Measles, Chicken pox, Meningitis, earache, sore throat, flu
or local infections such as an abscess.

A moderate fever is not harmful but a fever 40c (104 F) and above can be dangerous
and may trigger seizures (Febrile Convulsions) in very young children.

Signs and symptoms

1. Raised temperature.
2. Initially pale, chilled feeling with goose pimples shivering and chattering teeth.
3. Later hot, flushed skin and sweating.
4. Headache.
5. Generalised aches and pains.

Management

1. Bring down the fever gradually (Do not use/apply ice).
2. Remove any excessive clothing. Cover with a light covering.
3. Give plenty of cool drinks.
4. Paracetamol can be given to reduce the fever and reduce aches and pains.
(Panadol tablets for adults, Calpol/Adol for babies and children). See Sub-section
202 page 24 for dosage and precautions.
5. Contact Medlink if necessary (especially for babies or young children with high
fever).



Febrile Convulsions

Young children and babies may experience convulsions if their temperature becomes
too high (40C/104 F above)
The words convulsion, fit and seizure mean the same thing.
Febrile convulsions usually last a few minutes and sometimes up to 15 minutes.

Signs and symptoms

1. Signs of fever: hot flushed skin and sweating.
2. Violent muscle twitching.
3. Arched back and clenched fists.
4. Twitching of the face with fixed or upturned eyes.
5. Holding the breath or drooling at the mouth.
6. Loss of or altered level of consciousness.

Management

Aim

To protect the child from injury
To cool the childs body temperature down

1. During the fit:
- Position pillows around the child/ baby to protect from injury.
- Ask the parents to remove excess clothing and blankets leaving only
underpants or nappy.
- Sponge the child with tepid (Luke warm) water, starting at the forehead, moving
downwards.
- Contact Medlink.
- Ensure you that you do not restrain the child/ baby and avoid over-cooling.

2. Once seizure has stopped:
- Keep the airway open by placing the child in recovery position or holding the
baby on their side.
- Monitor child/ baby and reassure parents/ guardians.
- When baby is fully conscious, administer Calpol/ Adol (see subsection 202,
page 24 for dosage and precautions).
- Arrange for Medical Assistance on ground.



Bleeding

Definition
Escape or loss of blood from the circulation

The average-sized adult has about six liters of blood and can safely lose around 500
ml during a blood donation. However, rapid blood loss of one litre or more can lead to
shock and death. A child losing 500 ml can be in extreme danger.

Classification of Bleeding

Bleeding is classified by the type of blood vessel that is damaged: artery, vein or
capillary.

Arterial Bleeding
Arteries carry bright red oxygen-rich blood under pressure from the heart. If an artery is
damaged bleeding may be profuse. Blood will spurt out of the wound in time with the
heartbeat. If a main artery is damaged blood may jet several feet high and the volume
of circulating blood will fall rapidly.

Venous Bleeding
Blood from the vein having given up its oxygen to the tissues, is dark red in colour. It is
under less pressure than arterial blood, however vein walls can widen and the blood
can pool inside them. If a major vein is damaged blood may gush from it profusely.

Capillary Bleeding
Bleeding from capillaries occurs with any wound. At first bleeding may be brisk ,
however blood loss is usually minimal, A blow may rupture capillaries under the skin
causing bleeding into the tissues (bruising).

Types
External bleeding
Internal bleeding

External Bleeding

Signs and symptoms
1. Visible bleeding from a wound.
2. Bruising.
3. Swelling.
4. Pain at the injured site.



Management

Aim
To control bleeding.
To minimize infection.
To prevent and minimize the effects of shock.

1. Apply pressure over the wound. See methods of controlling blood loss on next page.
2. Elevate and support affected limb.
3. Bandage the dressing in place.
4. Monitor closely.
5. Monitor signs of circulation in the affected limb. See subsection 205 page 10.

If necessary
6. Treat for shock.
7. Inform SCCM and Captain.
8. Contact Medlink.

Methods of controlling blood loss

1. Direct pressure and elevation
2. Indirect pressure and elevation
3. Tourniquet, Only as Last Resort (See subsection 205 page 9)

Direct pressure

Apply direct pressure using sterile dressings (see subsection 205 page 7). Maintain
pressure on wound for about 10 minutes. This will allow the blood to clot. Do not remove
original dressing if it becomes saturated with blood. Apply a second dressing over original
dressing. If bleeding continues through second dressing, then remove all dressings and
apply a fresh dressing. Elevate limbs using triangular bandage.



Indirect pressure
If there is a protruding foreign body or a bone (open fracture), build up pads on either
side of the object until they are high enough to bandage over the object without pressing
on it

Amputation

Definition
The force and direction of an injury may be such that a limb, or part of a limb (e.g. a
finger or toe), is partially or completely severed.

It is sometimes possible, using microsurgical techniques, to re plant amputated
parts. The sooner the casualty and severed part reach hospital the better.

Management

Aims
To minimise blood loss and shock
To preserve the injured part

Care of the Casualty

1. Wear gloves and control blood loss by applying direct pressure, and raising the
injured part.
2. Apply a sterile dressing or non-fluffy clean pad and secure with a bandage.
3. Treat the casualty for shock.
4. Contact Medlink and inform Captain.

Care of the Amputated Part

1. Wrap the severed part in kitchen film or a plastic bag.
2. Wrap again in gauze or soft fabric, then place the package in another container (or
another plastic bag) filled with crushed ice. Chilling will help preserve the part.
3. Mark the package with the time of injury, the casualtys name and give it to the
Emergency Services on ground.



Do not
4. Wash the severed part as this causes destruction of the cells.
5. Apply cotton wool to any raw surface.
6. Allow the severed part to come into contact with ice as this leads to frostbite.

Internal Bleeding

Possible causes
Stomach ulcers, miscarriage, fractures, etc

Signs and Symptoms
1. Signs and symptoms of shock may develop.
2. Possible escape of blood from the bodys natural openings e.g. ears, nose.
3. Swelling.
4. Bruising.
5. Pain at the injured site.

Management
1. Assess the situation and take history.
2. Observe for any bruising.
3. Make casualty comfortable and cover with a blanket. If he becomes unconscious,
then handle as unconscious casualty.
4. Administer oxygen if necessary.
5. Give nothing to eat or drink.
6. Treat for shock.
7. Contact Medlink.

Nose Bleeding

Nosebleeds can have various causes such as trauma to the nose, excessive blowing,
sneezing and changes in altitude.

Management

1. Seat passenger upright and tilt head slightly forward to prevent swallowing of blood.
2. Pinch nostrils firmly for 10 minutes then release pressure. If the bleeding has not
stopped ask the casualty to repeat the process until the bleeding stops.
3. After the bleeding has stopped, instruct the casualty to continue breathing through
their mouth.
4. Advise the casualty to rest quietly for few hours and not to blow their nose as this can
disturb blood clots that may have formed in the nose.

Note: If bleeding persists for more than 30 minutes contact Medlink.



Burns

Definition
Damage to the skin caused by extreme temperature of Heat and Cold

Depth of burns

Superficial Burn

Injury to the outer layer of the skin only. Skin appears red and inflamed. Pain in the
affected area.

Partial Thickness Burn

Injury to the outer layer and the underlying tissue. Skin appears red and blistered. Pain in
the affected area.

Full Thickness Burn

The full depth of skin may be damaged with a charred or waxy appearance. There is no
pain due to nerve ending damage

Note: Casualties with full thickness burns will have areas of superficial and partial
thickness burns (for example at the edges) and may still have severe pain.

Management

Aim
To cool the burning process and prevent infection

1. Place affected area in cool water for approximately 10 minutes.
2. Remove jewelry or constricting clothing from injured area before swelling occurs.
3. Apply burn dressing, e.g. water gel dressing or Silvadiazine cream to prevent
contamination and infection.
4. Cover with loose dressing. Do not apply pressure to the burn.
5. Elevate affected part when possible, to reduce swelling.

If necessary
6. Treat for shock.
7. Advise Purser/SFS and Captain
8. Contact Medlink.




Burns dressings Location
Use
Watergel/Hydrogel dressing FAK
All types and depths of burns
Do not leave on the skin for
more than 4 hrs.

Do not:
1. Put ice directly on the skin.
2. Touch, cough or sneeze over a burn.
3. Use adhesive dressings or apply bandages too tight.
4. Break blisters.
5. Apply lotions, ointments, creams or fats to the affected area.
6. Remove anything that is sticking to the burn or interfering with the injured area.

NOTE
For all depth of burns, once a burn has been cooled and Silvadiazine cream applied,
plastic cling film (found in the galley) can be used as an alternative to a sterile dressing
over the burnt area. Ensure that the first two turns of the roll are removed prior to use.



