10 Flashcards
1
Q
When medical assistance is required on board the aircraft,
A
the PIC bears the ultimate responsibility for the actions of the crew.
2
Q
It is the __ responsibility to keep the PIC informed at all times and their decisions are based on the available information.
A
Cabin Crew’s
3
Q
When voluntary medical assistance is required from passengers, all reasonable measures must be taken by the Cabin Crew to identify the professional status.
A
Under the circumstances the first crew on the scene (the Assessor) should assess and deal with the situation and also call for assistance either verbally or by using the call bell.
The second crew (the collector) will inform the Senior Cabin Crew Member (SCCM) of the nature/severity and location of the incident and collect the appropriate medical equipment, i.e. EMK, Aero-Medic First Aid Kit (after seeking PIC’s permission) and return to the scene.
The Senior Crew Member (Teller) informs the PIC as quickly as possible, makes a PA for a medical qualified practitioner.
4
Q
If during a flight, a passenger or a crew becomes ill and immediate medical assistance is required upon arrival at the destination Airport, the SCCM needs to supply the PIC with the following information:
A
- Is it for Passenger or Crew,
- Passenger’s seat number,
- Condition of passenger,
- Is Passenger responsive or not, and
- Travelling alone?
5
Q
Crew need to be clear about the status/severity of the passenger’s condition so as to provide the airport ambulance team with as much information as possible, to enable them to respond in an appropriate manner and with the right equipment.
A
The PIC will inform the ground station, by means of ACARS or air-to ground communication.
6
Q
The Principles of First Aid
A
First - Immediate, before anyone else
Aid - Assistance, help or treatment
- To someone ill or injured, and
- Before the arrival of a doctor or medical assistance.
7
Q
The Fundamentals of First Aid
A
- To PRESERVE life,
- To PREVENT condition worsening, and
- To PROMOTE casualty’s recovery.
8
Q
To Preserve Life
A
- Pay attention to safety,
- Assess the passenger, and
- Control any major bleeding.
9
Q
To Prevent Condition Worsening
A
- Make a diagnosis of illness or injury, and
2. Consider hidden/secondary conditions.
10
Q
To Promote Casualty’s Recovery
A
- To relieve pain or anxiety, and
2. Arrange for medical attention.
11
Q
First Aid - STEPS
A
Stay calm and in control,
Think first before taking any action, what can I see or hear, Effective communication use, with passenger, crew and PIC, Protect yourself and prevent condition from worsening, and Safety, is anyone in danger or at risk.
12
Q
Assessment and Diagnosis
A
Collecting Information History Symptoms Signs Diagnosis First Aid Treatment Disposal Action Plan
13
Q
History
A
- Illness – previous attacks?
2. Accident – How did it happen?
14
Q
Symptoms
A
Unpleasant sensations that passenger complains of e.g. nausea.
15
Q
Signs
A
Abnormalities observed by the First Aider e.g. pale, clammy skin, sweating.
16
Q
Disposal
A
Request for medical assistance on board and at destination, unscheduled landing if required.
17
Q
An Action Plan which will help crew manage any incident calmly and in the most effective way - AMEGA
A
A - Assess situation M - Make Area Safe E - Examine and give Emergency treatment G - Get Help – Take Assistance A - Aftermath – Clear up the area Write up – report of the incident Stock up – resealing of kit so that it is sent for restocking
18
Q
Diseases caused by bacteria can be spread by various routes i.e.
A
person to person contact, animals (rats and mice) and insects (flies and cockroaches) and through food and water.
19
Q
Bacteria will be preserved in __
A
ice.
20
Q
The most favorable conditions for the growth of bacteria are a combination of the following:
A
Time,
- Medium temperature,
- Moisture, and
- Suitable food
21
Q
Contaminated food or water can cause Typhoid, Fever and Cholera
A
Bacteria
22
Q
Prevention of the Spread of Bacteria
10.4.2.1 Personal health care and cleanliness must be observed
A
- Wash hands with soap and water before and after treating a passenger,
- Usage of protective gloves is advisable,
- Keeping inoculations up to date,
- Take care of your skin. Wounds and scratches should be kept clean and antiseptic creams applied,
and - Regular showers and hair washing are a must in Gulf and tropical climates. Use effective deodorants
when necessary.
23
Q
All aircraft galleys and equipment must be kept clean
All aircraft galleys and equipment must be kept clean by:
A
- Checking cutlery, crockery, glasses, trays and servers for cleanliness,
- Using tongs to handle food,
- Keeping hot food above 1450 degrees F/787 degrees C and cold food below 500 degrees F/ 260
degrees C, - No smoking, coughing or sneezing when handling food, and
- Washing hands before a meal service, after using the toilet and after handling such items as gash
bags, air sickness bags etc.
24
Q
Typhoid
A
Inoculation, valid for 5 years.
Contaminated food and water supplies.
25
Malaria
Precautionary Measures.
| Mosquitoes transmit malarial parasites.
26
Tetanus (lock jaw)
Course of injection, one injection every 10 years
| Tetanus spores gain entry through open wounds
27
Poliomyelitis
Vaccinated as child with a booster dose every 5 years
| Virus infection, which attacks the spinal cord.
28
Yellow Fever
Inoculation, valid for 10 years
| Virus transmitted by the bite of a mosquito
29
Normal resting pulse rate (per minute)
ADULT 60 -100
CHILD 70 -120
INFANT 120-160
30
Normal resting breathing rate (per minute)
ADULT 12 - 20
CHILD 20 - 30
INFANT 30 - 60
31
Possible causes of a rapid pulse and rapid breathing
1. Exercise,
2. Emotional conditions e.g. stress, anxiety,
3. Fever,
4. Bleeding, and
5. Shock.
32
Possible causes of a slow pulse and slow breathing
1. Rest and sleep,
2. Head injuries, and
3. Brain diseases e.g. Stroke.
33
Finding the Pulse
The pulse can be recorded at the wrist (known as the Radial pulse).
In babies, the Brachial pulse, on the inside of the upper arm, may be easier to find.
34
Wrist (Radial Pulse)
Place 2-3 fingers above the wrist creases at the base of the thumb, and press lightly.
