Air travel is a crucial part of the modern world, and ensuring the safety and well-being of passengers and crew is of utmost importance. Medical emergencies are rare but can occur during a flight, where onboard medical kits are the first defence against medical escalations. Ensuring your aircraft is equipped with a comprehensive first aid kit and emergency medical kit can make all the difference—even life-saving—when symptoms appear unexpectedly in flight.
In this blog post, we'll explore the importance of maintaining updated and fully equipped first aid and emergency medical kits, including Automated External Defibrillators (AEDs) and Personal Protective Equipment (PPEs). We'll examine how this level of preparedness delivers significant benefits to aviation industry operators, discuss relevant aviation regulations and oversight from civil aviation authorities, and show how MedAire can customise kits to meet unique requirements.
HISTORY AND REQUIREMENTS FOR MEDICAL KITS
Onboard medical equipment has mirrored the growth of the aviation industry, transitioning from basic first aid kits to comprehensive Emergency Medical Kits (EMKs). As air travel became more prevalent and passenger demographics expanded, the necessity for advanced medical preparedness to address both routine and unexpected in-flight medical events has become critical.
The evolution of onboard medical equipment has been a fundamental aspect of the aviation industry's growth since the early 20th century. Initially, first aid kits were rudimentary, designed primarily to assist in aircraft accidents. However, as passenger air travel expanded and became a routine means of transportation, the need for more comprehensive medical supplies to treat common in-flight ailments became evident. Early medical kits contained basic items such as bandages and pain relievers, but as aircraft technology progressed and long-haul flights became more common, the demand for advanced medical kits increased. The advancements in aircraft capacity and range, coupled with a growing and aging population, have raised the likelihood of in-flight medical events, necessitating a transformation in onboard medical preparedness. From basic first aid kits (FAKs) to sophisticated Emergency Medical Kits (EMKs), aviation medical provisions have evolved to address a wide array of medical needs, ensuring passenger safety and well-being during flights.
HOW REGULATIONS AND REQUIREMENTS HAVE EVOLVED
Over time, aviation regulations have evolved significantly to address the changing landscape of air travel and its associated medical needs. Civil aviation authorities such as the Federal Aviation Administration (FAA), European Union Aviation Safety Agency (EASA), and the International Civil Aviation Organization (ICAO) have progressively updated their guidelines to mandate the inclusion of more comprehensive medical kits on board, reflecting the technological advancements and growing passenger demographics. These authorities continually evaluate and update their standards to ensure that airlines are optimally equipped to provide the highest level of care for passengers and crew and enhance overall flight safety and regulatory compliance across the industry.
THE INTERNATIONAL CIVIL AVIATION ORGANISATION (ICAO)
A United Nations agency in charge of standardising practices and making recommendations to countries' aviation regulatory agency agencies, ICAO has been addressing medical equipment and supplies required on board civil aircraft since the early days of aviation. After its founding in 1947, ICAO’s first Standards and Recommended Practices (SARPs) for the medical aspects of aviation were published in 1951. ICAO's regulation of medical kits on board civil aircraft aims to ensure the safety and well-being of passengers and crew during flights. By setting standards for medical kit contents as well as the qualifications of crew members responsible for administering first aid, ICAO helps to ensure that medical emergencies can be addressed effectively in the air.
SARPs have been updated and revised over the years to reflect the changing nature of the aviation industry and advancements in medical technology. For example, ICAO now advises on the inclusion of AEDs onboard. According to ICAO, operators should determine the inclusion of AEDs through a comprehensive risk assessment that considers the specific requirements of their operation. Many operators choose to include AEDs on their aircraft as they are the sole effective remedy for cardiac fibrillation. MedAire's experience tells us that sudden cardiac arrest can occur in any operation. From a duty of care standpoint, including an AED is always welcome.
UNITED STATES FEDERAL AVIATION ADMINISTRATION (FAA)
From 1926 to 1958, civil aviation regulation was managed under the Department of Commerce. When the Federal Aviation Act was passed in 1958, it established the Federal Aviation Administration (FAA) as a separate agency to regulate and oversee civil aviation within the US. One of its early mandates was to set standards for the contents and maintenance of onboard medical kits.
Decades later, in 1998, the Air Transport Medicine Committee of the Aerospace Medical Association made its first recommendations concerning medical kits for commercial airlines. In the same year, the US Congress passed the Aviation Medical Assistance Act, which directed the FAA to review and revise regulations regarding the contents of aircraft medical kits. In the following years, MedAire played a pivotal role by providing data and the testimony of Joan Sullivan Garrett, its founder, to the US Congress about the need to revise the content of EMKs. Thanks to these efforts, AEDs became a required component of onboard medical kits on all US commercial aircraft in 2004.
BEFORE THE ESTABLISHMENT OF EASA
In Europe, national aviation authorities such as Germany's Luftfahrt-Bundesamt (LBA), France's Direction Générale de l'Aviation Civile (DGAC), Italy's Direzione Generale dell'Aviazione Civile (DGAC), and the United Kingdom's Civil Aviation Authority (CAA) were responsible for regulating and overseeing medical equipment on aircraft within their respective countries.
