Lesson 1Physiology of cabin altitude and hypobaric hypoxia: effects on oxygen saturation, cardiovascular compromise, and symptom thresholdsDescribes cabin altitude physiology and hypobaric hypoxia, including typical cabin pressures, effects on oxygen saturation and cardiac workload, symptom thresholds in healthy and vulnerable passengers, and implications for treatment.
Typical cabin pressure and equivalent altitudeGas laws relevant to the aircraft cabinEffects on oxygen saturation and dyspnoeaCardiovascular strain and ischaemia riskVulnerable groups and symptom thresholdsImplications for oxygen and diversion decisionsLesson 2Oxygen therapy titration, fluid resuscitation principles in the cabin, and safe use of medications (aspirin, nitrates, bronchodilators, intramuscular adrenaline) with aviation constraintsDetails oxygen titration at cabin altitude, fluid resuscitation with limited resources, and safe use of key drugs, integrating contraindications, dosing, delivery routes, and aviation safety rules for storage, labelling, and documentation.
Oxygen delivery devices and flow settingsTitrating SpO₂ targets in hypobaric hypoxiaFluid resuscitation with limited suppliesSafe aspirin and nitrate use in flightBronchodilators and inhalation techniquesIntramuscular adrenaline: dose and precautionsLesson 3Available onboard equipment and medications: typical first-aid kit, emergency medical kit contents, oxygen delivery systems, AED, and limitationsOutlines standard onboard medical resources, including first-aid and emergency medical kits, oxygen systems, AED capabilities, and key limitations, highlighting variability between airlines and implications for clinical decisions.
Regulatory minimum first-aid kit contentsEmergency medical kit drugs and devicesPortable and fixed oxygen system typesAED functions, prompts, and safe useEquipment variability between operatorsPlanning care around equipment limitsLesson 4Common in-flight cardiopulmonary emergencies and differential diagnoses for sudden dyspnoea and hypotension (ACS, PE, pneumothorax, anaphylaxis, arrhythmia, syncope, hypovolaemia)Reviews common in-flight cardiopulmonary emergencies, emphasising pattern recognition and differential diagnosis of sudden dyspnoea and hypotension, distinguishing ACS, PE, pneumothorax, anaphylaxis, arrhythmias, syncope, and hypovolaemia.
Recognising life-threatening dyspnoea patternsDifferentiating ACS from pulmonary embolismIdentifying tension pneumothorax in the cabinAnaphylaxis versus isolated bronchospasmArrhythmias, syncope, and hypotensionHypovolaemia and occult blood loss in flightLesson 5Criteria and process for diversion decisions: clinical thresholds, flight phase, time to suitable diversion airport, passenger stability, and operational/legal considerationsExplains clinical and operational criteria for diversion, including instability thresholds, response to treatment, flight phase, diversion airport suitability, legal responsibilities, and shared decision-making with the captain and ground control.
Clinical red flags mandating diversionTime-critical versus time-tolerant conditionsAssessing time to a suitable diversion airportCommunicating risk to the flight crewLegal and liability aspects of diversionDocumenting the diversion decision processLesson 6Immediate management algorithms for suspected acute coronary syndrome, pulmonary embolism, anaphylaxis, and cardiogenic or hypovolaemic shock in flightProvides stepwise algorithms for managing suspected ACS, PE, anaphylaxis, and shock in flight, adapting standard emergency protocols to limited diagnostics, cabin hypoxia, and constraints on drugs, fluids, and monitoring.
Suspected ACS: assessment and first-line careManaging suspected pulmonary embolism aloftRapid recognition and treatment of anaphylaxisCardiogenic versus hypovolaemic shock stepsUse of oxygen, positioning, and fluidsWhen algorithms trigger diversion or CPRLesson 7Documentation steps during and after the event: in-flight records, handover information for ground emergency services, incident reporting to airline operations and aviation medical authoritiesCovers accurate documentation during and after events, including structured in-flight notes, times and treatments, concise handover to ground teams, and mandatory reports to airline operations and aviation medical authorities.
Essential elements of in-flight medical notesTime stamping assessments and treatmentsPreparing handover for EMS at landingCommunicating with cockpit and operationsIncident and safety reporting requirementsConfidentiality and data protection issuesLesson 8Systematic in-flight assessment using remote medical consultation: focused history, vital sign targets, use and interpretation of portable pulse oximetry, and monitoringExplores structured in-flight assessment using remote medical support, emphasising focused history, symptom timelines, vital sign targets, pulse oximetry limits, and ongoing monitoring adapted to cabin altitude and equipment constraints.
Primary survey in the aircraft cabinFocused history and symptom timelineTarget vital signs at cabin altitudeUse and limits of portable pulse oximetersWhen and how to call ground medical controlContinuous monitoring and reassessment
