Medical Manual 11th Edition-rev1 - IATA

1 Medical ManualJune 2018 Edition11thMedical Manual 11th edition ISBN 978-92-9229-713-8 2018 international Air transport association . All rights GenevaNOTICEDISCLAIMER. The information contained in this publication is subject to constant review in the light of changing government requirements and regulations. No subscriber or other reader should act on the basis of any such information without referring to applicable laws and regulations and/or without taking appropriate professional ad-vice. Although every effort has been made to ensure accuracy, the international Air transport association shall not be held responsible for any loss or damage caused by errors, omissions, mis-prints or misinterpretation of the contents hereof.

2 Furthermore, the international Air transport As-sociation expressly disclaims any and all liabil-ity to any person or entity, whether a purchaser of this publication or not, in respect of anything done or omitted, and the consequences of any-thing done or omitted, by any such person or en-tity in reliance on the contents of this publication. international Air transport association . All Rights Reserved. No part of this publica-tion may be reproduced, recast, reformatted or transmitted in any form by any means, electronic or mechanical, including photocopying, recording or any information storage and retrieval system, without the prior written permission from:Senior Vice PresidentMember and External Relations and Corporate SecretaryInternational Air transport Association33, Route de l A roport1215 Geneva 15 AirportSwitzerland TABLE OF CONTENTS SECTION 1 ROLE AND RESPONSIBILITIES OF AN AIRLINE Medical SERVICE.

3 1 Introduction .. 1 Potential functions of a Medical Service .. 1 Passengers Health .. 2 Occupational Health .. 3 Aircrew Health and Medical Certification .. 5 Alcohol and Other Drug Programs .. 8 Health and Wellbeing Promotion .. 8 Health Strategy and Risk Management .. 9 Primary Care Service .. 11 SECTION 2 THE CABIN ENVIRONMENT .. 12 Introduction .. 12 Pressurisation .. 12 Ventilation .. 13 Contaminants .. 13 Temperature .. 14 Relative Humidity .. 14 Passenger Space Available .. 14 Noise and Vibration .. 15 15 Conclusion.

4 15 References .. 16 Appendix A .. 18 Figure Engine Bleed Air System .. 18 Appendix B .. 19 Figure Physiological Impacts of Decreased Atmospheric Pressure .. 19 Appendix C .. 20 Figure Ventilation System .. 20 Appendix D .. 21 Figure Cabin Air Flow Pattern .. 21 SECTION 3 CREW Medical STANDARDS .. 22 Flight Crew Medical Standards .. 22 Rationale for Medical Standards .. 22 Environmental and Occupational Considerations .. 22 General and Specific Medical Considerations .. 22 Medical Standards .. 23 Selection and Initial Medical Examination.

5 23 Medical Manual Responsibilities of Flight Crew .. 23 Responsibilities of the Airline Companies .. 24 Responsibilities of Authorised Medical Examiners .. 24 Cabin Crew Medical Standards .. 24 Cabin Crew Working Conditions .. 24 Aeromedical Assessment .. 25 SECTION 4 OCCUPATIONAL HEALTH FOR AIR CREW .. 26 Sleep and Circadian Rhythms .. 26 Sleep Physiology .. 26 Alcohol .. 27 Sleepiness .. 27 Circadian Rhythms .. 27 Effect of Flight Operations .. 28 Strategies .. 29 Medication .. 31 Testing of Medication .. 31 Assessing Treatment Needs.

6 31 Principles of Prescribing .. 32 Over-the-Counter Medications .. 32 Alternative Medicines .. 32 Travel Medicine .. 33 Principles of Risk Minimisation Identification of Risk .. 33 Vaccinations and Travel .. 33 Important Diseases Associated with Travel .. 34 Environmental Issues .. 35 Jet Lag .. 35 Obligations of Airlines to Staff .. 36 Cosmic Radiation .. 36 Ty pes of Radiation .. 37 Benefits and Risks of Radiation .. 37 Ionising Radiation on Earth .. 37 Cosmic Ionising Radiation .. 38 Measurement of Ionising Radiation .. 39 Exposure to Ionising Radiation.

7 39 Radioactive Cargo .. 40 Occupational Exposure to Cosmic Radiation .. 40 Risks to Health .. 41 Definitions .. 42 SECTION 5 AIRCRAFT OPERATIONS .. 44 Food and Hygiene .. 44 Disinsection .. 44 Importance of Aircraft Disinsection .. 44 Legal Situation .. 45 General Principles of Aircraft Disinsection .. 45 WHO Recommended Disinsection Procedures (update 1998) .. 46 Considerations .. 49 Communication to Passengers and Crew .. 49 Cargo .. 49 Dangerous Goods .. 49 Emergency Treatment Following Exposure to Dangerous Goods Item .. 50 Storage and Handling of Toxic and Corrosive Materials.

8 51 transport of Dangerous Goods by Air .. 51 SECTION 6 PASSENGER CARE .. 52 Fitness to Fly .. 52 Responsibility for Medical Clearance .. 52 General Guidelines for Medical Clearance .. 52 Passenger Categories .. 52 Logistics of Medical Clearance .. 53 Special Services .. 53 Specific Medical Guidelines .. 53 Airline Initial Emergency Medical Response Programmes .. 62 First Aid and Emergency Medical Kits .. 62 Cabin Crew Training .. 62 Air to Ground Communication .. 63 Automatic External Defibrillation .. 63 Telemedicine .. 63 Reporting of Medical Incidents.

9 63 Handling of Deaths on Board .. 64 Medif Forms and Fremec Clearance .. 64 IDENTIFYING PASSENGERS WITH REDUCED MOBILITY? .. 64 MEDIF .. 64 FREMEC .. 65 Appendix A .. 66 Medical Clearance Procedures Example .. 66 Appendix B .. 67 Emergency Medical Kit - Medication .. 67 Emergency Medical Kit Equipment Contents .. 69 Medical Manual First Aid Kit .. 70 Universal Precaution Kit .. 71 Appendix C .. 72 First Aid Training .. 72 Appendix D .. 75 Sample of Medical Incident Report Form .. 75 Appendix E .. 77 MEDIF 77 FREMEC .. 81 SECTION 7 Medical INVOLVEMENT FOLLOWING AIRCRAFT INCIDENTS.

10 82 Crisis Response .. 82 Appendix A .. 83 INTRODUCTION IATA commissioned this Medical Manual to provide up to date information on airline Medical issues to its members, especially those which may not have the benefit of an in-house Medical advisor. The practice of airline medicine has changed substantially since the last edition of the Medical Manual was written and this is reflected in the fully revised document. The Manual will be reviewed regularly to ensure it remains relevant to the needs of IATA s members. The Medical Manual has been compiled with the expert advice of the IATA Medical Advisory Group.