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But who governs the conduct of onboard health and
what rules apply? Generally, airlines must comply
with the rules of the authority with whom they are
registered. In the UK, for example, the Civil Aviation
Authority (CAA) regulates aircraft registered in Great
Britain. “Rules relating to onboard health are laid
down in Europe by the Joint Aviation Authorities
(JAA) operations manual, known in the industry as
JAR-OPS 1,” explains Dr Raymond Johnston, head
of the CAA’s Aviation Health Unit. “This sets out
medical standards for fitness for cabin crew and
provides general guidelines for cabin crew on the
treatment of passengers.” Countries’ individual
regulators, like the CAA, can subsequently build on
these minimum standards and enforce their own
additional requirements for members.
An association of representatives of the civil aviation
authorities of various European states who have
agreed to cooperate on safety standards – known as
the European Aviation Safety Agency (EASA) – will
soon take over some of the JAA’s work, Dr Johnston
explained. As a European Union body, the EASA will
have the power of the EU’s lawmaking capacities
behind it.
“Currently, cabin crew must have basic first aid
training that is tailored with specific reference to
what can occur on an aircraft,” says Dr Johnston.
Some airlines, however, provide additional training
to that which is required as a minimum standard.
BA says its cabin crews undergo rigorous first aid
training, above and beyond statutory
requirements, as part of their entrance training.
Five days are devoted to learning life-saving
Travel insurance is all well and good, but what if you fall ill during your flight? Diana
Bentley looks at how well prepared airlines are in case of medical emergency and where
responsibility for onboard health actually lies
www.itij.co.uk International Travel Insurance Journal
NEWSANALYSIS 25
procedures as well as more general first aid skills,
and refresher courses must be completed
annually. Cabin crews of Singapore Airlines
undergo a four-month training programme that
includes health and safety. Crews will have specific
training for the new double-decker A380 craft,
including medical and health programmes.
Under JAA rules, two different sorts of equipment
must be used on airlines: a first aid kit that includes
basic medical supplies like bandages and antiseptic
cleaner, and a medical kit that contains more
complex equipment and drugs, which can only be
used under the supervision of a qualified person
such as a doctor or a nurse. Many airlines exceed
the minimum requirements laid down by their
relevant regulator, however.
In the UK, semi automated external defibrillators –
used in cases of sudden cardiac arrest – do not
have, by law, to be carried onboard an aircraft, but
some airlines stock them by choice. Low-cost or
short haul airlines may not. Since 2004, the Federal
Aviation Administration of the US has required that
all planes in the country carry defibrillators, though
some airlines already did. “Some airlines like Qantas
and Virgin Atlantic used them before the US rules
came into force,” says Joan Sullivan Garrett,
founder and Chairman of MedAire, the USheadquartered
global telemedicine company. “We
regard them here not as medical equipment but as
part of first aid.”
Medical standards, however, evolve with medical
developments and with what regulators consider
desirable for passenger safety. Presently, the JAA is
reviewing what needs to be carried onboard and its
conclusions are expected later this year.
Handling cases onboard
As to who may be especially at risk on a flight, the
CAA’s Dr Raymond Johnston says: “The (USbased)
Aerospace Medical Association (ASMA) has
general guidelines on fitness to fly, but each airline
has its own rules, and passengers with health
problems should ask their airline for advice if they
think they need it.” According to BA, most people
with existing medical conditions can fly on a
commercial aircraft without any difficulty, but when
cabin air pressure is equivalent to an altitude of
6,000 to 8,000 feet, special care is sometimes
needed. “Passengers with problems like heart
disease or breathing difficulties should discuss their
journey with their doctor before booking, and if
they are flying with us they or their doctor can speak
to our Passenger Medical Clearance Unit,” says BA’s
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