14.2 CPR Protocols, AED Operation & Airway Obstruction Management

Basic Life Support (BLS) & The DRSABCD Emergency Chain

In-flight cardiac arrest and severe respiratory emergencies represent critical life-threatening events onboard commercial aircraft. Cabin crew members must administer Basic Life Support (BLS) rapidly following standardized guidelines established by the International Civil Aviation Organization (ICAO) and the International Liaison Committee on Resuscitation (ILCOR) / American Heart Association (AHA).

The foundational protocol for responding to an unconscious or unresponsive passenger is structured around the DRSABCD emergency sequence:

1. D - Danger: Prioritize scene safety. Ensure there are no active cabin hazards such as spilled Jet-A fuel, electrical fires, loose high-voltage cables, or uncontained biohazard spills before approaching the victim.
2. R - Response: Assess passenger responsiveness. Gently tap the passenger's shoulders and shout loudly in both ears: "Are you okay? Can you hear me?"
3. S - Send for Help: If unresponsive, immediately shout for cabin crew assistance. Direct another crew member to notify the Flight Deck, retrieve the onboard Automated External Defibrillator (AED), First Aid Kit (FAK), Emergency Medical Kit (EMK), and request a medical volunteer announcement.
4. A - Airway: Open the victim's airway. Place the victim flat on their back on the cabin aisle floor. Execute a Head-Tilt / Chin-Lift maneuver (place one hand on the forehead and two fingers under the bony part of the chin to tilt the head backward). If cervical spine trauma is suspected, perform a Jaw-Thrust maneuver without extending the neck.
5. B - Breathing: Check for normal breathing for no less than 5 seconds and no more than 10 seconds. Observe chest rise, listen for breath sounds, and feel for air on your cheek. Note: Agonal gasps (infrequent, noisy gasping) are a sign of cardiac arrest and must NOT be mistaken for normal breathing.
6. C - CPR: If the victim is not breathing normally or only gasping, immediately commence chest compressions and rescue breaths at a 30:2 ratio.
7. D - Defibrillation: Apply the AED as soon as it arrives at the scene. Follow all audible and visual prompts immediately.

CPR Ratios, Dynamics & Demographic Differentiation

High-quality CPR is the single most critical determinant of survival in cardiac arrest. Effective chest compressions maintain coronary and cerebral perfusion pressure until defibrillation or advanced life support can be provided.

Automated External Defibrillator (AED) Operational Guidelines

An AED is a computerized medical device that analyzes heart rhythms and delivers an electrical shock to treat ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT). Onboard AEDs are safe, automated, and provide explicit voice and visual instructions.

Step-by-Step AED Protocol

1. Power On the AED: Press the green power button or open the device lid to activate voice prompts.
2. Expose and Prepare Chest: Remove or cut away clothing from the victim's upper torso. Ensure the chest is clean and dry. If the chest is wet or soaked in fluid, wipe it dry immediately. If chest hair prevents pad adhesion, use the razor in the AED accessory kit to shave pad sites.
3. Apply Electrode Pads:
   • Pad 1 (Upper Right): Attach to the upper right chest directly below the collarbone (clavicle).
   • Pad 2 (Lower Left): Attach to the lower left lateral chest wall below the armpit (mid-axillary line).
   • For pediatric application on infants/small children: Use pediatric pads if available. If unavailable, place one adult pad in the center of the chest (anterior) and the second pad in the center of the back (posterior).
4. Connect Cable & Stand Clear: Plug pad cable into AED (if required). Loudly command: "CLEAR PATIENT! DO NOT TOUCH THE PATIENT!" Ensure no crew member or passenger is touching the victim while the AED analyzes the heart rhythm.
5. Shock Delivery: If a shockable rhythm is detected, the AED charges automatically and instructs: "Shock Advised. Stand Clear." Ensure visual clearance around the victim, shout "EVERYONE CLEAR!", and press the flashing Shock button.
6. Post-Shock CPR: Immediately after shock delivery (or if "No Shock Advised" is announced), resume 30:2 CPR starting with chest compressions. Perform CPR for 2 minutes (approx. 5 cycles) before the AED re-analyzes the heart rhythm.

Managing Foreign Body Airway Obstruction (Choking)

Choking occurs when a foreign object blocks the pharynx or trachea. Airway obstructions are classified as either mild (victim can speak, cough forcefully, and breathe) or severe (victim cannot speak, breathe, or cough, and may display the universal choking sign of clutching the neck).

1. Conscious Adult and Child Choking Protocol

If the victim displays severe airway obstruction:

• Stand behind the victim and support their chest with one hand.
• 5 Back Blows: Deliver up to 5 sharp blows between the shoulder blades using the heel of your hand.
• 5 Abdominal Thrusts (Heimlich Maneuver): If back blows fail, stand behind the victim, wrap arms around their waist, make a fist with one hand (thumb-side against the abdomen midway between the navel and xiphoid process), grasp fist with other hand, and pull inward and upward in a quick motion up to 5 times.
• Repeat cycles of 5 back blows and 5 abdominal thrusts until the object is expelled or the victim becomes unconscious.
• Special Population: For pregnant female passengers or obese victims, substitute abdominal thrusts with chest thrusts positioned on the lower half of the sternum.

2. Conscious Infant Choking Protocol (Under 1 Year Old)

Abdominal thrusts are strictly prohibited in infants due to high risk of liver laceration.

• Lay the infant face-down along your forearm, resting your forearm on your thigh, supporting the head and jaw without pressing soft throat tissues (head lower than chest).
• Deliver 5 sharp back blows between the infant's shoulder blades using the heel of your hand.
• Turn the infant face-up along your opposite forearm, head lower than trunk.
• Deliver 5 chest thrusts over the lower sternum using two fingers (1 second per thrust).
• Repeat 5 back blows and 5 chest thrusts until the object is cleared or the infant loses consciousness.

3. Unconscious Choking Victim Protocol (All Demographics)

If a choking victim loses consciousness at any point:

• Gently lower the victim onto the cabin aisle floor.
• Call for help and send for the AED.
• Begin CPR immediately starting with 30 chest compressions.
• Visual Airway Inspection: Prior to delivering rescue breaths, open the victim's airway and look inside the mouth. If a foreign object is clearly visible, perform a finger sweep to remove it. Never perform a blind finger sweep if no object is seen, as it may force the obstruction deeper into the airway.
• Attempt 2 rescue breaths. If chest does not rise, reposition head tilt and attempt rescue breaths again. Continue 30:2 CPR cycles.