Dislocations

Definition

Displacement of one or more bones at a joint, e.g. shoulders, fingers.

Signs and symptoms

1. Severe pain.
2. Deformity of joint.
3. Loss of movement of affected limb.
4. Swelling and possible bruising.
5. Possible shock.

Management

1. Immobilise and support using Sam Splint, padding, sling, bandages.
2. Apply a cold pack if swelling appears.
3. Reassure the passenger.
4. Seek medical advice.

Note: Do not try to put a dislocation back into its joint.

Eye Injury

Foreign Body in the Eye (Non-Embedded)

Signs and symptoms:

1. Blurred Vision.
2. Pain or discomfort.
3. Redness and watering of the eye.

Management

1. Do not rub the eye.
2. Do not attempt to remove with a sharp instrument.
3. If simple chemicals in the eye, wash with water.
4. If foreign body is visible, attempt to wash with water cover with sterile pad.
5. Eye drops can be used for minor eye irritants and minor eye infections.




Foreign Body in the Eye (Embedded)

Signs and symptoms:

1. Intense pain.
2. Bruising or swelling of eyelids and area around eye.
3. Visible wound and/ or bloodshot appearance.
4. Partial or loss of vision.

Management

1. Do not attempt to remove a sharp or foreign body, which has pierced the eye.
2. Tell casualty to keep both eyes still.
3. Cover affected eye with a sterile dressing and secure with a bandage.
4. Reassure and offer pain relief.

Fractures

Definition

A crack or break in a bone.

Types of fractures
Closed
Open

Closed Fractures
The bone is broken, but the surrounding skin is intact.

Signs and symptoms

1. Casualty will feel or hear bone break.
2. Pain, tenderness, deformity.
3. Partial or complete loss of movement.
4. Swelling and bruising.
5. Possible shock.



Management

Aim
To prevent movement at the injury site

1. Steady and support affected part.
2. Immobilise by using a Sam splint or other padding.
3. Secure the splint with bandages.
4. If possible, elevate affected part after securing a splint around the area.
5. Treat for shock.
6. Check the circulation beyond the splint.

Open Fractures

The bone is broken and protrudes through the skin.

Signs and symptoms (As per Closed Fracture Points1-5)
6. Wound.
7. Protruding bone.
8. Moderate - severe bleeding.

Management

Aim
To prevent blood loss, movement, and infection at the site of injury

1. Put on gloves.
2. Cover the wound with a sterile dressing and apply pressure around the bone to
control bleeding.
3. Build up bandages or clean soft material around the bone until you can bandage
over the pads.
4. Secure the dressing and bandage firmly and check the circulation beyond the
bandage.
5. Immobilise the injured part as for a closed fracture.

Do not press down directly on a protruding bone end.
Rolled up bandages can be used on either side of the wound.

Note: Do not attempt to straighten/realign fractured limbs.



Head Injury

Definition
Injury to the brain, spinal cord or bones of the head

Causes
Impact from a falling object from galleys and hatracks and turbulence

Signs and symptoms

1. Headache
2. Nausea or vomiting
3. Dizziness/Restlessness
4. Confusion/loss of memory
5. Slow - strong pulse.
6. Deep or irregular breathing

7. Fractures with or without bleeding
8. Seizures - often at the time of injury or
thereafter
9. Blood or clear fluid draining from the
ear
10. Altered levels of consciousness

Management

Responsive Casualty

1. Do not move casualtys head or neck.
Keep absolutely still.
2. Control any bleeding. Dress wound.
3. Give oxygen (high flow.)
4. Reassess for altering levels of
consciousness
5. Assess for signs and symptoms of
shock.
6. Contact Medlink

Unresponsive Casualty

1. Check ABC, do not move casualty.
2. Open airway.
3. If breathing, give oxygen high flow.
4. Blood/clear fluid draining from the ear
should be covered with a sterile pad.
5. If the casualty is unconscious after 3
minutes, suspect a more serious
injury.
6. Contact Medlink

Note: A responsive casualty can become unresponsive at any time



Neck And Back Injuries

The possibility of neck and back injuries must always be suspected in any accident where
force has been involved such as a fall or blow to the head.
A neck injury must also be suspected in all unconscious casualties who have had a
head injury.

Signs and Symptoms

1. Possible pain or tenderness in neck or back.
2. Loss of sensation or weakness in legs and /or arms.
3. Difficulty in moving arms and legs.
4. Loss of sensation in areas below injury site.
5. Difficulty in Breathing.
6. Signs of head injuries, e.g. bruising, swelling or wound.

Management

1. Do not move the casualty from the position found.
2. Assess dangers around.
3. Reassure casualty and tell them not to move.
4. Assess the casualty to determine the nature and severity of injury.
5. If bleeding is present attend to injury without moving the head.
6. Kneel behind the casualtys head and keep the head aligned with the neck and
spine. This can be achieved by placing your hands on either side of the head and
supporting it.

If you are unable to support the head, place rolled up blankets or articles or clothing on
either side of the casualtys head, neck and shoulders.

7. Monitor the casualty for loss of consciousness.
8. Maintain the support until medical assistance takes over.
9. Give Oxygen, high flow.

Note: If the casualty becomes unconscious do not move the casualty, maintain
open airway, and monitor ABC until Medical assistance takes over on ground.



Sprains

Definition

Injury caused by overstretching of a ligament at a joint.

Signs and symptoms

Pain.
Swelling.
Bruising.
Loss of movement.

Strains

Definition

Overstretching/tearing of a muscle or tendon.

Symptoms

Pain.
Stiffness and cramp.

Management of sprains/strains

The R.I.C.E. Procedure

R Rest effected part
I Ice, to reduce swelling
C Compression using cream bandage.See subsection 205 page 7
E Elevation

Note: If in doubt, always treat injured part as a fracture



Chest injuries

The heart and lungs and the major blood vessels around them lie within the chest.
These structures are protected by the breast bone and the 12 pairs of ribs that make up
the rib cage. The ribcage extends far enough downwards to protect the upper
abdominal organs.

Penetrating Chest Injury (Including Pneumothorax)

Signs and Symptoms

1. Visible signs of a wound (e.g. bleeding)
2. Difficult and painful breathing, possibly rapid, shallow and uneven
3. Severe anxiety
4. Sharp pain on taking a deep breath
5. Grey-blue skin (lips, earlobes and nail-beds)
6. Possible coughing up of frothy, red blood
7. Sucking sound as air moves in and out of the wound
8. Signs and symptoms of shock

Management

Aims
To seal the wound and maintain breathing
To minimize shock
To arrange urgent contact with Medlink

1. Reassure casualty
2. Apply disposable gloves
3. Encourage casualty to lean towards the injured side
4. Cover the wound with Melolin dressing
5. Cover Melolin with plastic bag, foil or kitchen film and seal along three sides,
leaving one side unsealed
6. Monitor vital signs
7. Administer oxygen
8. Treat for shock
9. Inform Captain
10. Contact Medlink
11. If casualty becomes unconscious follow DRSABCD



Ribcage Injuries

Ribs may be fractured by direct force to the chest, from a blow or a fall, or by indirect
force produced in a crush injury.

Signs and Symptoms

1. Sharp pain at the site of the fracture
2. Pain on taking a deep breath
3. Shallow breathing
4. Difficulty in breathing
5. Possible open wound over the fracture, through which you might hear air
being sucked into the chest cavity
6. Signs and symptoms of shock

Management

Aims
To support the chest wall
To arrange contact with Medlink

Closed Rib Fracture

1. Reassure the casualty
2. Support the arm on the injured side using an elevation sling (see subsection
205 page 7)
3. Contact Medlink
4. Inform Captain

Open or Multiple Rib Fractures

1. Cover and seal any wound to chest wall (refer to Penetrating Chest Wounds
subsection 209 page 13)
2. Encourage casualty to lean towards the injured side
3. Support the arm on affected side using elevation sling (refer to subsection
205 page 7)
5. Contact Medlink urgently
6. Inform Captain
7. If casualty becomes unconscious follow DRSABCD (chest compressions
should be administered if required)



Abdominal Injuries

The abdominal organs have little protection at the front therefore they are prone to
injury.

Signs and Symptoms

Possible signs of bleeding (e.g. in penetrating wounds)
Signs and symptoms of internal bleeding (swelling and bruising)
Severe pain
Possible vomiting
Signs and symptoms of shock

Management

Aims
To minimize shock
To seal the wound
To arrange contact with Medlink

1. Apply disposable gloves
2. Lie flat with knees bent (use pillow to support knees if necessary)
3. Cover wound with Melolin dressing and secure with Micropore tape
4. Do not remove an object that has punctured the abdomen (e.g. in penetrating
wounds)
5. Control bleeding using direct or indirect pressure (whichever is applicable)
6. If casualty vomits or coughs put pressure on or around wound to avoid
expulsion of abdominal contents
8. Monitor vital signs
9. Inform Captain
10. Contact Medlink

Note: Do not touch protruding abdominal contents. Cover the area with cling film to
prevent contents from drying out. (refer to subsection 209 page 6 for guidelines on the
use of cling film).