Record:
1. The rate (beats per minute),
2. The strength (strong or weak), and
3. The rhythm (regular or irregular).
35
Upper arm (Brachial Pulse)
Place 2 fingers in the hollow between muscles on the inside of upper arm, lightly press. Record:
1. The rate (beats per minute),
2. The strength (strong or weak), and
3. The rhythm (regular or irregular).
36
MINOR IN-FLIGHT EMERGENCIES
```
Gastrointestinal Discomforts
- Indigestion (Wind Pain)
-Diarrhea
-Constipation
Swallowing a SHARP OBJECT
Motion Sickness
Nose Bleed
Headache
Earache Due to Pressure Changes
Toothache
Bleeding Tooth-Socket
Hysteria
Stress Reactions
Allergic Reactions
```
37
It is a general discomfort in the stomach and chest.
Indigestion (Wind Pain)
Treatment
Anti-acid tablets. Walking around the cabin may help the condition.
38
Frequent passing of watery stools/loose motions.
Diarrhea
Treatment
Anti-diarrhea tablets. Encourage plenty of bland fluids.
39
Unable to pass stools easily.
Constipation
Treatment
Encourage plenty of bland fluids and high fibre foods.
40
For example a fish bone or a chicken bone.
Swallowing a SHARP OBJECT
Treatment
Administer soft dry bread or dates. Advise passenger to seek medical advice on arrival at destination.
41
It is commonly known as travel sickness or airsickness.
Motion Sickness
Treatment
Sit passenger inboard if possible. Recline the seat; loosen clothing and open air-vents. Give anti - sickness tablets. Give sips of water and make sure that sick bags are readily available.
Note: Advice passenger that medication may cause drowsiness prior to administration, do not give to pregnant passenger.
42
It commonly occurs when a blood vessel inside the nose ruptures.
Nose Bleed
Treatment
Sit passenger upright with head slightly forward. Pinch the soft part of the nose. If bleeding continues after 10 minutes place an ice pack on the bridge of the nose. Instruct passenger to breathe through the mouth and not to blow thier nose. Advise him to spit any blood into a sick bag.
43
Headache
Treatment
1. Reassure, and
2. Administer Panadol/Paracetamol.
44
Any passenger travelling with a cold, sinus infection or sore throat is particularly susceptible.
Earache Due to Pressure Changes
Treatment
1. A sweet or gum may be given,
2. Advise passenger to yawn/swallow or perform jaw movements,
3. If passenger is a child or baby, advise the mother to feed him/her, and
4. Valsalva maneuver must not be practiced.
45
Usually caused by a decayed tooth and can be made worse by eating or drinking. Throbbing toothache may indicate an infection.
Toothache
Treatment
Administer pain killer tablets.
46
It could generally occur following a dental extraction.
Bleeding Tooth-Socket
Treatment
Advice passenger to bite on a wad of sterile dressing/gauze placed over the socket. Give ice to suck.
47
Portraying symptoms of an emotional complaint. The fits vary from temporary loss of control, to laughing, crying and tearing of hair and clothes.
Hysteria
Treatment
Patient will only portray these symptoms in the presence of others. Therefore, remove to a position where he will be least observed and take a firm attitude. Loosen clothing, open air-vents and then monitor the patient.
Note: It should never be necessary to slap the passenger’s face.
48
It (also called stress disorder or simply SHOCK) is a psychological condition arising in response to a terrifying event. It is the mind and body's response to feelings of intense helplessness (both perceived and real).
Stress reaction
49
Signs and Symptoms of Stress Reaction
1. Anxiety,
2. Impaired judgment,
3. Confusion,
4. Detachment, and
5. Depression.
50
Treatment of Stress Reaction
1. Take History and provide comfort,
2. Stay with pax and provide reassurance,
3. PA for a Doctor, and
4. Inform the PIC.
51
They are sensitivities to a specific substance, called an allergen that is contacted through the skin, inhaled into the lungs, swallowed, or injected.
Allergic reactions
52
Common Allergens
1. Dust,
2. Plants,
3. Pollens,
4. Animal dander,
5. Bee stings or stings from other insects,
6. Insect bites,
7. Medications, and
8. Food (examples: Nuts, Shellfish).
53
Signs and Symptoms of Allergies
1. Itchiness,
2. Sneezing,
3. Puffiness around the eyes,
4. Redness of the skin,
5. Skin inflammation,
6. Rushes/hives,
7. Difficulty of breathing and swallowing,
8. Chest discomfort, and
9. Swelling of the face
54
Treatment of Allergies
1. Take history and reassure,
2. Minimize/remove exposure to allergens,
3. Administer Oxygen, if necessary,
4. Administer antihistamines:
PA for a Doctor or Nurse, and EMK contains allergy injections.
55
Food Allergy Policy
| Help Desk will forward the following information to Briefing Office for Crew briefing:
1. Acceptance of customer and flight details,
2. Any special instructions including nature and severity of allergy,
3. Requirement for on board announcement(if required), and
4. SPML uplift (if applicable).
56
Crew Procedure
1. SCCM to brief Crew accordingly,
2. Follow special handling requirements,
3. Make the announcement on ground if advised,
4. Check on customer and their needs at regular intervals, and
5. Submit detailed E-VR.
57
It is any substance that, if taken into the body in sufficient quantity, can cause temporary or permanent damage. e.g. Psychoactive Substances, Chemicals, Alcohol.
Poison
58
Treatment for Poison
1. Quickly ask the conscious passenger what has happened. Remember that he may lose consciousness at any time,
2. Do not attempt to induce vomiting,
3. P.A for Dr/nurse, inform the PIC,
4. If passenger goes unconscious, place in recovery position, and
5. If no pulse and no breathing, immediately commence emergency resuscitation.
59
Caused by eating food contaminated by bacteria or by toxins.
