Author: Air Transport Association

This information was posted on the International Air Transport Association Website and on the MEC Website

General Guidelines for Cabin Crew

The following are general guidelines for cabin crew when facing a suspected case of communicable disease on board. During an outbreak of a specific communicable disease, the World Health Organization (WHO) or member states may modify or add further procedures to these general guidelines. However, these general guidelines would always provide a basic framework of response that would reassure cabin crew and help them through any unplanned incident.

A communicable disease is suspected when a passenger 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
• Abnormal bleeding
• Reduced mental clarity

If associated with a fever (temperature of 38° C 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 company-established protocol.

1. If medical support from the ground is available, contact that ground support immediately and/or
2. Page for medical assistance on board (as per company policy)
3. If medical ground support and/or on board health professional agrees with your suspicion or no support is available:
   
   
   1. Relocate the passenger in a more isolated area if space is available. If the passenger is relocated, make sure that the cleaning crew at destination will be advised to clean both locations.
   2. Designate one cabin crew to look after the sick passenger, preferably the cabin crew that has already been dealing with this passenger.
   3. More than one cabin crew may be necessary if more care is required.
   4. When possible, designate a specific lavatory for the exclusive use of the sick passenger. If not possible, clean the commonly touched surfaces of the lavatories (faucet, door handles, waste bin cover, counter top) with soap and water or available disinfectant after use by the ill passenger.
   5. If the sick passenger is coughing, ask him/her to wear a surgical mask.
   6. If no mask is available or the sick passenger cannot tolerate the mask because of severe difficulty breathing, provide tissues and ask him/her to cover the mouth and nose when coughing. Tell the sick passenger to use a sick bag to collect the used tissues.
   7. If the sick passenger cannot tolerate a mask and the airline recommends that designated cabin crew should do so, the airline should ensure that their cabin crew have adequate training in its use to ensure they do not increase the risk (for example by more frequent hand-face contact or adjusting and removing the mask). The designated cabin 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.* In fact, immediately after activities involving contact with a suspect case or any body fluids, gloves should be carefully removed as per training syllabus and discarded as per paragraph f and hands should be washed with soap and water. An alcohol-based hand rub can be used if the hands are not visibly soiled.
   8. Store soiled items (disposable masks, oxygen mask and tubing, linen, pillows, blankets, seat pocket items, etc.) in a biohazard bag if one is available. If not, use a sealed plastic bag.
   9. Ask accompanying passenger(s) (spouse, children, friends, etc.) if they have all or some of the same symptoms.
4. As soon as possible, advise the captain of the situation because he/she is required by the International Civil Aviation Organization regulations to report the illness to the destination station before arrival.
5. Unless stated otherwise by ground medical support or quarantine officials, ask the passengers 3 rows in front and 3 rows behind the sick passenger to fill a passenger locator card if those cards are available in the aircraft or at the arrival station.

* A general term referring to any action of hand cleansing, performed by means of applying an antiseptic hand rub (i.e., alcohol-based hand rub) if hands are not visibly soiled, or washing one’s hands with soap and water for at least 15 seconds. Avoid touching the face with hands.