Each country's authority developed their own guidelines and requirements for aircraft medical kits based on its understanding of the risk of medical events and emergencies that could occur during flights, resulting in varying regulations across European countries. However, despite differences, the countries all recognised the need for well-equipped onboard medical kits to address common in-flight medical emergencies.
Consequently, regulations focused on providing basic first aid supplies, essential medications, and medical equipment to stabilise and manage various medical conditions until the aircraft could reach a suitable medical facility. This emphasised the importance of preparing for in-flight medical emergencies and ensuring that aircraft medical kits met basic standards.
EUROPEAN AVIATION SAFETY AGENCY (EASA)
Established in 2003, the European Aviation Safety Agency (EASA) aimed to standardise safety regulations for aviation across EU member states by harmonising individual country regulations. EU Regulation (EU) 2019/1383 replaced the previous regulatory framework (EU) 965/2012 and provided updated requirements for aircraft medical kits for various operations. EASA's Acceptable Means of Compliance (AMC) and Guidance Material (GM) documents outline the kits' contents. These documents also specify the qualifications and training required for crew members responsible for administering first aid and using medical equipment.
EASA keeps its regulations current with advancements in medical technology and knowledge. This ensures that the contents of the medical kits on aircraft meet the necessary standards and can be used to manage common as well as infrequent but flight-threatening in-flight medical emergencies. In 2015, EASA made it mandatory for large commercial aircraft to carry Automated External Defibrillators (AEDs) as part of their medical kits in response to the increasing importance of addressing cardiac emergencies on planes. Again, MedAire participated in the task force established to discuss the matter, providing more data and expertise.
CIVIL AVIATION REGULATIONS IN ASIA
Throughout the 20th century, national aviation authorities were established across Asia to oversee air traffic and aviation safety. In China, the Civil Aviation Administration of China (CAAC) was established in 1949, and in India, the Directorate General of Civil Aviation (DGCA) was founded in 1952. Japan's Ministry of Land, Infrastructure, Transport and Tourism (MLIT) was established in 1949.
These authorities were responsible for developing regulations and standards for onboard medical equipment and aircraft safety. While regulations varied across countries, there was a shared recognition of the importance of having well-equipped onboard medical kits to address common in-flight medical emergencies. In addition, authorities aimed to provide basic first aid supplies, essential medications, and medical equipment to stabilise and manage various medical conditions in-flight until the aircraft could reach a suitable medical facility.
Recently, these authorities have updated their regulations to incorporate new technologies and best practices. For example, in 2017, the CAAC issued new guidelines for the contents of medical kits, which included updated equipment and medications. The DGCA in India also updated its guidelines for aircraft medical kits in 2020, considering the COVID-19 pandemic and the need for onboard personal protective equipment (PPE).
RECOMMENDED MEDICAL EQUIPMENT FOR EVERY AIRCRAFT
While there are minimum regulatory requirements, it remains the responsibility of each airline or operator to determine the specific contents of their medical kits, and this is where MedAire's expertise provides invaluable guidance.
We’re pivotal in emphasising the necessity of staying current with advancements in aviation medical care. We convene annually with a panel of aviation medical experts dedicated to reviewing and enhancing solutions for onboard medical kits. Our proactive collaborations with global aviation regulatory and advisory bodies, such as the FAA, EASA, and CAAC, allow us to share invaluable insights into the nature of in-flight medical events and advocate for updated medical kit regulations.
We confidently provide evidence-based recommendations to these organisations by collecting and analysing data from numerous flights. Our comprehensive data access enhances our ability to substantiate the need for medical advancements, ensuring that onboard medical provisions are not just adequate but exemplary. Leading this initiative is Dr. Paulo Alves from MedAire, who spearheaded the task force of the Air Transport Medical Committee, delivering the most recent recommendations to the FAA on behalf of the revered Aerospace Medical Association.
The recommended list of items for an aircraft first aid kit covers essential categories to address various medical situations that may arise during a flight. Here are some of the items required or recommended to be onboard.
Examples of first aid supplies:
- Adhesive bandages: To cover and protect minor cuts, abrasions, or blisters.
- Gauze: For covering and cushioning more extensive wounds and helping to stop bleeding.
- Adhesive tape: To secure dressings, gauze, or bandages in place.
- Antiseptic wipes: To clean and disinfect minor wounds, preventing infection.
- Scissors: For cutting gauze, adhesive tape, or clothing when necessary.
Essential medications:
- Analgesics: Aspirin, ibuprofen, or paracetamol can help alleviate pain and reduce fever.
- Antihistamines: For treating mild allergic reactions.
- Antiemetics: To manage nausea and vomiting, which may occur due to food poisoning, motion sickness or other causes.
