U.S. Department 

of Transportation 

Federal Aviation 

Administration 

Advisory 

Circular 

Subject: AIR CARRIER FIRST Date: 3/9/95 ACNo: 120044A 

AID PROGRAMS Initiated by: AFS-203 Change: 

1 PURPOSE. This advisory circular provides guidance about 

first aid program resources, subjects, equipment, and pertinent 

regulations. 

2. RELATED FEDERAL AVIATION REGULATIONS (FAR) SECTIONS. 

a. FAR Part 91, Subpart A - General. Section 91.3. 

b FAR Part 91, Subpart C - Equipment, Instrument, and 

Certificate Requirements. Section 91.211. 

c. FAR Part 121, Subpart G - Manual Requirements.. _ ,i -. 

Sections 121.133 and 121.137. 

d FAR Part 121, Subpart K - 

Requirements. 

Instrument and Equipment 

Sections 121.309 and 121.327-331. 

e. FAR Part 121, Subpart M - Airman and Crewmember 

Requirements. Section 121.383. 

f FAR Part 121, Subpart N - Training Program. 

Sections 121.415-417 and 121.427. 

g FAR Part 121, Subpart T - Flight Operations. 

Sectioi 121.574. 

h 0 FAR Part 121, Appendix A - FIRST-AID KITS AND EMERGENCY 

‘MEDICAL KITS. 

i. FAR Part 125, Subpart F - Instrument and Equipment 

Reauirements. Section 125.207. 

0 

I FAR Part 125, Subpart H - 

Requirements. 

Airman and Crewmember 

Section 125.271. 

k FAR Part 135, Subpart B - 

Section 135.91. 

Flight Operations. 

1 FAR Part 135, Subpart C - Aircraft and Equipment. 

Sections 135.157 and 135.177. 

m. FAR Part 135, Subpart H - Traininq. Section 135.331. 
AC 120044A 319195 

3 a BACKGROUND. Information about possible first aid resources 

including a curriculum for first aid training and complete first 

aid training programs may be obtained by contacting various 

organizations including the American MedicalAssociation, 

American Red Cross chapters, American Heart Association chapters, 

and hospitals. In addition, information about protecting 

employees from bloodborne pathogens and other sources of 

infectious diseases may be obtained from these sources and the 

Occupational Safety and Health Administration. Nevertheless, 

many people have requested first aid information specific to air 

carrier operations. This advisory circular provides information 

to assist air carriers in developing first aid programs which 

meet the needs of that air carrier's operations and may provide 

one means of complying with existing regulations. 

4 DISCUSSION. Air carrier crewmember first aid programs 

should include first aid information in crewmember manuals and in 

any required emergency training. When addressing various aspects 

of first aid, the limited space on aircraft and the necessity for 

crew coordination throughout an occurrence should be stressed. 

First aid programs should include: 

, 

. . 

. _ +* ._ 

a. First Aid and Emeraencv Medical Equipment. Air carrier 

first aid programs and manuals should provide information about 

protection from bloodborne pathogens and treatment of illness and 

injuries. In addition, first aid programs and manuals should 

provide information about the locations, function, and operation 

of first aid and emergency medical equipment. They should also 

include methods to ensure that the contents of the first aid kit 

and emergency medical kit are complete. Procedures for 

replenishing used kits should be provided. 

b Use of Emergency and First Aid Oxygen. Air carrier 

training programs and crewmember manuals should include the 

location, function, and operation of emergency oxygen equipment. 

This should include methods to determine when supplemental and 

first aid oxygen equipment are ready for use, locations of all 

oxygen equipment, and procedures for administering oxygen. In 

addition, air carrier training programs and crewmember manuals 

should include the air carrier's policy and the FAR that prohibit 

smoking in the vicinity of oxygen use, and proper restraint of 

oxygen equipment when in use. Air carriers which use 

chemically-generated passenger supplemental-oxygen systems should 

include in their crewmember manuals and training programs 

information which is specific for these types of oxygen systems. 