Food poisoning
60
Prevention
1. Ensure frozen poultry and meat is fully defrosted before it is cooked,
2. Cook meat, poultry, fish and eggs thoroughly to kill harmful bacteria,
3. Never keep food lukewarm for long periods, bacteria can multiply without obvious signs of spoilage,
4. Wash hands before preparing food, and
5. Wear protective gloves if you have cuts on your hands.
61
Signs and Symptoms
1. Nausea and Vomiting, Cramping abdominal pains, Diarrhea [possibly blood stained], and
2. Headache or Fever, Features of Shock, Collapse.
62
Treatment
1. To encourage the passenger to rest,
2. To seek medical aid,
3. To give passenger plenty of bland fluids to drink, and
4. Air sickness bag if passenger vomits.
63
Swallowing Of Chemicals and Corrosive Liquids
| If Passenger Is Conscious
Identify what kind of chemical or liquid was swallowed.
Nothing by mouth unless advised by a Health professional
Do not leave passenger unattended.
Keep checking level of consciousness
Note: Never induce vomiting
64
Swallowing Of Chemicals and Corrosive Liquids
| If Passenger Is Unconscious
Has Normal breathing.
Place in Recovery Position.
Give oxygen if required.
If not breathing or gasping, start CPR.
Note: Never induce vomiting
65
Chemical Splashes in the Eye
| e.g. Hydraulic fluids, acid, perfume.
Flush the eye area with water. Lay the passenger across a block of seats or stand him over a sink and commence washing the affected area, rinse away from unaffected eye for approx. 10 mins. Cover the eye area with an eye pad and advise patient to seek medical aid as soon as possible
66
FOREIGN BODY IN THE EYE
e.g. dust, dirt or grit.
Treatment
Seat the passenger facing a good light. Using moistened sterile dressing/gauze. Stand behind the passenger and ask him to lean thier head back.
Instruct passenger to
1. Look up,
2. Look down, and
3. Look right and then left.
Where to search
1. Check under the lower lid,
2. Pull the upper lid gently back and look at the center and upper part of the eye, and
3. Check the left corner of eye and then the right.
67
If a foreign body is seen remove it, using moistened sterile dressing/gauze, cleaning away from nose.
If foreign body is stuck to the eye DO NOT attempt to remove it. Cover the eye with an eye pad and advise passenger to seek medical attention on arrival at destination.
68
A recurrent condition often triggered by anxiety and nervousness. The attacks may vary from “mild wheezing” to severe difficulty in breathing accompanied by blueness of the lips and face.
Asthma
69
Treatment
1. Take History, Reassure and Calm the passenger,
2. Sit passenger down and lean forward on a tray table,
3. Allow passenger to take thier medication to treat the condition; this is usually a “Ventolin” inhaler,
4. Give oxygen immediately,
5. Cabin Crew will PA for Doctor/Nurse, and keep the PIC informed, and
6. Apply resuscitation if necessary. Cabin Crew must ensure AED is immediately used.
70
Anxiety frequently causes people to hyperventilate (over – breathing) resulting in a lack of carbon – di – oxide in the body.
Hyperventilation
71
Sign & Symptoms of Anxiety
Short panting breaths, over breathing , passenger may complain of tingling of the hands and feet. The hands may go into spasms, assuming a claw – like position. Dizziness and fainting may occur. Face maybe flushed.
72
Treatment
1. Take History, Reassure and Calm the passenger,
2. Sit passenger down and lean forward on a tray table,
3. Allow passenger to take thier medication to treat the condition; this is usually a “Ventolin” inhaler,
4. Give oxygen immediately,
5. Cabin Crew will PA for Doctor/Nurse, and keep the PIC informed, and
6. Apply resuscitation if necessary. Cabin Crew must ensure AED is immediately used.
73
Anxiety frequently causes people to hyperventilate (over – breathing) resulting in a lack of carbon – di – oxide in the body.
Hyperventilation
74
Sign & Symptoms of Anxiety
Short panting breaths, over breathing , passenger may complain of tingling of the hands and feet. The hands may go into spasms, assuming a claw – like position. Dizziness and fainting may occur. Face maybe flushed.
75
Treatment
| Hyperventilation
1. The object is to slow down the passenger’s breathing,
2. Reassure and instruct passenger to hold thier breath for 30 seconds,
3. If no relief, ask passenger to breathe into a sick bag re-breathing own air, replacing lacking carbon
dioxide,
4. As symptoms subside an explanation of the condition should be given and advise on how to prevent
a recurrence,
5. If symptoms deteriorate, e.g. cyanosis, assess colour of the skin and administer oxygen,
6. PA for a medical qualified practitioner, and
7. Inform the PIC
76
It occurs when a foreign object blocks the back of the throat causing muscular spasms and impairing breathing.
Choking
77
Choking Mild Cases
| Signs and Symptoms
1. Passenger is responsive, and
| 2. Air Exchange (Breathing) is normal.
78
Treatment
| Conscious Adult/Child
Encourage passenger to cough.
| If condition does not improve, call for assistance (PA)
79
Choking Severe Cases
| Signs And Symptoms
1. Passenger has difficulty in speaking and breathing,
2. Passenger’s face may turn blue,
3. Passenger may grasp their throat, and
4. May go into unconsciousness.
Death may occur within 3-4 minutes if obstruction is not removed
80
Treatment
| Conscious Adult
1. Reassure the passenger
2. Perform Abdominal Thrust ( Stand behind with the person. Place one arm with a clenched fist around
passengers waist , place flat hand inwards. Place above navel and pull sharply inwards and upwards
3. Continue until the airway is cleared or passenger becomes unconscious. Apply resuscitation if
required, and
4. PA for Medical Practitioner
81
Unconscious Adult
1. Lie adult passenger on thier back,
2. Check for Breathing,
3. If normal breathing is present, place in recovery position,
4. If no breathing or gasping, start CPR immediately, and
5. Continue until adult passenger shows signs of life or until medical help arrives.
82
Conscious Child
1. Reassure the passenger,
2. Perform Abdominal Thrust (Position yourself behind the child, use only one hand, clench your fist
with the thumb facing inwards. Place above navel and pull sharply inwards and upwards),