Effective Date:





Travel Health
Infectious Diseases - Information And Precautions

Disease Incubation Period Spread By Recognition Precautions on Board
Hepatitis A 3-6weeks Faecal /Oral Routes
Mild Fever, Diarrhoea, Nausea
Vomiting, Abdominal Pain
Use Gloves for all body
fluids.
Good hygiene standards
Washing of hands is
imperative.

Hepatitis E 6 weeks Faecal /Oral Route As Above

As Above

Hepatitis B,C,D
Hep B.1 to 5 months
Hep C.2 -26 weeks
Infected Blood and blood
products, sexual contact with
an infected person.
In acute illness, mild fever, joint
pain and rash.
As Above
Tuberculosis from weeks to years
Droplet form, infected
Sputum and cough,
sneezing.
If a casualty is coughing Possible
fever, recent weight loss, liaise
with purser/Captain who could
possibly offload casualty.
Transmission has only
been recorded In-flight of >
8 hours. (W.H.O.) If
possible move casualty to
an empty area of the
cabin.
Chicken Pox
10-21 days after contact
with an infected person.
Person to Person by direct
contact or airborne from an
infected person
coughing/Sneezing.
Fever, headache, intense itching.
Avoid direct contact with
person if they have blisters
Scabies
4-6 weeks if never had
scabies before several
days if casualty has had
scabies in the past.

skin to skin contact with a
person already infected with
scabies
itching specially webs
in between fingers, wrist, elbow
Avoid prolonged contact.
Shaking of hands will not
usually spread infection.



Disease Incubation Period Spread By Recognition Precautions on Board
Measles 9-21 days
Secretions from nose or
mouth airborne droplets
fever, cough, conjunctivitis
Red blotchy rash.
Use gloves for body fluids.
Washing of hands is
important.
Malaria
10days up to 4 weeks
can be up to 1 year
From a bite from Malaria
infected mosquito. This
mosquito bites from dusk to
dawn
Headache, fever, flu like illness.
Insecticide Spray It cannot
be transmitted from
touching a person with
malaria.
HIV
can take up to
10 years for symptoms
to develop.
direct contact with blood or
body fluid of someone who is
infected with the Virus
No immediate physical signs. Can
take up to 10 years for Symptoms
to show. Some are persistent -
diarrhoea, night sweats
pneumonia
Universal precautions,
wearing gloves when
dealing with body fluids.

It must be remembered that the passenger should be treated with respect at all times, regardless of the crewmembers
personal view or the passengers appearance. Always extend the normal 'Emirates' courtesy and consideration to all our
passengers.
It is always recommended that for general hygiene and safety, crewmembers wear gloves and apply precautions when dealing with
a First Response situation, e.g. bleeding, vomiting or handling wounds. Always thoroughly wash hands after contact with bodily
fluids.



Immunisation
All flying staff must ensure their immunisations as required and advised by the airline are
kept up to date. Any queries should be referred to the Emirates Clinic Nurse Advise Line.
Crew will not be offloaded for not having their vaccinations up to date with the exception of
Yellow Fever. This is mandatory for certain parts of Africa and South America. If your
vaccinations have expired please book an appointment with the Clinic Nurse as soon as
possible to have them updated.

B.C.G (Bacillus Calmette Guerin) against tuberculosis:
Booster normally done once in a lifetime. Crew are checked for a scar- if no scar crew
must book in for a PPD skin test which is read 3 days later. If no reaction- BCG advised.
BCG is not mandatory but advised by the clinic. PPD skin test is mandatory every 2
years.

Typhoid:
One vaccine booster every three years.

Hepatitis A and B combined vaccine:
3 doses needed.0, 4weeks and third dose 6 months after the first dose.
Hepatitis A booster given every 10years (life cover).
As per EK Medical Clinic protocol if full course of Hep B given no booster required.

Hepatitis A:
1 dose is needed. Booster is needed 6 -12months later then every 10 years thereafter
(life cover).

Hepatitis B:
3 doses needed 0,28 days and 6 months later. Rapid schedule of 0,4 weeks,8 weeks
and then 1 year later (life cover) or rapid schedule 0,7days,21 days booster after 1 year
(booster required due to rapid course).

Meningitis ACWY:
1 injection required. Booster required every 3 years.

Yellow Fever:
One injection. Booster required every 10 years.

Poliomyelitis:
Oral vaccination given every 10 years.

Boostrix (Diphtheria/Tetanus/Inactivated polio/pertussis):
1 injection. Booster required every 10 years

Varicella immunisation:
Required if have not previously had chickenpox. 2 doses required 4-8 weeks apart.

MMR (Measles, mumps and Rubella):
Two doses 3 months apart (if had one of the diseases booster only given).



Key Facts For First Responders

What is AIDS?

Acquired Immune Deficiency Syndrome; a condition which results from a breakdown of
the immune system; the bodys own defense mechanism against infection. This is
caused as far as Doctors know by the Human Immunodefiency Virus or H.I.V

What is Hepatitis?

It is an Acute (sudden) or Chronic (long-term) inflammation of the liver caused by a virus
called Hepatitis B, spread by contact with infected blood and blood products which
presents a risk to health care workers and first aiders.

HIV and Hepatitis B

How are these Two Viruses Transmitted?

Unprotected sexual intercourse with an infected person. Safe sex needs to be
practiced all the time.
Blood or blood products entering the blood stream e.g.- Drug users sharing infected
injecting equipment
From an infected mother to her baby
In addition, Hepatitis A can also be transmitted via other bodily fluids such as saliva
contaminated water and urine if they are able to gain entry into the blood stream
through broken skin, the eyes, or the lining of the nose and throat.

Note: You cannot contract either the HIV or Hepatitis virus from social contact with a
person e.g. - shaking hands, removing a customer tray or by having a conversation.

What are the risks to me as a first responder?

It is almost inevitable that at some point, you as a first responder may come into contact
with blood or bodily fluids. Although A.I.D.S and Hepatitis are both serious conditions, if
simple precautions are followed the risk of you contracting either of the two viruses is
extremely small.

We cannot tell by looking at a person if they are infected by A.I.D.S, HIV or Hepatitis.
Therefore it is sensible when handling blood or bodily fluids as possibly infectious and
to take precautions

Precautions

Always cover any cuts or broken skin you may have with water proof dressings
Wash hands before and after treating a casualty
When handling scissors and other sharp instruments do so with care



Should you accidentally injure yourself, encourage the wound to bleed by squeezing
and hold under running water for several minutes. Finally wash the area with soap
and water.
If for any reason you are accidentally splashed in the eye or mouth , quickly rinse
area well with cold clean water
Gloves should be worn where possible
Report incident and seek medical advice.

Communicable Diseases:
The following are general guidelines based on IATA recommendations for cabin crew
when facing a suspected case of communicable disease on board. During an outbreak
of a specific communicable disease, Emirates Medical Services may modify or add
further procedures to these general guidelines with the guidance of IATA/WHO.

Aim:
To provide cabin crew with the knowledge on how to manage a suspected case of a
communicable disease on board the aircraft.

Definition:
A communicable disease is one that can be transmitted from an infected person to
another.

A communicable disease is suspected when a traveler or a crewmember exhibits one or
more of the following signs or symptoms:
- Appearing obviously unwell
- Persistent coughing
- Impaired breathing
- Persistent diarrhea
- Persistent vomiting
- Skin rash
- Bruising or bleeding without previous injury
- Confusion of recent onset
If associated with a fever (temperature of 38C or greater), the likelihood that the
passenger is suffering a communicable disease is increased.

Note: If in-flight food poisoning is suspected, proceed as per existing protocol.