- Epinephrine: To treat severe allergic reactions (anaphylaxis) that can be life-threatening. Ideally, in the form of an auto-injector to expedite its use during the life-threatening anaphylaxis.
Advanced medical equipment:
- Automated External Defibrillator (AED): A life-saving device used to administer an electric shock to a person experiencing sudden cardiac arrest.
- Electronic Blood pressure cuffs: To monitor a patient's blood pressure during a medical emergency without interference from engine background noise and vibration.
- Pulse oximeter: A non-invasive device used to measure blood oxygen saturation levels and provide pulse rate, which can help assess a patient's respiratory or cardiac status during a medical emergency.
- Glucometer: A device used to measure blood glucose (sugar) levels, which is essential for managing diabetic emergencies such as hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar).
Personal protective equipment (PPE):
- Gloves: To protect the caregiver from potential bloodborne pathogens and reduce the risk of infection transmission.
- Face masks or shields: To prevent the spread of airborne particles and protect the caregiver and the patient.
- Eye protection: To shield the caregiver's eyes from potential splashes, sprays, or flying debris.
- Protective gowns: Disposable or reusable gowns that cover the torso, arms, and legs, providing a barrier against potential bloodborne pathogens or other infectious materials.
- Biohazard disposal bags: Specially designed bags for the safe disposal of contaminated PPE, used supplies, or waste, reducing the risk of infection transmission during the cleanup process.
Prescription medications:
- Nitroglycerin: A medication for chest pain (angina) that helps to dilate blood vessels and improve blood flow to the heart.
- Bronchodilators: Medications that help to open the airways in individuals with asthma or other respiratory conditions.
- Injectable antihistamines (only commercial aircraft): For treating severe allergic reactions when oral antihistamines are insufficient.
WHY CUSTOMISE AIRCRAFT MEDICAL KITS?
Regulators establish the baseline operators must adhere to; however, the specific needs of your passengers may call for additional items beyond the regulation. Therefore, while all Emergency Medical Kits contain prescription medications for severe cases, many operators include additional medications or advanced medical equipment to assist their specific operational profile.
By customising your aircraft's first aid kit, you demonstrate a commitment to the safety and well-being of those on board, enhancing your reputation as a responsible and proactive operator in the aviation industry.
"The aircraft is not a hospital; we don't want to turn it into one. Each aviation operator needs to assess their specific needs and risks. When working with MedAire, we consult on the passenger profile, operational profile and regulations when selecting the right kit. Having the right equipment is just the start. Regular training for crew members in using the equipment and administering first aid, as well as open communication with medical professionals on the ground to support the management of in-flight medical emergencies, is critical to effectively treat ill passengers,” said Dr. Paulo Alves, MedAire's Global Director of Aviation Health.
MAINTAINING AND REFURBISHING MEDICAL EQUIPMENT
Ensuring that your aircraft meets regulations and upholds duty of care with onboard medical equipment is not a one-time consideration. MedAire kits have an annual expiry and must be refurbished to remain in compliance. There have been several news stories in recent years where faulty medical equipment or improper maintenance has resulted in severe consequences, which underscores the importance of proper upkeep and maintenance of life-saving equipment in critical situations.
Managing the expiration dates of Enhanced Medical Kits (EMKs) can be challenging. Therefore, partnering with an expert like MedAire to ensure these kits are always ready for use and compliant with regulations is essential. To ensure medical kits remain well-stocked and up-to-date, operators should establish a regular maintenance schedule for inspecting and replenishing their onboard kits. This process should involve the following:
- Check expiration dates: Regularly review the expiration dates of all medical kits and refurbish as necessary according to expiry dates and regulatory compliance practices.
- Inspect medical equipment: Routinely inspect all equipment, such as AEDs, manual resuscitators, and blood pressure cuffs, for proper functioning and signs of wear or damage. Replace or recharge the batteries for these devices if they are low.
- Monitor inventory levels: Keep track of the expiration dates of all medical kits and allow ample time to refurbish the kit each year.
- Stay up to date with regulations and best practices: To ensure the contents of the onboard medical kit meet current regulatory requirements and reflect the latest industry best practices, regularly review requirements for the Civil Aviation Authorities for the destinations you travel to or consult with aviation medical experts, such as MedAire.
A valid and comprehensive medical kit onboard is vital for the safety and well-being of passengers and crew. As an aviation industry operator, maintaining and updating your aircraft first aid kit and all onboard medical kits ensures your operation meets regulatory requirements and demonstrates your commitment to the highest safety standards.
MedAire's expertise in aviation medicine and commitment to innovation make it the industry's leading medical and security services provider. With the help of MedAire, operators can access expert guidance and resources to guarantee their medical kits meet all regulatory requirements and reflect best practices in aviation medicine.
As a trusted aviation safety and security partner, MedAire offers solutions to help operators prepare for any medical emergency and respond quickly and effectively. By providing the best equipment to trained crewmembers with remote assistance from doctors, you can ensure the best possible outcomes for passengers and crew.