3. Continue until the airway is cleared or passenger becomes unconscious. Apply resuscitation if required, and
4. PA for Medical Practitioner.
83
Unconscious Children
1. Lie child on their back,
2. Check breathing, if no breathing or gasping, start CPR immediately, and
3. Continue until the child shows signs of life or until medical help arrives.
84
Conscious Infant
1. Lay baby along your forearm,
2. Perform Chest Thrust with two fingers (Lay baby on its back, draw an imaginary line between the
nipples. Place the tip of two fingers one fingerbreadth below this line. Press inwards to one third the
depth of the chest),
3. Continue until the airway is cleared or passenger becomes unconscious. Apply resuscitation if
required, and
4. PA for Medical Practitioner.
85
Unconscious Infant
1. Lie infant on thier back,
2. Check breathing, if no breathing or gasping, start CPR immediately, and
3. Continue until the infant shows signs of life or until medical help arrives.
Note: In all cases of choking, after obstruction is removed:
Apply Resuscitation if necessary, P.A for Doctor or nurse and inform the PIC. Cabin Crew must ensure AED is immediately used, if required
86
It s a brief loss of consciousness that is caused by a temporary reduction of blood flow to the brain. A faint may be a reaction to pain or fright or the result of emotional upset, exhaustion, or lack of food. Normal Faint should not last longer than one minute.
FAINTING
87
Signs and Symptoms
1. A brief loss of consciousness causing the passenger to fall to the floor,
2. A slow pulse, and
3. Pale, cold and clammy skin.
88
Treatment
1. Lay passenger down, raise and support thier legs (if seated place thier head between knees),
2. Loosen restrictive clothing and open air-vents,
3. As he recovers, reassure and help passenger sit up gradually,
4. Look for and treat any injury that has been sustained through falling,
5. PA for a medical qualified practitioner, and
6. Inform the Captain.
Note: If passenger does not regain consciousness quickly.
Place in the recovery position, if normal breathing is present
89
```
EMERGENCY RESUSCITATION
D – Danger
R – Response
C – Compression A – Airway
B – Breathing
```
D
DANGER
Assess Situation
Move passengers only if Danger is present
R
RESPONSE
To Voice, Touch, Pain
NO
Call For Help
C
COMPRESSION
Check For Breathing or No Normal Breathing
NO
Start CPR giving 30 chest compressions
A
AIRWAY
Open Airway using Chin Lift, head Tilt or Modified Jaw Thrust
B
BREATHING
Give Two breaths
NO
Immediately give 30 Chest Compressions followed by 2 Breaths. Continue Until ADULT Passenger shows signs of life or Until the rescuer is exhausted or until Medical help Arrives and takes over
Note: In case of CHILD/INFANT, immediately start 30 chest Compressions followed by 2 breaths. For Two Rescuers, continue chest compressions while breaths are being delivered.
Continue until passenger shows signs of life, until the rescuer is exhausted, until the medical team takes over.
If NORMAL breathing is present, place the passenger in the Recovery Position
90
When stoppage of breathing is accompanied by cardiac arrest (stoppage of the heart) Artificial Respiration will be accompanied with Cardiac Massage. There is a real danger of damage to internal organs if Cardiac massage is not carried out correctly and should only be used if you are sure that the heart has stopped.
CARDIO-PULMONARY RESUSCITATION [CPR]
91
If Passenger is not Breathing OR Gasping
1. One Rescuer/Two Rescuers [Adult – Over 8 years]
| 2. If Passenger Is Not Breathing or Gasping
92
Adult/Child/Infant
1. Assess the Situation. Is there any danger to the passenger, to you, or other passenger/s,
2. Check for Response (Voice, Touch and Pain)
3. No Response – call for help.
4. Give 30 Chest Compressions (Observe signs of breathing i.e. chest movement. If NO breathing or gasping start 30 chest compressions),
5. First find the right place on the casualty’s chest,
6. Slide your index and middle finger up the lowest rib,
7. Middle finger is on the mid-point where the ribs meet,
8. Index finger is on the breastbone,
9. Slide the heel of your other hand down the breastbone,
10. Heel of hand meets index finger on breastbone,
11. Heel of first hand in position on breastbone,
12. Heel of second hand on top, fingers interlocked and pulled up from chest,
13. Lean well over passenger to apply pressure:
A. Arms straight, press vertically down through heels of hands,
B. Fingers raised to avoid pressure on ribs,
C. Release pressure without moving hands off the chest, and
D. Repeat the sequence with steady rhythm and NO pauses until professional help arrives or the
casualty shows signs of recovery.
14. Tilt the head slightly and check for any visible obstructions in the mouth, if present, remove with a finger sweep and open the airway. If no obstruction, open airway using chin lift head tilt or modified jaw thrust, and
15. Breathing, give two breaths
93
Remember the CHAIN of SURVIVAL
The Chain of Survival: The most important thing to remember is that the Passenger has the best chance of survival when all the links in the following chain are present
Early Access – Early CPR – Early Defibrillation – Early Advanced Care
94
Children and Infants
Preparation of the child/infant is the same as for an adult but the technique differs slightly.
95
Infant under 1 year
A hard surface is not required for an infant as the pressure exerted on the chest wall is a gentle pressure using 2 fingers.
96
Child – 1 year to 7 Years
Position your hand as you would for an adult, but use the heel of one hand only. Same as adult, but only 1 heel of the hand required for Cardiac Massage.
Note: If child is over 8yrs treatment is as an adult
97
Adult and child over 8yr
Heel of hand, one on top of the other.
| Middle of the Breastbone, 2 fingers above the sternum
98
Child 1yr-7yr
Heel of one hand only.
| Middle of the Breastbone, 2 fingers above the sternum
99
Infant under 1yr
Two fingers only.
| 1 finger width below the imaginary line between the two nipples.
100
It is due to some form of illness or injury, which interferes with the normal functioning of the brain.