Procedures:
1. Contact Medlink immediately and follow their advice, taking into consideration Step 2
below. If unable to establish connection, PA for medical assistance on board.
2. If no medical support is available:
2.1 Relocate the ill passenger to a more isolated area of the cabin if appropriate
and if space is available. If the ill traveler is relocated make sure that the cleaning
crew at destination will be advised to clean both locations.
2.2 Designate one cabin crew to look after the ill traveler, preferably the cabin crew
that has already been dealing with this traveler. More than one cabin crew may be
necessary if more care is required.
2.3 Retrieve the hygiene kit from its storage; refer to Subsection 202 p30 for
information relating to the Universal Precaution Kit (Hygiene Kit).
2.4 If possible, designate a specific toilet for the exclusive use of the ill traveler. If not
possible, clean and disinfect the commonly touched surfaces of the toilets (faucet,
door handles, waste bin cover, counter top) with soap and water, and disinfectant
wipes available in the Universal Precaution Kit, after each use by the ill traveler.
2.5 The ill passenger should be asked to wear a medical (N95) mask provided from
the Universal Precaution Kit. As soon as the mask becomes damp/ humid, it
should be replaced by a new one. These masks should not be reused but safely
disposed afterwards in the biohazard bag. After touching the used mask, proper
hand hygiene must be practiced immediately.
2.6 If the ill traveler is coughing ask him/her to follow respiratory etiquette:
a. Provide tissues and advice to use the tissues to cover the mouth and nose
when speaking, sneezing and coughing.
b. Advise the ill traveler to practice proper hand hygiene. If the hands become
visibly soiled they must be washed with soap and water.
c. Provide an air sickness bag for used tissues; dispose this in the biohazard bag.
2.7 If the ill traveler cannot tolerate a mask, the designated cabin crew member(s),
or any person in close contact (less than 1 meter) with the ill traveler, should wear
a medical mask. When wearing a mask, crew must ensure that handface contact,
adjusting or removing the mask, be kept to a minimum.
2.8 The designated crew should wear disposable gloves when assisting the sick
passenger and when in direct contact with blood or other body fluids. Gloves are
not intended to replace proper hand hygiene. Gloves should be carefully removed
and discarded into the biohazard bag. Hands should be washed with soap and
water. An alcohol-based hand rub can be used if the hands are not visibly soiled.
2.9 Ask accompanying traveler(s) spouse, children, friends, etc., if they have any
similar symptoms.
2.10 Ensure hand carried cabin baggage follows the ill traveler and comply with
Public Health Authoritys requests.
2.11 Store soiled items (used tissues, disposable masks, oxygen mask, tubing,
linen, pillows, blankets, seat pocket items, etc) in a biohazard bag. This
biohazard bag should be sealed tightly, stored in an upright position. Notify
cleaning crew so that disposal can be done following their protocols.



2.12 Store unused and unsoiled items back in the hygiene kit and reseal with red
tag. An entry should be made in the cabin log book. Engineering will return the kit
to Medical Services for restocking.
3. As soon as possible advise the captain of the situation because he/she is
required by International Health Regulations (ICAO and WHO regulated) to
report the suspected case(s) to the destination ATC before arrival. The report
should include passenger information such as: name, age, seat number,
approximate body temperature and countries recently visited (within the last 2
weeks).
Also remind the Captain to advise the destination station that cleaning and
disinfection will be required.
4. Unless stated otherwise by Ground Medical Support or Public Health officials,
ask the passengers in the same row and 2 rows in front and 2 rows behind the ill
traveler to complete a passenger locator card if those cards are available in the
aircraft. Otherwise this should be done at the destination station.
5. If a traveler with a communicable disease is identified, it is most important that on
arrival the cleaners are made aware of the location(s) where the traveler was
seated.
In Dubai:
If the cleaner is not available, or does not understand your instructions, then call
the DNATA Cleaning Duty Officer 050-6253020. As backup you can call the
Dubai Duty Manager Airport Services (MAS) 050-5521096.
Outstations:
All bio hazard waste must be placed in a bio hazard bag and sealed tightly. On
arrival please liaise with the aircraft cleaning supervisor who will advise of the
correct procedure appropriate to the station. If you are having difficulty at any of
the Outstations as regards cleaning and disinfection call the MAS (Outstations)
on +971-4-7081099.

NOTE: When dealing with customers with communicable diseases onboard
flights to and from the US, please refer to section 201, page 22-24 for additional
regulations in accordance to the Air Carrier Access Act (ACAA).

Section 700 of the green Cabin Crew Manual also provides details regarding the
ACAA ruling in terms of communicable diseases.



Guidelines And Administrative Procedures For

The Prevention Of Cross Infection.

Issued By: Group Medical Training.

Issuing Date: 15-July-2012

PERIODIC REVIEW

BIANNUAL

STANDARD OPERATING PROCEDURES FOR PREVENTION OF CROSS
INFECTION.




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STANDARD OPERATING PROCEDURES FOR PREVENTION OF
CROSS INFECTION

Title: Guidelines and Procedures for the prevention of cross infection.

CONTENTS:

1. PURPOSE AND SCOPE.

2. RESPONSIBILITIES.

3. DEFINITION.

4. POLICY.

5. PROCEDURE:

5.0.1 Introduction
5.0.2 Protection from infection
5.0.3 CPR training Maniquins
5.0.4 Hand Washing
5.0.5 Use of barriers
5.0.6 Dealing with waste

6. DOCUMENTATION

7. APPLICABILITY.

8. NON-COMPLIANCE.

9. ADDITIONAL NOTES.

10. PERIODIC REVIEW.




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1. PURPOSE & SCOPE:

This document is to provide guidelines and direction to all staff within Group
Medical Training (GMT) and Emirates Cabin Crew in order to assist in the
prevention of cross infection of organisms or bacteria from one person to another
by following a safe work practice.

This safe work practice applies to all persons, (regardless of status), in the
handling of all bodily fluids including blood (including dried blood), saliva, non-
intact skin and mucous membranes. It is important to understand that all bodily
fluids carry a potential risk of infection.

2. RESPONSIBILITIES:

Staff within GMT and Emirates Cabin crew must follow and adhere to these
guidelines.
GMT Department Training Manager (Sheree Hassan) will review policies and
procedures in terms of effectiveness and compliance and submit
recommendations.

3. DEFINITION:

Infections are diseases that cause infections to the human body and are
transmitted by contact or by cross infection. Infection may be due to bacteria,
viruses, parasites or fungi. The usual methods of transmitting are direct contact
(contact with an infected person), indirect contact (contact with infected materials),
airborne infection or through an insect.




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Title: Guidelines and Procedures for the prevention of cross
infection.

4. POLICY:

This policy is to ensure that staff working in the training department or cabin crew
who are care givers or treat patients who are ill or injured, are trained to protect
themselves from injury and infection. To ensure that this process is carried out
safely, the following guidelines are recommended.

It is the responsibility of each staff within GMT and each crew member to
ensure that these procedures are followed and implemented.

5. PROCEDURE:

5.0.1 INTRODUCTION:
When carrying out medical procedures, it is important that medical staff coming in
contact with patients protect themselves from injury and infection. One of the
primary rules is to ensure that the situation is safe before treating a casualty. Bear
in mind that infection may be a risk, even with relatively minor injuries, so staff
need to take steps to avoid contracting an infection from a casualty or passing on
any infection to the casualty.

On several occasions GMT staff have been called to assist in a medical incident
that involves a sick or injured casualty during their duty period. Part of this service
could involve a risk of contracting or transmitting infection (especially blood borne
viruses such as hepatitis B, and Human Immuno deficiency virus (HIV) which can
only be transmitted by blood to blood contact) if an infected persons blood makes
contact with a graze or cut on the health care providers skin.

Fear of acquiring infection, especially HIV infection, can delay prompt initiation of
mouth-to-mouth ventilation. Although pathogens can be




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Title: Guidelines and Procedures for the prevention of cross
infection.

isolated from the saliva of infected persons, salivary transmission of
blood borne viruses is unusual and transmission of infection has been rare.
Transmission of hepatitis B virus, hepatitis C virus, or cytomegalovirus during
CPR has not been reported. There have been no reports of infection acquired
during CPR training. Simple infection-control measures, including use of barrier
devices, can reduce the risk for acquisition of an infectious disease during CPR
and CPR training

5.0.2 PROTECTION FROM INFECTION (IMMUNISATION):

It is recommended that all medical trained personnel are immunised against
communicable diseases especially Hepatitis B. Currently there is no vaccine
against hepatitis C or HIV. There is no evidence to suggest that hepatitis or HIV
being transmitted during resuscitation. If staff for some reason have been
exposed to any infection as mentioned above after giving first aid, seek medical
aid immediately.

5.0.3 CPR TRAINING MANIQUINS:

Although the spread of infection through the use of training mannequins has
more in common with transmission through fomites or endoscopes than with
transmission through contact with living patients, the use of precautions has been
extended to CPR training since the possibility that mannequins might harbour
infectious agents has been raised.
The general guidelines for the prevention of cross infection while using the
training mannequins recommend that thorough disinfection is required if more
than one trainee is using the same mannequin. The use of high level mannequin
disinfectant wipes can be used between each trainee commencing CPR. The
mannequin wipe must be kept in place after the mannequins mouth and nose is
cleaned vigorously. The wipe must remain in place for 30 sec.