This should include the heat-generating properties and the 

correct handling of the oxygen canisters. 

Page 2 Par 3 1 
319195 AC 120044A 

C. The Handlinq of Illness and Injury. An air carrier's 

first aid program should provide information about protection of 

crewmembers from bloodborne pathogens (including use of barrier 

gloves), familiarization with the contents of the medical kit and 

the assessment of the severity and possible treatment of the 

medical problems listed below. This list also provides 

suggestions pertinent to some problems. However, neither the 

list nor the suggestions are all inclusive.‘ Each air carrier 

should develop first aid programs which are appropriate to that 

air carrier's operations, equipment, and personnel. These 

programs should include information on the following: 

(1) History and Assessment of individuals who are ill 

or injured. . This information should be communicated to the 

flight crewmembers, any on-board medical assistants, and anyone 

offering medical assistance to the flight from the ground, and 

should be given to medical personnel who meet the flight. 

(2) Lack of Breathing, Choking, Hyperventilation. 

(3) Profuse Bleedinq (including nosebleed). . , . b r* 

(4) Shock, Unconsciousness, Major Allergic Response. 

(5) Chest Pain. 

(6) Cardio-Pulmonarv Resuscitation (CPR) I including 

use of available airway equipment. The material should address 

problems specific to the aircraft including movement of the 

person receiving CPR. 

(7) Stroke. 

(8) Seizures. 

(9) Diabetic Emergencies. 

(10) Childbirth. 

(11) Abdominal Distress. 

(12) Airsickness. 

(13) Injuries to the Extremities. 

(14) Injuries to the Skull, Spine; and Chest. 

Par 4 Page 3 
AC 120044A 3/g/95 

(15) Eve Injury. 

(16) Ear Distress. 

(17) Infectious Diseases/Conditions. 

(18) Universal precautions against bloodborne pathogens 

(see Appendix A). 

(19) Physical agents, which include the management of 

common injury situations such as minor burns caused by the 

spillage of hot liquids, in-flight fire/smoke situations, and 

situations where passengers and crew could be exposed to extreme 

conditions such as in a water landing. The treatment of chemical 

burns, smoke inhalation, and excessive heat exposure should be 

included. 

(20) Hvpoxia and proper use of oxygen, including 

reference to conditions that may be exacerbated by administration 

of oxygen. 

(21) Special Communications Situations, which may k -./ 

include the elderly, the visually impaired, the hearing impa*ired, 

those with behavioral problems, and those who do not understand 

English. 

(22) Drug and Alcohol Abuse which includes the 

different ways this may be manifested depending on the type of 

drug that has been abused. 

d 0 Assistance. 

(1) From Persons on Board. Each first aid program 

should provide a procedure for identifying medically qualified 

persons on board the aircraft. These procedures should list 

those persons who would be considered medically qualified. For 

example, medical doctors, nurses, emergency medical technicians, 

or first aid instructors could be listed. 

(2) From Persons on the Ground. Many airlines have 

procedures which allow crewmembers on board the flight to consult 

with medical personnel on the ground. This practice is highly 

desirable. Air carrier manuals and training should provide 

guidelines to crewmembers about obtaining medical consultation 

from the ground. The information obtained through the medical 

history and assessment should be passed on to these medical 

personnel. 

Page 4 Par 4 : 
3/g/95 AC 120044A 

(3) Following the Flight. The pilot in command should 

use all the information available to determine the level of 

medical assistance needed when the flight arrives. Some of the 

information will be obtained through the medical history and 

assessment. The crewmembers on board the flight are the only 

people who have direct knowledge of the nature and severity of 

the medical problem; therefore, while the decision regarding the 

level of assistance needed may be made by consulting ground 

personnel, no one on the ground should downgrade the level of 

assistance requested by the pilot in command. 

e. Medical Emergency Landinq. First aid programs should 

provide specific guidelines which give information about when a 

medical emergency landing may be needed. This information should 

be covered during emergency training, should be included in the 

manual, and should also be provided in a glchecklist'V or some 

other easily-read format. It should be carried on the airplane 

either in the first aid kit or some other area easily accessible 

to the crewmembers. The guidelines should be specific and 

include medical emergencies such as suspected heart attacks, 

diabetic coma, low blood sugar conditions, unconsciousness, and 

profuse bleeding. It should be emphasized, however, that th& - 

decision to make a medical emergency landing rests with the pilot 

in command who will also have to consider the overall safety of 

the flight and operational requirements. 