Unconsciousness
101
Signs and Symptoms
1. Appears to be in a deep sleep,
2. Will not respond when spoken to,
3. Will not react to pain, and
4. Pupils may not react to light i.e. when a bright light is shone into the eyes.
102
Some Causes of Unconsciousness
1. Head injury,
2. Psychoactive substance overdose,
3. Brain disease,
4. Poisoning,
5. Hypoxia,
6. Narcotics,
7. Asphyxia,
8. Diabetes,
9. Shock,
10. Epilepsy,
11. Will not respond when spoken to,
12. Will not react to pain, and
13. Pupils may not react to light i.e. when a bright light is shone into the eyes.
103
Treatment
1. Assess the situation,
2. Check presence of breathing,
3. Clear and maintain an open airway,
4. Check level of consciousness (reaction to speech, pain and touch),
5. Check for injuries, fractures, bleeding etc.,
6. Remove any sharp objects and check for medic alert tags or cards, which may be helpful in
establishing the cause of unconsciousness,
7. Place in the Recovery Position, providing there are no neck or back injuries,
8. Stay with the passenger and keep checking pulse and breathing,
9. Give oxygen,
10. Give nothing by mouth, and
11. P.A for a doctor/nurse, remain with passenger until consciousness returns
For landing, place the unconscious passenger on the floor against a bulkhead to prevent forward movement. If a neck or back injury is suspected, leave the passenger in the discovered position and pad with pillows and blankets. Maintain an open airway throughout.
104
Maintain a Clear Airway
1. Extend the neck by placing your hand on passenger forehead and gently pushing back. (Providing there is no neck or back injury), and
2. Place two fingers under passenger’s chin gently pull jaw up and forward. (In cases of neck and back injuries this is the only action to be taken to open and maintain airway).
105
Recovery Position
The Recovery Position is the safest for an unconscious casualty because:
1. Chin is lifted to keep airway open and clear, head is lower than body, so fluids will drain out of mouth and are less likely to be inhaled,
2. Hand supports and protects head,
3. Arm and leg are bent to make position stable and stop body rolling forward, and
4. Chest is not flat on ground, so breathing process is easier.
106
To Move Casualty into the Recovery Position
| ]
Stage 1
1. Maintain the open airway position,
2. Remove casualty’s eye glasses, and any bulky objects from pockets [especially keys]. Check for
Medical Tags,
3. Straighten legs,
4. Place arm nearest to you at right angles to the body, palm upwards,
Stage 2
Bring other arm across the chest and hold the casualty’s hand against the cheek throughout stages 3,4 and 5 to support the head,
Stage 3
Grasp the casualty’s leg just above the knee and lift it towards you [ so the leg bends at the knee and the foot stays on the floor],
Stage 4
1. Maintain your grasp of the casualty’s thigh and pull towards you,
2. Use your knees to stop the casualty rolling too far,
Stage 5
1. Adjust the upper leg if necessary [hip and knee should both be bent at angles], and
2. Draw the casualty’s chin forward to clear the tongue from the throat and aid drainage, adjusting the
hand under the cheek if necessary.
3. If Major injuries are apparent this may affect WHEN and HOW you turn the casualty into the
Recovery Position
Remember – the Airways is always the Priority
107
It is a system failure arising from sudden illness or injury to the body, which results in reduction of blood flow and therefore lack of oxygen to the brain and other vital organs (e.g. brain, heart, kidneys). The degree of shock can vary from being mild to moderate to a more severe state of shock depending on the nature and extent of the cause. It is a serious condition and can prove fatal.
Shock
108
* In Heart attack cases, chest injury, head injury, recline passenger in thier seat. In cases of fractures, keep them in the position that they were first found in, unless they are located in an unsafe area. Move the passenger after immobilizing the affected part.
** In cases of Burns, Renal Colic, Vomiting and Diarrhea, sips of water may be given to prevent dehydration
109
This may be sudden without warning at any time even at rest. This condition is more serious than Angina Pectoris because an artery has been blocked or obstructed and as a result part of the heart muscle dies
Heart Attack
110
Signs and Symptoms
| Heart Attack
1. Sudden and severe chest pain, which may spread into both arms,
2. Passenger may go into severe shock,
3. Skin colour is blue/grey,
4. Pulse is rapid and weak,
5. Breathing is rapid and shallow, and
6. Passenger may be agitated and restless.
111
Treatment
1. Take history,
2. Reassure,
3. Place passenger seated in a reclined position,
4. Give oxygen,
5. PA for a Doctor or Nurse, and inform the Flight Deck ,
6. If passenger has NO breathing or no normal breathing (gasping), commence CPR, and
7. Cabin Crew must ensure AED is immediately used.
112
When the arteries of the heart become too narrow for an adequate supply of blood to reach the heart muscle. Angina Pectoris can develop. When exercise or emotional stress increases the demand for oxygen, the narrowed artery cannot pass blood quickly enough to meet the body’s
ANGINA PECTORIS
113
Signs & Symptoms
| Angina Pectoris
1. Severe cramping pain in the center of chest,
2. The face becomes pale and may be Blue/Grey,
3. Pulse is rapid and weak,
4. Breathing is rapid and shallow, and
5. Passenger is calm
114
Treatment
1. Take history,
2. Reassure,
3. Rest passenger in thier chair in the reclined position,
4. Loosen restrictive clothing,
5. P.A for a doctor/nurse, Inform PIC,
6. Give oxygen, and
7. Passenger normally has thier own medication. Assist him with the administration.
115
In medicine, deep vein thrombosis is the formation of a blood clot in a deep vein. Deep vein thrombosis commonly affects the leg veins or the deep veins of the pelvis. A DVT can occur without symptoms, but in many cases the affected extremity will be painful, swollen, red, warm and the superficial veins may be engorged
DEEP VEIN THROMBOSIS (DVT)
116
Signs and Symptoms
There may be no symptoms referable to the location of the DVT, but the classical symptoms of DVT include pain, swelling and redness of the leg and dilation of the surface veins.
117
Causes
The most common risk factors are recent surgery or hospitalization, advanced age, obesity, infection, immobilization, use of combined (estrogen-containing) forms of hormonal contraception, tobacco usage and air travel ("economy class syndrome", a combination of immobility and relative dehydration)
118
Prevention
Prevention consists of adequate hydration (drinking, abstaining from alcoholic beverages and caffeine), moving around and calf muscle exercises.
119
BURNS AND SCALDS
These are injuries to the body tissues caused by heat, chemicals or radiation.
