14.3 First Aid Kit, Emergency Medical Kit & In-Flight Medical Emergencies

Regulatory Framework & Aircraft Medical Equipment (Nig. CARs Part 7)

Under the Nigeria Civil Aviation Regulations (Nig. CARs) Part 7 (Instruments and Equipment), commercial air carriers operating within or into Nigerian airspace must carry standardized medical equipment. Cabin crew members must be fully conversant with the contents, locations, operating limits, and legal access restrictions governing onboard medical supplies.

1. First Aid Kit (FAK)

• Carriage Mandate: Mandatory on all commercial passenger flights. The number of required FAKs scales with passenger seating capacity under the 7.9.1.11(a)(3) schedule: 1 kit for 0–100 seats, 2 for 101–200, 3 for 201–300, rising to 6 for more than 500 seats.
• Accessibility: Accessible to trained cabin crew members at all times during flight for treating minor injuries and illnesses.
• Standard Contents: Sterile adhesive bandages (assorted sizes), sterile gauze swabs, triangular bandages, safety pins, sterile burn dressings, roll bandages, adhesive tape, antiseptic wipes/solution, disposable nitrile gloves, CPR pocket mask, scissors, tweezers, splinting materials, and a standardized First Aid manual.

2. Emergency Medical Kit (EMK / Doctor's Kit)

• Carriage Mandate: Required by Nig. CARs 7.9.1.12 on a passenger flight in an aeroplane authorised to carry more than 100 passengers on a sector length of more than two hours. A smaller aeroplane, or a short sector, may lawfully carry none.
• Access Restriction: STRICTLY RESTRICTED. The EMK is locked/sealed and can only be opened and administered by a licensed medical physician, registered nurse, or qualified paramedic after their professional credentials/ID have been verified by the crew, or under direct authorization from ground medical advisory services (e.g., MedLink).
• Standard Contents: Advanced emergency pharmaceuticals and diagnostic tools:
  • Cardiac & Respiratory Meds: Epinephrine (Adrenaline 1:1,000 and 1:10,000), Atropine, Nitroglycerin spray/sublingual tablets, Albuterol/Salbutamol inhaler, Aminophylline.
  • Analgesics & Sedatives: Injectable analgesics, Antihistamines (Diphenhydramine), Corticosteroids (Hydrocortisone/Dexamethasone).
  • IV & Diagnostic Gear: Normal Saline / Ringer's Lactate IV fluids, IV cannula set, syringes and needles, blood pressure cuff (sphygmomanometer), stethoscope, oropharyngeal airway tubes, and tourniquet.

3. Universal Precaution Kit (UPK)

• Carriage Mandate: Required on aircraft configured to carry more than 250 passengers, or when risk assessment dictates for public health protection during infectious disease outbreaks.
• Purpose: Protects crew members handling biohazardous body fluids (blood, vomit, feces, urine) or managing suspected cases of communicable diseases (e.g., Ebola, Lassa Fever, COVID-19).
• Standard Contents: Dry powder for solidifying liquid spills, germicidal disinfectant spray, skin cleansing wipes, face shield / safety goggles, fluid-resistant surgical masks, disposable protective aprons, biohazard disposal bags with ties, and heavy-duty nitrile gloves.

The Nigerian carriage schedules (Nig. CARs Part 7)

The numbers below come directly from Part 7 and are the ones an NCAA examiner will use.

First-aid kits — 7.9.1.11(a). No person may operate an aircraft unless it is equipped with accessible, approved first-aid kit(s), with contents complying with IS 7.9.1.11 and carried in at least the following numbers:

First-aid kits shall be distributed evenly throughout the aircraft, be readily accessible to cabin crew members where cabin crew are required for the flight, and be located near the aircraft exits in case they are needed outside the aircraft in an emergency.

Universal precaution kit — 7.9.1.11(b). No person shall operate an aircraft that requires a cabin crew member unless it carries at least one universal precaution kit. An aircraft authorised to carry more than 250 passengers shall carry two, plus additional kits as determined by the Authority at times of increased public health risk such as an outbreak of a serious communicable disease with pandemic potential.

Emergency medical kit — 7.9.1.12. No person may operate a passenger flight in an aeroplane authorised to carry more than 100 passengers on a sector length of more than two hours unless the aeroplane is equipped with an approved emergency medical kit for the use of medical doctors or other qualified persons in treating in-flight medical emergencies. Contents comply with IS 7.9.1.12, and the kit shall be stored in a secure location.