Alternatively the use of mannequin face shields is recommended for proper
hygienic conditions during training. The mannequin face shields



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are designed to allow inexpensive barrier protection and to train the use of
Resusci Patient face shields made for use in real cases.

If a crew member who is being assessed on CPR skills is identified as having a
cold or with Herpes infection, the use of a barrier device is highly recommended.
Alternatively this crew member can be assessed at the end after all other cabin
crew members have been assessed, since this will limit the spread of infection.
Once the face shield has been used it must be discarded appropriately (refer to
waste disposal below 5.0.6)

The mannequin face shields can be reused after thorough disinfection
techniques, by using a high level disinfectant. (Vikron or equivalent) which is
diluted for 5 litres of water (1% solution).

The used mannequin faces are to be immersed in the 1% Vikron solution for at
least 10 minutes. All stubborn stains to be scrubbed and then rinsed off with
fresh water. Once the faces have been dried they can be reassembled and
mounted back onto the mannequin. Alternatively the faces can be disposed off
on a weekly basis and new faces used on the mannequin as long as disinfectant
wipes are used between trainees demonstrating CPR.

If a biohazardous exposure has occurred (if blood or open sores were apparent
in the patient's mouth and mouth-to-mouth ventilation was performed or if a
member of the resuscitation team sustained a needlestick or a mucous
membrane or non-intact skin exposure to the patient's blood) the patient should
be tested for infection with bloodborne viruses.

5.0.4 HAND WASHING:

Even with the emphasis on use of gloves for contact with client secretions,
nothing is more effective in preventing the spread of infection than hand washing.




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If facilities are available, wash hands thoroughly with soap and water before and
after treating the casualty. A through hand wash should be done for 15 30
seconds, focusing under fingernails ,and wash hands from hands up to the
elbows.

5.0.5 USE OF BARRIERS:

The use of barriers is normally recommended to prevent cross infection. The
most commonly used barriers are masks, gowns, gloves, bagging of
contaminated equipment. With the advent of AIDS, goggles or face shields have
been added to prevent cross infection.

MASKS: Masks prevent transmission of infectious viruses through the air. They
protect the wearer from inhaling droplets, which are transmitted by close contact
and usually travel a short distance (up to 3 feet). Masks lose their effectiveness if
they are worn for long periods or become wet. They are also ineffective if they
are not changed after caring
for each casualty. Once the mask has been used it must be discarded as
medical waste and disposed of appropriately.
If a mask in unavailable try not to breathe, cough or sneeze over a wound, while
treating a casualty. If a face shield or pocket mask is available, use it when giving
rescue breaths.

GLOVES: Gloves protect personnel from acquiring infectious organisms on the
hands. Gloves also reduce the likelihood that personnel will transmit their own or
other patients infection from their hands to patients. Clean, nonsterile gloves
should be worn when direct contact with moist body substances from any client is
anticipated. Gloves should be changed and discarded between patients or when
they become torn or grossly soiled. Gloves should not be washed and reused,
but discarded appropriately (refer to waste disposal below).

DISPOSABLE APRONS: Use of a plastic apron is recommended when dealing
with large quantities of body fluids. Once the apron has been used it must be
discarded appropriately (refer to waste disposal below).

NOTE: Cover cuts and grazes on hands with waterproof dressings. Avoid
touching a wound or touching any part of a dressing that will come into




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contact with a wound. Take care not to have a needle stick injury. If this occurs
accidentally wash the area thoroughly and seek medical help
immediately. NEVER RECAP NEEDLES as this could lead to needle stick
injuries.

5.0.6 DEALING WITH WASTE:

Once treatment has been completed, all waste material must be disposed off
carefully to prevent spread of infection. Examples of clinical waste include:
Body fluids: vomit, blood, urine, faeces, semen and saliva

Equipments: needles, lancets, gloves, oxygen tubing, pocket masks, face
shields, suction machine, and manikin lungs.

On board the aircraft:

Dubai:
Biohazard waste must be placed in a biohazard bag (available in the
FAK, EMK, and the Hygiene Kit) sealed tightly and stored upright. Bags
Must not be filled to more than 80% of their capacity.
A sharps container must be used to dispose off sharp objects, such as
Needles, syringes and lancets.
Inform the captain who will then radio ahead and inform the Aircraft Duty
Appearance Supervisor prior to landing- he/ she will meet the aircraft on
arrival and arrange for the safe disposal of the waste.
If contact cannot be established by the captain, the Purser is required to
telephone 6253020 on landing and request assistance.
Extra biohazard bags (if required) can be provided by the supervisor- please
request in advance.

Outstations:
Please contact the aircraft cleaning supervisor on landing who will advise of
the procedures pertaining to the individual station.




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Group Medical Department:

All medical waste must be placed in a yellow biohazard bag and sealed
tightly.
Waste will be disposed of on a weekly basis by an authorized contractor.
(Refer to Standard Operating procedure for the Maintenance of Training
equipment)

6. DOCUMENTATION:

Documentation must be readily available stating any treatments provided to the
sick or injured casualty. If for some reason a staff member has been exposed to
blood borne viruses, must be tested for evidence of infection.

7. APPLICABILITY:

These guidelines apply to all staff handling or in contact with medical waste.

8. NON-COMPLIANCE:

Group Medical Training will be responsible for addressing and reporting issues
pertaining to non compliance of this policy.

Non- compliance of this policy will be immediately addressed and concerned staff
may be subject to training by GMT or may be liable to disciplinary action.




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9. ADDITIONAL NOTES:

A passenger who presents for consultation/treatment should be assured of
confidentiality and privacy. In pursuit of maintaining confidentiality, it is imperative
that treatment be conducted in a professional manner that does not violate the
passengers right to privacy.

10. PERIODIC REVIEW:

A review of this policy will be done yearly from the date of issue. However, if
a need is identified for earlier review, this will be undertaken.




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REFERENCES:

Ballew KA., 1997, Cardiopulmonary resuscitation, British Medical Journal,
314:1462-5.

Cohen HJ, Minkin W, 1985, Transmission of infection during training for
cardiopulmonary resuscitation, Int Medicine , university of Calgary.

Laerdal Medical AS, 1999, Rev A, Resusci Anne catalog, Norway. Pg 10-11.

Ruth F Craven & Constance J. Hirnle, Fundamentals of Nursing, Human Health
and Function, 4th Ed, Lippincott Williams, Philadelphia.

First aid Manual, St Johns ambulance, St Andrews Ambulance association,
British Red cross, 2002, 8th edition, Dorling Kindersley, London.




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REVISION HISTORY:

REVISION DATE DESCRIPTION
1 15-Jan-2007 Original
2 15-July-2012 Updated to the name of GMT
Training Manager

Originator: Training and Development Manager Group Medical Training.

____________________________________________.
Sheree Hassan


Chickenpox:

Chickenpox is highly contagious, infecting up to 90% of people who come into contact
with the disease. It is spread through direct person to person contact, airborne droplet
infection or through contact with infected articles such as clothing and bedding. The
incubation period (time from becoming infected to when symptoms first appear) is from
10 to 21 days. The most infectious period is from 1 to 2 days before the rash appears
but the infection can be spread until all the lesions have crusted over (commonly about
5 to 6 days after onset of illness). It is most commonly seen in children under 10 years
old.
Background:
Chickenpox occurs throughout the year but is most common in winter and spring in the
West. The majority of people are infected in childhood and remain immune for life.
However, current data shows an increasing trend in the number of first infections
affecting older age groups. The reason for this is not known but this has important
consequences as the infection is more serious in adults.

Symptoms of Chickenpox:
A rash that usually begins on the body and face and later often spreads to the scalp
and limbs.

It may also spread to the mucous membranes especially in the mouth and on the
genitals.
The rash is often itchy.
It begins as small red spots which develop into blisters in a couple of hours.
After one or two days, the blisters turn into scabs.
New blisters may appear after two to six days.
The number of blisters differs greatly from one person to another.
The infected person may have a temperature.



These symptoms are mild in young children.
Chickenpox lasts 7 to 10 days in children and longer in adults.
Adults can feel very ill and take longer to recover. They are also more likely than
children to suffer complications.

Treatment:
The treatment mainly consists of easing the symptoms:

The infected person should stay indoors until new blisters have stopped appearing
and all the blisters have scabs to prevent spreading the infection.
Avoid scratching the blisters because of the risk of infection.
Cut the nails short or make the patient wear gloves.
Pay attention to personal hygiene.
Calamine lotion will help to relieve the itching.
Keep the patient in cold surroundings, as heat and sweat may make the itching
worse.
In serious cases of chickenpox in people with a weak immune system, aciclovir (eg
Zovirax tablets/suspension), which works specifically against chickenpox, can be
used.