120
Types of Burns
1. Dry burns - Caused by contact with flames or hot equipment e.g. ovens,
2. Scalds - Caused by wet heat e.g. hot water, tea, steam etc.,
3. Cold Burns - Caused by something very cold e.g. Dry ice,
4. Chemical Burns - Caused by contact with chemicals e.g. acids,
5. Electrical - Caused by electrical currents or lightning, and
6. Radiation - Caused usually by the sun
121
The severity of a burn depends on a combination of factors, but the best guide to severity of burns in first aid is the area of the burn. Small deep burns are much less serious than large area superficial burns.
Aims of the First Aider
1. To reduce pain by treating the burn,
2. To treat for shock. This will vary with the degree of burn. Frequent sips of water should be given, and
3. To prevent infection by applying dry sterile dressings to the injured area.
122
If the passenger clothes are on fire wrap him in a coat or blanket. Gently remove jewellery from the injured area before it begins to swell. Do not remove any clothing. Cover with dry sterile dressings and treat for shock
Dry Burns
123
Minor Burns and Scalds
Gently remove any jewellery and clothing, if necessary. Immediately flush the burned area with cold water or immerse in cold water for at least ten minutes. Apply dry sterile dressings if necessary.
124
Cold Burns
Gently remove any clothing and jewellery. Warm the area by using a warm part of the casualty or yourself e.g. your hands or place the injured part in warm water. Cover with dry sterile dressings and treat for shock.
125
Chemical Burns
Gently remove any jewellery. Flush the area with water, speed is essential. Cut away any clothing. Cover with dry sterile dressings and treat for shock
126
Electrical Burns
Break the current and check pulse and breathing. Commence Artificial Resuscitation if necessary. Treat the burn and treat for shock.
127
Do not risk infection by
1. Bursting Blisters,
2. Touching the burn, and
3. Remove charred clothing
128
WOUNDS AND BLEEDING
It is an abnormal break in the skin (or any other body tissue), which usually causes bleeding. Bleeding may be internal or external.
129
Wounds
| Abrasions
These are on the surface only and are caused by a grazing or scraping. Bleeding is minimal.
130
These are on and just under the surface, with skin splitting and bruising. Bleeding is seldom severe
These are on and just under the surface, with skin splitting and bruising. Bleeding is seldom severe
131
Treatment of External Bleeding
| Minor Bleeding
1. Flush the wound with water and/or clean with alcohol wipes, and
2. Cover with Sterile dressing and or band aid
132
Major Bleeding
1. Apply direct pressure on the wound using a dry sterile dressing,
2. Elevate and treat for shock,
3. If bleeding continues, apply new dressings over the existing bandage, and
4. Make a PA for Dr./nurse, and inform PIC.
Note: Do not remove first dressing and keep applying pressure.
If direct pressure is impractical e.g. metal, glass or an open fracture, apply pressure around the wound using a ring pad or bringing the edges of the wound together
133
Incised Wounds
| Direct Pressure
These are clearly cut by a sharp edge. Bleeding may be severe and dangerous, especially if an artery is cut.
134
Lacerations
These are irregular or torn. Bleeding is sometimes severe
135
Puncture Wounds
These have a small surface area but are deep. Bleeding may be a problem especially with stab wounds, when serious or fatal internal bleeding may occur.
136
Severe pain
Skin is pale, cold and clammy.
Assess and take history.
137
Severe bleeding
Shivering and sweating.
Reassure.
138
Severe burns
Headache, dizziness and nausea.
Loosen restrictive clothing.
139
Fractures
Thirst.
Lie passenger down, raise legs. *
140
Loss of body fluids e.g. vomiting or diarrhea
Rapid shallow breathing.
Do not move passenger, if unconscious with normal breathing, place in recovery position.
141
Heart attack
Weak rapid pulse.
Give nothing by mouth. **
142
Angina
Feels anxious or dull.
Cover with a blanket.
143
Renal Colic
May become unconscious.
Give Oxygen.
P.A for Dr. or Nurse, Inform the PIC.
144
Perforating Wounds
These pass right through a part of the body, as with some stab or gunshot wounds. Bleeding may be serious if an artery has been cut
145
Any of these wounds may become infected.
Abrasions, contusions and lacerations often contain visible dirt. Puncture wounds can sometimes lead to dangerous infectious, such as lockjaw (tetanus) or gangrene.
146
It may result from broken bones, injuries, stab or bullet wounds or disease
Internal bleeding
147
Lungs
| .
Bright red and frothy, coughed up blood
148
Stomach
Brown, gritty blood vomited.
149
Bladder
Blood in urine.
150
The passenger will exhibit signs and symptoms of shock and may complain of pain around the site of bleeding.
Internal bleeding
151
Treatment for Internal bleeding
Treatment is aimed at reducing shock.
1. Nothing is to be given by mouth,
2. Make a PA for Dr./nurse, and inform PIC,
3. Keep passenger at rest, reassure and monitor for any change in passenger condition,
4. Administer oxygen, and
5. Apply resuscitation if necessary. Cabin Crew must ensure AED is immediately used.
152
It is a broken or cracked bone
Fracture
153
Types of Fracture
Closed Fracture
Open Fracture
Complicated Fracture
154
The surface of the skin is not broken and underlying organs are uninjured by the broken
bone
Closed Fracture
155
The bone has gone through the skin or there is a wound leading to the fracture
Open Fracture
156
The broken bone damages underlying organs nerves or vessels
Complicated Fracture
157
Signs and Symptoms
1. Pain and tenderness,
2. Swelling,
3. Deformity,
4. Limitation of movement, and
5. Shock.
Comparison with the uninjured side will assist in the diagnosis. If in doubt, treat as a fracture.
158
Treatment
1. Assess the situation,
2. Apply life saving measures (Check breathing and stop bleeding),
3. Take a history, reassure the pax and do not move,
4. Immobilize the injured part to reduce pain and prevent further injury,
5. Cover all open wounds,
6. Treat for shock, and
7. Make a PA for Dr./nurse, and inform PIC.
159
This is a simple and convenient way of immobilizing a fracture by using the body as a splint. Bandages and other suitable bindings can be used to secure the injured part to the body.