"William J. White 

Deputy Director, Flight Standards Service 

Par 4 Page 5 

3/g/95 

APPENDIX A. BLOODBORNE PATHOGENS. 

AC 120044A 

Appendix A 

1 PURPOSE. The purpose of this appendix is to provide 

information about the types of material which could be included 

in a program to encourage awareness of and prevention of exposure 

to bloodborne pathogens (awareness program). This program, if 

given, should be part of the air carrier's emergency training and 

other information pertaining to first aid (first aid program) and 

should provide information to crewmembers about precautions to 

take when crewmembers believe they may be exposed to a bloodborne 

pathogen. 

2 BACKGROUND. Certain pathogens can be found in the blood and 

other body fluids of infected individuals. These bloodborne 

pathogens may be transmitted when an individual is exposed to 

infected body fluids. The two most significant diseases caused 

by bloodborne pathogens are Hepatitis-B, which is caused by the 

Hepatitis-B Virus (HBV), and Acquired Immunodeficiency Syndrome 

(AIDS) I which results from the Human Immunodeficiency Virus 

(HIV). Both of these diseases are dangerous, and eventhough *. ' 

there is only a slight possibility that crewmembers would be 

exposed, it is still important to provide them with information 

about the nature of bloodborne pathogens, which could cause these 

and other diseases. Such information can be obtained from a 

number of sources including local hospitals, doctors, state 

health departments, and the Occupational Safety and Health 

Administration. 

The awareness program should provide material appropriate in 

content and vocabulary to crewmembers and the tasks they perform. 

The awareness program does not necessarily have to be part of a 

classroom presentation. Air carriers are encouraged to be 

creative in the presentation of the awareness program and may use 

various methods of presenting the material including 

computer-based training (CBT), video presentations, and written 

materials. Information about this program should be listed with 

other training information in the emergency first aid section of 

the air carrier's training program and should be contained in 

appropriate parts of crewmember manuals. Subjects which can be 

included in an awareness program include, but are not limited to, 

the following: 

a. A general explanation of the epidemiology and symptoms 

of bloodborne diseases; 

Page 1 
AC 120044A 319195 

Appendix A 

b An explanation of the modes of transmission of 

bloodborne pathogens and the rationale for, and use, of universal 

precautions; 

c. A description of the tasks and other activities that 

may involve exposure to blood and other potentially infectious 

materials; 

d An explanation of the use and limitations of practices 

that will prevent or reduce exposure, including work practices 

and proper use of gloves; 

e. Information on the types, location, removal handling, 

proper use and/or disposal of gloves; 

f Information on the Hepatitis-B vaccine, including 

information on its efficiency, safety, and the benefits of being 

vaccinated; and 

g Information on the appropriate actions to take and 

persons to contact when crewmembers have come in contact with -. 

body fluids (see paragraph 2(b)). 

Page 2 *U.S. G.P.0.:1995-387-549:113 

U.S. Department 

of Transportation 

Federal Avktion 

AdministMion 

BULK MAIL 

POSTAGE & FEES PAID 

FEDERAL AVIATION 

ADMINISTRATION 

PERMIT NO. G-44 

800 Independence Ave., S.W. 

Washington, D.C. 20591 

FORWARDIN AND RETURN 

POSTAOE OUARANTEED 

Official Business 

Penalty for Private Use $300 

-. 

, , _ . . .*