Aero medical considerations:
Due to the confines of the cabin environment and the nature of its spread, air crews are
at a greater risk of acquiring and spreading the virus compared to the normal
population. A period of approx 10 days will be required for cabin crew and pilots to be
off work whilst they recuperate from this illness as long as there are no complications.
Residual effects with regard to aesthetics like scabs and scars may also pose an issue
for our grooming unit once the infectivity of this condition has waned.


Protocol for crew:

Note: All cabin crew should know their immune status with regard to chickenpox
infection

If you cannot recall having chickenpox previously then you should attend the
Emirates Medical Clinic and have the vaccination.
If you wish to confirm whether you have been exposed to chickenpox or whether you
have had the vaccination, you should book an appointment for a blood test
If you do not want to be vaccinated you should advice the clinic in writing.
The nurse will administer 2 vaccinations approximately 4-8 weeks apart.
If you are then exposed to chickenpox (passengers or other crew), you need only to
watch out for a rash for the next 3 weeks.
If you are exposed and not immune or are unsure of your immune status you should
call the nurse advice line at the clinic.

Reference:
Author Unknown 2007, Centre for Disease Control and Prevention viewed at
http://www.cdc.gov/nip/diseases/varicella/SampleOpEdChickenpox.rtf on 19/05/2007.

Davies EG, Elliman DAC, Hart CA, Nicoll A, Rudd PT 2001, Manual of Childhood
Infections, 2nd edition, Royal College of Paediatrics and Child Health China, p.240-244.

Miller E, Vurdien J, Farrington P 1993, Shift in age in chickenpox, Lancet volume
341:308-9.



Glossary

This Glossary is based on definitions from a variety of Medical literature resources.
Some words have been simplified for the purpose of understanding, particularly for
those cabin crew whom English is not the Mother tongue. Translations of medical terms
in another language are available through Group Medical Training.

Literature that was used as reference are listed below
Australian First Aid manual (St John Ambulance) 2000
Airline Medical Manual (Chapman et al) 1991
Medical Dictionary (Merriam Webster) 1995
Human Body (Diamond Books) 1994
The Rescue 911 Family First Aid & Emergency Care Book (Pocket Books) 1996
Anatomy and Physiology in Health and Illness (Ross and Wilson

A
Abdomen: Part of the body between the chest and the pelvis, containing digestive
organs.
Abdominal thrust: A quick inward and upward movement. Used when attempting to
dislodge a total obstruction of the airway.
Abnormal: Not normal, malformed.
Acetone: The sweet, fruity odour on the breath of a person with Diabetes; when
excessive amounts of sugar (hyperglycaemia) are produced in the body.
Adams apple: A projecting lump of cartilage at the front of the neck.
Adhesive: Sticky
Adjunct: An accessory or auxiliary agent or measure. E.g. An oropharyngeal airway is
an airway management adjunct.
Administer: Apply or give e.g. administer oxygen
Agitated: When someone is restless or unable to be still.
A.I.D.S: Acquired Immune Deficiency Syndrome; condition causing serious illness and
death through breakdown in functioning of the bodys immune system.
Air: A mixture of gases in the atmosphere, including oxygen and carbon dioxide.
Airway: The passage through which air enters and leaves the lungs. Also known as the
nose, mouth and trachea.
Allergic reaction: The bodys abnormal reaction to a substance which it is exposed
to.eg. food, pollen or insect bites. The skin may become red with a rash, lips and face
may swell.



Align: To bring parts into proper co-ordination
Allergy: Hypersensitivity to a substance, causing an abnormal reaction
Amniotic fluid: The fluid surrounding the foetus/ baby in the uterus contained in the
amniotic sac.
Amniotic sac: A thick, transparent sac that holds the foetus/ baby suspended in the
amniotic fluid.
Amputation: Complete or partial removal of a part of the body
Anaemia: Reduced number of red blood cells in the body.
Anaphylactic shock: Form of shock, often severe, that occurs as a result of a violent
allergic reaction.
Anatomy: Refers to the structures of the body.
Angina: A heart condition involving chest pain caused by narrowing of the coronary
arteries around the heart, which leads to a reduced blood supply to the heart muscle
usually occurs after exertion but may occur at rest.
Ankle: The joint connecting the leg and the foot.
Antiseptic: A solution that kills bacteria and helps to prevent their growth.
Anus: The external opening of the rectum.
Anxious: A state of tension, which affects both the mind and body.
Aorta: The large artery rising out of the heart, which supplies oxygenated blood to the
body.
Appearance: The outward look of a person.
Appendix: A short, closed tube attached to the large intestine.
Appendicitis: Inflammation of the appendix
Apply: To put on
Armpit: The arm where it joins the shoulder.
Arterial blood: Oxygenated blood, bright red in colour.
Artery: A blood vessel that carries oxygenated blood away from the heart to the rest of
the body.
Assessment: Evaluation of problems affecting a casualty as indicated by history,
symptoms and signs observed by the first responder.
Asthma: Breathing condition causing small air passages in the lungs to go into spasm
(constrict). Usually due to an allergy e.g. dust, animal hair, pollen. This causes difficulty
in breathing especially breathing out.
Aura: A feeling or warning sign. May indicate the beginning of an epileptic fit/seizure.



B
Bandage: A material used to hold a dressing in place, also to support and elevate an
injured limb
Barotrauma: Injury of a part or organ as a result of changes in barometric pressure.
Basic life support: Maintenance of the airway, breathing and circulation.
Bladder: A sac acting as a reservoir, E.g. Urinary bladder (for urine) Gall bladder (for
bile)
Blister: A collection of fluid under the top layer of skin.
Blood :The fluid that circulates through the heart, arteries, veins and capillaries,
carrying nutrients and oxygen to the cells of the body and removing waste products
such as carbon dioxide.
Blood clot: A jelly like lump of blood caused by a cluster of red cells, white cells and
platelets. This is the bodys normal reaction to stop bleeding from a wound.
Blood pressure: The force exerted by blood against the walls of the blood vessels.
Blood vessel: A tubular structure that transport blood
Blurred: Not clear, hazy
Bone: The dense connective tissue that forms the skeleton.
Bowel: Part of the digestive canal below stomach and duodenum.
Brachial: Artery that runs down the inner side of the arm.
Brain: Part of the central nervous system contained within the skull.
Breastbone: Flat bone (also called sternum) which forms the middle of the chest and
helps separate and support the ribs.
Breathing: An involuntary response of inhaling and exhaling air via the lungs.
Bruise: An injury that does not break the skin but causes damage to the small
underlying blood vessels (capillaries) which leads to an internal bleed and causes
discoloration beneath the skin.
Burn: Damage to the skin caused by extremes of temperature hot and cold;
chemicals; corrosive substances; electricity; friction and radiation.
Superficial burn: A burn causing only reddening of the outer layer of skin.
Partial thickness: A burn extending through the outer layer of skin and
underlying tissue, causing blisters and oedema.
Full thickness: A burn extending through all layers of the skin, at times through
muscle or connective tissue. It can appear white, leathery or black and charred.
Skin grafting is usually necessary to heal a full thickness burn.



C
Capillary: Minute, smallest of the blood vessels, gaseous exchange takes place here.
Carbon dioxide: A gas, which is part of the air that we breathe out. It is a Waste
product of human metabolism.
Cardiac arrest: Term used when the casualty is unresponsive; there is no breathing
and no signs of circulation.
Cardio pulmonary resuscitation (CPR): Combination of Rescue Breathing and chest
compressions. Provides oxygen and pumps the blood around the body.
Carotid artery: The main artery supplying blood to the head. The carotid pulse can be
felt in the neck.
Cartilage: A tough, elastic, connective tissue that covers areas of the ears and nose.
Casualty: A person, alive or dead, who has suffered an accident or sudden illness.
Cerebro-spinal Fluid (CSF): Fluid which surrounds and protects the brain and spinal
cord.
Cervical: Part of the spine. Located at the neck and made up of 7 bones.
Cervix: The lower part of the uterus that extends into the vagina. Opening into the
uterus.
Cervical plug: A collection of thick mucus in the uterine cervix that is often expelled at
the onset of dilation of the cervix. (1st stage of labour)
Chin: The front part of the face below the lips.
Chest: The front of the body from the neck to the stomach.
Choking: A partial or total obstruction of the airway.
Cholesterol: Fatty substance which circulates in blood and may be deposited into walls
of arteries.
Circulation: The flow of blood around the body.
Clammy: An unpleasant sticky, moist damp feeling on the skin
Clonic: The third stage of an epileptic fit.(Seizure)
Closed fracture: Where the bone is broken underneath the skin
Clot: Semi-solid mass of cells and blood products that can build up within the blood
stream.
Collapsed: To suddenly fall down due to illness/injury.
Coma: Complete unconsciousness when all reflexes are absent.
Compress: A folded cloth or pad used for applying pressure to stop bleeding or used as
a wet dressing.
Compression: To apply pressure.