Body Splinting a Fracture
160
Method
1. Bring the uninjured limb gently to the side of the injured limb,
2. Pad between the legs (or between the arm and body),
3. Using triangular bandages, apply a figure of eight around the ankles and feet,
4. Continue to secure the injured limb, always bandaging above and below where the fracture is, and
5. The bandages should be tied to the uninjured side in a double knot
Used for – Open fractures of the arm and the leg and Closed fractures above the knee and above the elbow.
161
Elevation Sling [High arm]
| An elevation sling may be used to immobilize certain types of fractures or injuries.
1. A fractured collar bone,
2. Finger and Hand injuries,
3. Fractured ribs,
4. Injured upper arm,
5. Wrist,
6. Forearm,
7. Elbow [which can be bent], and
8. Dislocated Shoulder
162
Special Fractures and Treatment
| Skull
1. Unconsciousness may be a complication,
2. Place into the recovery position,
3. (If there is bleeding from the ear, Turn the affected ear downwards), and
4. Apply a dressing
163
Neck or Spine
Do not move passenger unless absolutely essential. Pad around with pillows and blankets and stay with the passenger
164
Do not give medication to passenger with Skull, Neck or Spine injuries.
Seek medical aid as soon as possible.
165
Caused by over stretched muscles. Treatment is aimed at supporting the injured part and reducing pain and shock.
Strains
166
Caused by wrenching or tearing of the ligaments and tissue around a joint. Treatment is to apply a cold compress and support the joint
Sprains
167
Treatment – RICE
R
Rest, steady and support the injured part.
I
Ice pack for 10-15 mins only or cold compress for at least 20 mins
C
Compress the injury using a thick layer of padding to apply gentle, even pressure
E
Elevate and support the injured limb
168
This condition is caused by bleeding within the brain (Cerebral Hemorrhage), or by a clot (Cerebral Thrombosis).
Stroke
169
Strokes are more likely to occur in late middle aged to elderly people.
The severity of the symptoms may vary with the area of the brain affected and the degree of damage.
170
Signs and Symptoms
1. Pain in the head,
2. Weakness or paralysis of one or more limbs,
3. Speech may be difficult, slurred or passenger may be unable to speak. May drool at the mouth,
4. Breathing is noisy,
5. Face is flushed,
6. Incontinence (loss of bladder and bowel control),
7. Passenger is distressed and tear-full, and
8. Passenger may suddenly go into unconscious.
171
If passenger is conscious
Place in a comfortable position [head and shoulders raised] with pillows to support them. Reassure and do not leave unattended.
172
If passenger is unconscious
| With normal breathing
Place in the recovery position. Do not leave unattended.
173
There are Four stages to a major epileptic fit.
Stage 1 - (AURA) The passenger has a warning that they are about to have a fit. It may be a headache, blurred vision or a strange taste.
Stage 2 - The passenger gives aloud cry and becomes rigid. thier eyes are staring and he may become blue.
Stage 3 - The passenger will start to convulse. Frothing at the mouth and incontinence may occur. He may injure himself.
Stage 4 - The passenger limbs will become limp and he will fall into a deep sleep.
174
Treatment
| The passenger should be prevented from injuring himself.
1. If seated, loosely fasten thier seatbelt,
2. Pad around with pillows or blankets and loosen tight clothing. Do not restrict thier movements,
3. Time the length of the fit. They usually last about two minutes, except in cases of continued fitting
with no return to consciousness. If this should occur inform the captain that an unscheduled landing
is advisable,
4. PA for a Doctor/Nurse, and the Flight Deck should be kept informed,
5. When the convulsions cease, clean the mouth and allow the passenger to sleep, and
6. Ensure clear/open airway
Apply resuscitation if necessary, Cabin Crew must ensure AED is immediately used
175
Insulin is a hormone necessary to regulate the sugar in our blood. If the brain does not receive the right amount of sugar [as well as oxygen] its function is affected
Diabetes
176
Low Blood Sugar
HYPOGLYCAEMIA
177
High Blood Sugar
HYPERGLYCAEMIA
178
Signs and Symptoms of Hypoglycaemia
1. Onset – sudden,
2. Skin – moist, sweaty,
3. Feeling faint, dizzy and light headed, and
4. Passenger will be confused and may become aggressive.
179
Signs and Symptoms of Hyperglycaemia
1. Onset – gradual,
2. Severe thirst, dry skin, and
3. Deep, sighing breaths with a strong sweet odour.
180
Treatment for Hypoglycemia
1. Immediately give two tablespoons of sugar in a glass of water. If there is no improvement give a light meal,
2. Do no hesitate as passenger may go into unconsciousness, and
3. PA for a Doctor/Nurse, and Inform Flight Deck
181
Treatment for Hyperglycaemia
1. Monitor the passenger until you reach your destination,
2. Give water to drink, and
3. PA for a Doctor/Nurse, Inform the Flight Deck
182
If in doubt treat as Hypoglycemia. Cabin Crew must never administer an insulin injection.
If the diabetic passenger becomes unconscious with normal breathing, place him in the Recovery Position. PA for Doctor
Give nothing by mouth - Hypo stop/Glucogel may be used if available.
183
DEHYDRATION
| This is basically lack of water in the body, may be due the following.
Insufficient intake of fluid, Excessive loss of fluid – caused by:
A. Excessive sweating,
B. Working in excessive heat (Tropical countries),
C. Severe diarrhea and vomiting, and
D. Severe hemorrhaging or burns
The air inside and aircraft is drier than that normally breathed outside, therefore the process of dehydration may be accelerated whilst flying.
184
Treatment
1. Do drink plenty of water. Cabin Crew on flying duty should drink a glass of water at least every hour – where possible, every half hour (The body requires up to 5 pints of water every 24 hours), and
2. Do not drink tea, coffee or fizzy drinks containing stimulants (Cola) as these stimulate the kidneys
and causes an increase in the amount of fluid lost. Only drink fizzy drinks unless there is no alternative as the gas expands at altitude and can cause abdominal discomfort.
