AircrewHealth.com

Suspected Communicable Disease

General Guidelines for Cabin Crew:

The following are general guidelines for Cabin Crew when facing a suspected case of communicable disease onboard.

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 to reassure cabin crew and help them manage such an event.

A communicable disease is suspected when a Traveler (passenger or a crewmember) has a fever (temperature 38°C/100°F or greater) associated with one or more of the following signs or symptoms:

• appearing obviously unwell
• persistent coughing
• impaired breathing
• persistent diarrhea
• persistent vomiting
• skin rash
• bruising or bleeding without previous injury
• confusion of recent onset

Note 1:  This list of signs and symptoms is identical to that listed in the Health part of the ICAO Aircraft General Declaration.

Note 2:  If food poisoning from in-flight catering 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 is available, crew should follow their advice accordingly.
4. If no medical support is available:
• a.)  Relocate the sick traveler in a more isolated area if space is available.  If the sick traveler is relocated, make sure that the cleaning crew at the destination will be advised to clean both locations.
• b.)  Designate one cabin crew member to look after the sick traveler, preferably the cabin crew that has already been dealing with this traveler.  More than one cabin crew may be necessary if more care is required.
• c.)  When possible, designate a specific lavatory for the exclusive use of the sick traveler.  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 traveler.
• d.)  If the sick traveler is coughing, ask him/her to wear a surgical mask.  If no mask is available or if the sick traveler cannot tolerate the mask, e.g. because of breathing difficulties, provide tissues and ask him/her to cover the mouth and nose when coughing.  Advise the sick traveler to use an "airsick" bag to collect the used tissues.
• e.)  If the sick person 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).
• f.)  The designated cabin crew should wear disposable gloves when assisting the sick traveler 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 g, and hands should be washed with soap and water.  An alcohol-based hand rub can be used if the hands are not visibly soiled.
• g.)  Store soiled items (used tissues, 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 and label it biohazard.
• h.)  Ask accompanying traveler(s) -- spouse, children, friends, etc. -- if they have any similar symptoms.
• i.)  Ensure hand carried cabin baggage follows the passenger and comply with public health authority's request, if any.
5. As soon as possible, advise the captain of the situation because he/she is required by International Civil Aviation Organization regulations (ICAO Annex 9, Chapter 8, and paragraph 8.15) and the World Health Organization International Health Regulations (WHO IHR 2005, Article 28(4))to report the suspectedcase(s) to air traffic control. Also remind the captain to advise the destination station that cleaning and disinfection will be required.
6. Unless stated otherwise by ground medical support or public health officials, ask all travelers seated in the same row, 2 rows in front, and 2 rows behind the sick traveler to complete a passenger locator card if such cards are available in the aircraft or at the arrival station.

*Proper hand hygiene: 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.  Touching the face with hands should be avoided.  Hands should be washed frequently.

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