Concussion: Any injury to the brain usually caused by a blow, which leads to an altered
state of consciousness or to unconsciousness.
Congestion: Become blocked with mucus.
Conscious: Awake, alert, responsive (physical and verbally).
Constipation: Difficulty in emptying the bowels due to build up of hardened faeces.
Constrict: To make smaller (become narrow)
Contagious Disease: An infectious disease transmitted by direct or indirect contact.
Contaminated: A term used in reference to a wound or other surface that has been
infected with bacteria. May also refer to polluted water, food or drugs.
Contraction: A shortening or drawing together especially applied to muscle action. e.g.
uterine contraction during childbirth, labour.
Convulsion: See fit.
Cornea: Clear tissue in front of the eye.
Coronary arteries: The vessels which deliver oxygenated blood to the muscles of the
heart.
Counselling: Guidance consultation
CPR: Cardio-Pulmonary Resuscitation. Revival of the heart and lungs.
Crack: Break or split without complete separation of the parts.
Cramp: A painful spasm, usually of a muscle.
Crushing: Pressing, squeezing
D
Dangers: Anything in the surrounding environment that could threaten the safety and
wellbeing of a person.
Defibrillation: Application of a controlled electric shock to attempt to restore heart
rhythm to normal.
Defibrillator: A machine which delivers an electric shock to the heart. Used for Cardiac
arrest.
Deformity: When an organ or body part looks abnormal or distorted .(not in normal
position)
Delivery: The act of giving birth to a baby.
Dehydration: Excessive loss of water, sugar and salt from the body.
Deoxygenated: Blood which has lost much of its oxygen and is returning to the lungs
for a fresh supply. Appears dark red in colour.
Diabetes: Condition in which there is a lack of insulin which is produced in the
pancreas. Insulin regulates our blood sugar levels



Diaphragm: The dome-shaped muscle separating the chest from the abdomen
Diarrhoea: Frequent need to go to the toilet to pass loose/liquid stools.
Dilated pupil: The black part of the eye is enlarged beyond its normal size
Dilation: The process of expanding or enlarging
Disabled: Lacking one or more physical abilities.
Disc: A layer of fibro-elastic tissue between the vertebrae.
Discomfort: To cause distress, mild pain or unease.
Dislocation: Injury in which bones at a joint are pushed out of normal contact with each
other.
Dislodge: Remove from a previously fixed position Disorder: An illness or medical
condition.
Disorientation: A state of mental confusion, particularly relating to time and place.
Dizziness: A light-headed feeling of unsteadiness, due to a reduced amount of oxygen
reaching the brain.
Dressing: A protective covering for a wound; used to stop bleeding and to prevent
contamination of the wound. E.g. Melolin dressing.
Drowsy: Heavy with sleepiness.
E
Electrocution: Injury or death caused by an electrical current.
EMT: Emergency Medical Technician (team situated at the airport)
Embryo: Any organism in the earliest stages of development
Epidermis: Outermost layer of the skin
Epilepsy: A condition of the brain leading to seizures caused by a brief disruption to the
electrical activity of the brain.
Euphoria: An exaggerated feeling of well being.
Eustachian tube: A tube that connects the ear to the back of the throat. This tube is
used to equalise pressure by swallowing or popping.
Exhalation: The act of breathing out
Extremity: A limb, arms, legs, fingers or toes
F
Face shields: Used as a barrier method when administering Rescue Breathing.
Faeces: Waste product passed by the bowel.
Fatigue: Physical or mental exhaustion due to exertion



Febrile (fever): Having an elevated body temperature, feverish. Temperature greater
than 37C.
Fainting: A brief, reversible loss of consciousness caused by insufficient blood supply
to the brain.
Femur: The bone that extends from the pelvis to the knee; the longest and largest bone
of the body; the thigh bone
Fever (febrile): An elevation of the body temperature beyond normal. Temperature
greater than 37 C.
First aid/ first response: Immediate assistance or treatment given to someone injured
or suddenly taken ill.
Fit: Is a simultaneous involuntary contraction of many of the bodys muscles, caused by
a disturbance in the electrical activity of the brain. Same as a convulsion or seizure.
Flu: An acute infection caused by a virus, especially of the respiratory tract.
Flushed: Redness of the face or neck
Foetus: The embryo of a mammal in the later stages of development e.g. baby in
womb.
Food poisoning: A sudden illness, usually vomiting and diarrhoea caused by eating
food contaminated with bacteria.
Forearm: The part of the arm between the elbow and the wrist.
Fracture: A break or crack in a bone
G
Gag reflex: Reflex action of the muscles of the throat when stimulated.
Gestation: The period that the mother carries the baby in the uterus until childbirth
occurs.
Glucose: A simple sugar
H
Haemorrhage: Escape of blood from a ruptured blood vessel. May be internal or
external.
Handicapped: A person with a mental or physical disability that interferes with normal
living.
Headache: A pain felt within the head.
Heart: The hollow, muscular organ that pumps blood around the body.
Heart attack: Chest pain of a crushing nature caused by complete blockage of a
coronary artery.
Heat exhaustion: A condition caused by loss of fluids and salts due to excessive
sweating.
Heat stroke: A serious, life-threatening condition caused by failure of the thermostat in
the brain, due to either prolonged exposure to very hot surroundings or illnesses
causing very high fever.



Hereditary: Inherited/passed down from ancestry i.e. Parents grand parents.
Hiccups: A spasm of the diaphragm producing a sudden breathing in of air resulting in
a characteristic sharp sound.
History (Related to First Response): story of incident or illness obtained from casualty
or witnesses.
HIV: Human Immuno Deficiency Virus causes the clinical illness called AIDS.
Hives: Red or white raised patches on the skin, often associated with severe itching; a
characteristic reaction in allergic responses.
Humidity: A measure of the amount of moisture in the air.
Hygiene: Clean or healthy practices
Hyper: Prefix meaning excessive, or increased
Hyperglycaemia: Excess sugar in the blood
Hyperventilation: Over breathing, which disturbs oxygen/carbon dioxide balance in the
blood.
Hypo: A prefix meaning less than, lack of
Hypoglycaemia: Abnormally low sugar in the blood
Hypoxia: Low oxygen content in the blood, tissues and body cells.
Hysteria: A mental disorder marked by emotional burstouts and often symptoms such
as paralysis.
I
Ice: Frozen state of water, used to reduce swelling post injury.
Immobilisation: To prevent from movement; to hold a part firmly in place. May use the
Sam Splint.
Immunity: The resistance of the body to fight infection.
Impact: The act of one object striking another; collision
Impulse: A stimulus transmitted in a nerve or muscle.
Indigestion: Difficulty in digesting food, a accompanied by stomach pain, heartburn and
belching
Infant / baby: A person aged 0-1 year.
Infection: The invasion and growth of harmful germs in tissues and fluids of the body.
Inflammation: A tissue reaction to disease, irritation, or infection. Characterised by
pain, heat, redness, and swelling
Inhalation: Breathing in
Intact: Left complete or perfect



Insulin: A hormone secreted in the pancreas; essential for the proper metabolism of
blood sugar.
Intestine: The bowel which extends from the stomach to the anus.
Intoxicated: Poisoned, commonly by means of drugs or alcohol causing diminished
mental and physical control.
Impaled object: An object that has caused a puncture wound and remains embedded
(stuck) in the wound.
Irritation: Inflamed, tender
J
Jaw: The movable bony structure in the head that holds the teeth and frames the
mouth.
Jerky: Moving with an irregular or spasmodic motion
Joint: The point at which two bones come together
K
Kidneys: The organs that filter blood and produce urine.
Knee: A hinge joint between the bone in the upper leg and the bones in the lower leg.
L
Labour: The process or period of childbirth especially the muscular contractions of the
uterus designed to expel the fetus from the mother.
Lethal: Deadly.
Lethargy: Drowsiness / sleepiness.
Ligament: Tissue connecting or supporting bones at joints.
Limb: Refers to arm or leg.
Liver: Large organ in the right upper abdomen that excretes bile, metabolises fat and
detoxifies substances such as alcohol etc.
Lumbar: Refers to the lower back
Lungs: The pair of breathing organs found in the chest.
M
Medication: A substance administered for therapeutic reasons, mainly prescribed by
doctors
Membrane: A pliable sheet like tissue that covers lines or connects organs or cells.
Menstruation: The monthly discharge of blood from the uterus, starting at puberty and
lasting until menopause. This occurs in approximate cycles of 28 days.
Midwife: A nurse qualified to deliver babies and to care for women before, during and
after childbirth.