185
It is a condition caused by a stone passing down the urinary tract from a kidney to the bladder.
Renal Colic
186
Signs and Symptoms of Renal Colic
1. Sudden onset of severe pain in the small of the back, which may radiate down to the groin. The pain is spasmodic, with periods of relief,
2. The passenger may double up with the pain,
3. Passenger may go into Shock,
4. Passenger may suffer from nausea and vomiting,
5. Passenger may want to pass small quantities of urine at frequent intervals. The urine may be blood stained, and
6. The passenger may have a history of previous attacks.
187
Treatment for Renal Colic
1. Reassure passenger and take a history,
2. Treat for Shock,
3. Encourage passenger to drink plenty of fluids,
4. If possible seat passenger near to a lavatory, block one off for thier use only,
5. PA for a Doctor/Nurse, and
6. Inform the PIC.
188
EMERGENCY CHILDBIRTH
The uterus is a hollow organ formed of many layers of strong muscular tissue. At the lower end is the cervix (birth canal), which is the exit from the womb. The baby develops in a sac inside the uterus and floats in a clear liquid, which gives the baby protection. The baby usually develops in a curled up position and head down. Whilst in the uterus, the baby obtains all necessary nourishment and oxygen through the mother’s blood supply, which passes from the placenta (later to become the afterbirth) to the baby via the umbilical cord. A baby is ready to be born (full term pregnancy) approximately 40 weeks after the last menstrual period.
189
A premature baby is one born between the __ after the first day of the last menstrual period. The baby will be fully formed, but smaller than normal.
28th and 37th week
190
Threatened Miscarriage Or Abortion
Any vaginal blood loss before the 28th week.
191
Treatment for Threatened Miscarriage Or Abortion
1. Treat for shock and internal bleeding,
2. Save all blood clots passed,
3. PA for a doctor or nurse, and
4. Inform the PIC
192
Transportation of Expectant Mother
1. If there are no complications of which the passenger is aware, flyadeal will carry a female passenger on services up to and including 28 weeks pregnant without a Doctor’s Certificate,
2. Between 29 to 32 weeks (inclusive) of pregnancy, flyadeal will carry a female subject to a doctor’s certificate,
3. The doctor’s certificate must state the following:
A. Number of weeks of pregnancy, and
B. Confirmation that:
i. The Expectant mother is ‘Fit to Travel’ for the entire duration of flight or series of flights (as Applicable),
ii. The Pregnancy is Complication Free single pregnancy or Multiple or Complicated Pregnancy,
iii. Premature delivery is not expected within the planned journey, including transit and return flights,
iv. State the Estimated Date of Delivery (EDD),
v. Be reader friendly and written in English, and
vi. Have appropriate ‘Date, Stamp & contact details’ from the qualified Doctor.
4. A medical certificate which is provided by a registered mid wife is not acceptable,
5. For Pregnancy of 33 weeks and above – carriage will be refused,
6. SSR code PRGN to be used and “flyadeal Expectant Mother Form should be completed by the
passenger, and
7. Check in staff will sign and collect 2 copies from pax. One copy is to be submitted to Flight Deck on
board and other copy to be retained in the flight file for records.
193
The items listed below are only for reference, they are not the only condition that may require for an Unscheduled Landing:
1. Stoppage of breathing and pulse,
2. Unconsciousness,
3. Severe shock,
4. Uncontrollable bleeding,
5. Internal bleeding,
6. Heart attack,
7. Recurrent Epileptic fits, and
8. Retained Placenta
194
It is preferred to the ankle pull.
Shoulder pull
195
It supports the head of the victim. The negative is that it requires the rescuer to bend over at the waist while pulling.
Shoulder pull
196
1. Grasp the victim by the clothing under the shoulders,
2. Keep your arms on both sides of the head,
3. Support the head, and
4. Try to keep the pull as straight and in-line as possible.
Shoulder pull
197
This is the preferred method for dragging a victim.
Blanket pull
198
1. Place the victim on the blanket by using the "logroll" or the three-person lift,
2. The victim is placed with the head approx. 2 ft. from one corner of the blanket,
3. Wrap the blanket corners around the victim,
4. Keep your back as straight as possible,
5. Use your legs, not your back, and
6. Try to keep the pull as straight and in-line as possible
Blanket pull
199
This only works with a child or a very light person.
One Person Lift
200
One Person Lift
Place your arms under the victim's knees and around their back
201
This technique is for carrying a victim longer distances.
Fire Fighter Carry
202
It is very difficult to get the person up to this position from the ground. Getting the victim into position requires a very strong rescuer or an assistant.
Fire Fighter Carry
203
Fire Fighter Carry
1. The victim is carried over one shoulder, and
2. The rescuer's arm, on the side that the victim is being carried, is wrapped across the victim's legs
and grasps the victim's opposite arm.
204
For the conscious victim, this carry allows the victim to swing their leg using the rescuers as a pair of crutches:
Human Crutch
205
Human Crutch
1. Start with the victim on the ground,
2. Both rescuers stand on either side of the victim's chest,
3. The rescuer's hand nearest the feet grabs the victim's wrist on their side of the victim,
4. The rescuer's other hand grasps the clothing of the shoulder nearest them,
5. Pulling and lifting the victim's arms, the rescuers bring the victim into a sitting position,
6. The conscious victim will then stand with rescuer assistance, and
7. The rescuers place their hands around the victim's waist
206
This technique is for carrying conscious and alert victim’s moderate distances. The victim must be able to stand unsupported and hold themselves upright during transport:
Four Handed Seat
207
Four Handed Seat
1. Position the hands as indicted in the graphic,
2. Lower the seat and allow the victim to sit,
3. Lower the seat using your legs, not your back, and
4. When the victim is in place, stand using your legs, keeping your back straight
208
This technique is for carrying a victim longer distances:
Two Handed Seat
209
Two Handed Seat
1. Pick up the victim by having both rescuers squat down on either side of the victim,
2. Reach under the victim's shoulders and under their knees,
3. Grasp the other rescuer's wrists,
4. From the squat, with good lifting technique, stand, and
5. Walk in the direction that the victim is facing.