Two consequences follow for cabin crew. First, a small regional aeroplane on a short sector may lawfully carry no emergency medical kit at all, so a crew member must know what is actually on their aircraft rather than assume. Second, the emergency medical kit is provided for qualified persons, which is why credentials are established before it is opened.

In-Flight Medical Emergency Management Protocols

When a passenger experiences an acute medical condition in flight, cabin crew members must follow a systematic procedure: maintain calm control, assign specific crew roles (primary caregiver, communicator, kit handler), inform the Flight Deck immediately, request qualified medical assistance via PA announcement, and contact ground medical controllers (MedLink).

1. Hyperventilation Syndrome

• Physiology: Rapid, excessive breathing driven by severe anxiety or panic causing abnormal loss of carbon dioxide ($CO_2$) in blood (hypocapnia).
• Signs & Symptoms: Rapid shallow breathing, dizziness, lightheadedness, anxiety, tingling/numbness around lips and hands, and carpopedal spasms (painful contraction of fingers and toes).
• Crew First Aid:
  • Reassure passenger calmly in a quiet area.
  • Encourage passenger to slow their breathing rate (coach 4-second inhale, 4-second hold, 4-second exhale).
  • Instruct passenger to breathe into cupped hands held over nose and mouth or a paper sickness bag to re-breathe $CO_2$.
  • Caution: Do NOT administer supplemental oxygen, as increasing oxygen delivery worsens hypocapnia.

2. Angina Pectoris & Myocardial Infarction (Heart Attack)

• Physiology: Reduced or completely blocked blood flow through coronary arteries to myocardium tissue.
• Signs & Symptoms: Heavy, crushing chest pain radiating to left arm, jaw, neck, or back; shortness of breath; pale, cold, clammy skin (diaphoresis); nausea and anxiety.
• Crew First Aid:
  • Position passenger sitting upright in a comfortable seat to reduce cardiac workload.
  • Administer high-flow supplemental oxygen via Portable Oxygen Cylinder.
  • Assist passenger in taking their own prescribed sublingual Nitroglycerin (or EMK nitroglycerin if authorized by doctor/MedLink).
  • If conscious and not allergic, assist passenger with chewing 300 mg of oral Aspirin.
  • Prepare AED immediately, notify Captain for priority emergency descent / diversion.

3. Stroke / Cerebrovascular Accident (CVA)

• Physiology: Interruption of blood supply to brain tissue due to a clot (ischemic) or ruptured vessel (hemorrhagic).
• Signs & Symptoms: Rapid neurological deficit assessed via the FAST protocol:
  • F - Face Drooping: One side of face droops or is numb; ask passenger to smile.
  • A - Arm Weakness: One arm feels weak or numb; ask passenger to raise both arms.
  • S - Speech Difficulty: Speech is slurred, garbled, or difficult to understand.
  • T - Time to Act: Record exact time of symptom onset and alert Flight Deck instantly for urgent diversion.
• Crew First Aid: Keep passenger calm and warm, elevate head 30 degrees, administer supplemental oxygen, do NOT give food, drinks, or aspirin.

4. Epilepsy & Generalized Seizures (Grand Mal)

• Physiology: Sudden abnormal electrical discharges in the brain causing involuntary muscle contractions.
• Signs & Symptoms: Sudden loss of consciousness, body rigidity followed by violent rhythmic jerking of limbs, foaming at mouth, eye rolling, temporary apnea, loss of bladder control.
• Crew First Aid:
  • Clear away nearby sharp objects, seat armrests, and hard items to prevent impact trauma.
  • Cushion the passenger's head using pillows or folded blankets.
  • DO NOT attempt to restrain the passenger's movements.
  • DO NOT force any object, finger, or airway tube into the passenger's mouth.
  • Once seizure activity ceases, place passenger into the Recovery Position (lateral recumbent) to maintain open airway and allow fluids to drain.
  • Administer oxygen and monitor vital signs until conscious.

5. Thermal & Electrical Burns

• Signs & Symptoms: Erythema (redness), blistering (partial thickness / 2nd degree), or charred/white tissue (full thickness / 3rd degree).
• Crew First Aid:
  • Immediately cool the burnt area using cool, clean running water or sterile saline solution for 10 to 20 minutes.
  • Cover the burn loosely with sterile non-adherent dressings or clean burn sheets.
  • DO NOT apply ice, cold packs, butter, ointments, or adhesive bandages directly onto burned skin.
  • Elevate burned limbs if possible and treat passenger for neurogenic shock.