Miscarriage: The loss of a foetus / baby before the 20th week of pregnancy,
Mottled: Characterised by a patchy, discoloured appearance.
Mouth to mouth rescue breathing: First response procedure for giving artificial
ventilation to a casualty. Who is not breathing.
Mouth to nose rescue breathing: An emergency method of Rescue Breathing when
mouth to mouth cannot be used.
Mucus: A slippery secretion that lubricates and protects various body organs.
Muscle: Strong tissue that has the ability to contract so producing movements of the
body
N
Nausea: An unpleasant sensation felt usually before vomiting.
Navel: The belly-button, point of connection where the umbilical cord was attached.
Nerve: A cordlike structure that conveys impulses of sensation and/or of movement
between the brain or spinal cord and other parts of the body.
Nervous system: The brain, spinal cord and nerve branches from the central,
peripheral and autonomic system
Needle: The long hollow pointed part of a syringe which is inserted into the body
Nipple: The small brownish projection in the centre of each breast.
Nostril: Either of the two openings at the end of the nose.
O
Obese: Very fat, overweight.
Oesophagus: The canal which extends from the back of the mouth to the stomach.
Open fracture: A fracture where the bone protrudes (sticks) through the skin.
Open wound: A wound in which the tissues are exposed
Oral: Relating to the mouth.
Organ: A part of the body designed to perform a certain function.
Oxygen: The life-sustaining gas element of the air.
P
Pale: To have a whitish appearance/colour, usually because of illness, shock or fear.
Pancreas: Gland that produces chemical agent such as insulin and glucagon. These
substances regulate the blood sugar level within the body.
Pant: To breathing with noisy gasps after exertion



Partial: Relating to only a part, not complete.
Paralysis: Loss or impairment of motor (movement) or sensory (feeling) function of a
part of the body.
Paraplegic: A person paralysed from the waist down.
Pelvis: The bone structure that forms lowest part of trunk.
Penetrate: To pierce.
Peptic: Caused by pepsin or the digestive juices.
Placenta: A vascular organ attached to the uterine wall that supplies oxygen and
nutrients to the foetus; also called afterbirth.
Plasma: The fluid part of the blood that cells are suspended in.
Platelets: Microscopic cells which float in blood and are involved in the clotting process.
Pollen: A substance produced by the anthers of shed bearing plants consisting of
numerous fire grains containing the male fertilising cells.
Pressure dressing: A dressing with which enough pressure is applied over a wound
site to stop the bleeding.
Profuse: A lot, excessive.
Puffer (Inhaler): device to deliver a regulated dose of asthma medication e.g. Ventolin.
Pulmonary: Relating to the lungs.
Pulse rate: The heart rate determined by counting the number of pulsations (beats) that
occur in an artery as blood is forced through it.
Pupil: The small opening in the centre of the iris (Black Part) of the eye.
Q
Quadriplegic: A person paralysed from the neck down.
R
Ratio: A quotient of two numbers or quantities
Recovery position: Used for an unconscious casualty with breathing and signs of
circulation.
Rectum: The lower part of the alimentary canal, ending in the anus.
Rescue breathing: Movement of air into and out of the lungs by artificial means,
commonly known in first response, as mouth to mouth.
Respiratory arrest: The term used when a casualty has stopped breathing, but signs of
circulation are present.



Respiration: The act of breathing.
Response: A casualtys reply to a first responders shake and shout, enabling
assessment of a casualtys state of consciousness.
Resuscitation: The act of reviving an unconscious or apparently dead casualty.
Rib: One of the 24 bones which form the ribcage.
R.I.C.E: Rest, Ice, Compression, Elevation first response technique used for soft
tissue injuries
Rigid: Physically inflexible or stiff
Rupture: To break or burst
S
Saliva: The clear, alkaline fluid secreted by the salivary glands
Scald: A burn caused by hot liquid or steam.
Seizure: See fit.
Semi-conscious: Slightly disorientated state of partial consciousness.
Sensation: Power of feeling things physically
Shock: Failure of the circulatory system (heart, blood and blood vessels) to supply an
adequate amount of blood and oxygen to the organs/tissues.
Signs: Features of a casualtys condition that can be seen, felt, heard or smelt.
Skeleton: The hard, bony structure that forms the main support of the body.
Skin: The largest organ of the body, the outer covering of the body.
Skull: The bony structure surrounding the brain.
Sling: A triangular bandage applied around the neck to support an injured arm or hand.
Slurred: Word pronounced or spoken un clearly.
Spasm: A sudden, involuntary contraction of a muscle, or group of muscles.
Spinal cord: Bundle of nerve tissue extending from base of brain to lower back;
surrounded and protected by the spine.
Soot: A black powder deposited during the incomplete combustion of organic
substances such as coal.
Stimulation: Excitement of a nerve or organ with stimulus which acts as an incentive.
Splint: Any rigid support used to immobilise a limb in treating fractures, dislocations or
venomous bites or stings.
Sprain: An injury to a joint that is usually caused by overstretching of a ligament.



Spurting: Gushing out in a sudden stream or jet.
Sterile: Free from living organisms, such as bacteria
Sternum: The breastbone.
Stiff: Not easily bent; inflexible
Sting: Sharp pain caused by a bite of an insect.
Strain: An injury to a muscle caused by overstretching or tearing of a muscle or tendon.
Stroke: A condition resulting from a bleed or blood clot in a blood vessels of the brain,
often involving partial paralysis and loss of speech.
Swallowing: Passing (food, drinks) through the mouth and gullet to the stomach.
Sweating: Characterised by clammy skin, which may feel cold or hot to touch.
Swelling: An enlargement of a part of the body as result of injury or infection.
Suffocation: Death from lack of oxygen.
Symptoms: What the casualty tells you about his or her condition.
Syringe: A device consisting of a hollow cylinder of glass or plastic, a tightly fitting
piston and a hollow needle, used for withdrawing or injecting fluids.
T
Tendon: Fibrous tissue that attaches itself to bone.
Tenderness: Pain when touched
Tingling: Feeling a prickling or stinging sensation of the flesh, as from cold or
excitement
Transmission: The passing of a disease from one place or person to another.
Tissue: Group of human body cells that perform a specific function.
Trauma: A wound, injury or other shocking experience.
Tremble: To shake with short slight movements
Tremor: Shaking or quivering movements of the body especially hands.
Tourniquet: A constrictive device used on the limbs to help stop/ control bleeding.
Twitching: A series of contractions by small muscle units
Trashing: Uncontrolled, rapid body movements
Toxic: Harmful deadly



U
Unconscious: Without response; an abnormal state in which the bodys control
mechanisms are impaired or lost. Casualty appears as if they are in a deep sleep.
Urine: Fluid containing waste products removed from the blood by the kidneys.
Uterus: The muscular organ that holds and nourishes the fetus/ baby, opening into the
vagina through the cervix; (the womb).
Umbilical cord: A flexible structure/ cord connecting the fetus / baby to the placenta
V
Vaccination: Injecting a person with vaccine so as to produce immunity against a
certain disease.
Vagina: The canal in the female extending from the uterus to the vulva; the birth canal.
Vaccine: A suspension of dead or weakened micro-organisms for inoculation to
produce immunity to a disease
Vein: Any blood vessel that carries deoxygenated blood from the tissues to the heart
then from the heart to the lungs.
Venom: A toxin (ie. a poison made by a living thing) usually from a snake, insect or
marine creature; secreted and injected by bite or sting.
Venous blood: Deoxygenated blood, dark red in colour.
Ventilation: The process of breathing.
Ventolin: Medication used to open / dilate the airways of a person suffering from an
asthma attack.
Ventricular fibrillation: A chaotic irregular heart rhythm which is the main cause of
cardiac arrest.
Vertebrae: The 33 bones of the spinal column. Singular vertebra.
Vomiting: A forceful, expulsion of stomach contents through the mouth.
W
Wheeze: A high-pitched, whistling sound while breathing out characteristic of an
obstruction or spasm of the airway. Usually associated with asthma.
White cells: Blood cells that float in plasma and fight infection.
Womb: The female uterus.
Wound: A cut, break or opening in the skin or tissue caused by an injury or operation.
Y
Yawning: To open mouth wide, often when sleepy or to equalize ears due to pressure
from altitude or underwater

200 - First Response

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EMIRATES IN-FLIGHT SERVICES CABIN CREW EMERGENCY MANUAL

Effective Date: 15 January 2007

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