Allergic Living has been sounding the alarm for years on the urgent need for Federal Aviation Authority (FAA) to update the contents of airlines’ emergency medical kits.
Finally, there is hopeful news to share on airplane EMKs. The U.S. Senate, followed by the House of Representatives, each passed an FAA reauthorization bill. Then on May 16, President Biden signed the FAA Reauthorization Act of 2024 into law.
Tucked into the sweeping bill is an important clause that directly references airplane emergency medical kits and anaphylaxis, the severe form of allergic reaction.
It states that the FAA must consider whether the EMKs include “appropriate medications and equipment that can practicably be administered” for anaphylaxis. That means epinephrine, the first-line medicine for treating anaphylaxis.
When it comes to administering epinephrine, this section (Section 368) of the bill opens the door for FAA rules that mandate epinephrine auto-injectors in planes’ medical kits. It should also cover future needle-free epinephrine options.
For those flying with serious allergies, the expected changes will be a huge improvement. In my reporting for Allergic Living, I’ve heard from many doctors assisting in-flight anaphylaxis emergencies who’ve encountered challenges.
Some doctors found epinephrine wasn’t in the airplane’s emergency medical kit at all. Other times, it wasn’t available as an auto-injector. In still other in-flight allergy emergencies, the vial and syringe method wasn’t available in the dosage suited to anaphylactic reactions.
Senator Tammy Duckworth has been invaluable to achieving the medical kit update. The Illinois senator has championed inclusion of epinephrine and auto-injectors in EMKs since 2019.
“I’m proud the FAA reauthorization bill includes my bipartisan provision – which I led with Senator [Deb] Fischer,” Duckworth told Allergic Living. She says the clause will “help ensure our airplanes have the most equipped emergency medical kits possible on-board for passengers and crew who might need it.”
Plane Medical Kit Incidents
As part of such a large regulatory reauthorization, the EMK changes have taken a long time and considerable lobbying. I’ve been part of that for a decade since, in addition to being Allergic Living’s airlines correspondent, I’m also the leading advocate for food allergy airline accommodations.
Allergy advocacy groups, including my No Nut Traveler nonprofit, sent a letter in May 2023 urging lawmakers to address EMKs in the 2023 version of the FAA reauthorization bill. The letter asked the Transportation Committee to include a provision that requires a review of airline medical kits and ensures the inclusion of best practice medications for anaphylaxis.
There’s no doubt, at 30,000 feet in the air, it’s critical to administer epinephrine without delay in an anaphylactic reaction. Yet, following are just some of the in-flight incidents Allergic Living has covered.
• In 2019, Dr. Mikhail Varshavski assisted a passenger suffering first-time anaphylaxis on a flight from New York City to Tel Aviv. In the plane’s medical kit, Varshavski, known as “Dr. Mike” on social media, found an epinephrine vial. But it was in the concentration for a heart attack, so he had to troubleshoot to correct the dosage – or he could have stopped the man’s heart. He later told me that, without epinephrine for anaphylaxis, “you’re leaving the medical professionals to battle a fire without water.”
• College student Alexa Jordan began to have an in-flight anaphylactic reaction to a purchased salad in 2019. In her well-known case, she used her own auto-injector. She says she was offered no further epinephrine or assistance in a reaction in which she was passing out. Jordan launched a petition, amassing thousands of signatures, and became an advocate for auto-injectors on airplanes.
• A 4-year-old experienced a first-time anaphylactic reaction on a transatlantic flight from to the United States in 2014. Dr. Patricia Leonard later related fumbling through drugs in the disorganized EMK. Eventually, she found the epinephrine vial and the child needed two doses. The allergist has lobbied for auto-injectors to avoid delay. As well, she says not all doctors would know the epinephrine dose for a child.
• Orthopedist Dr. Samara Friedman had to jerry-rig a cardiac epinephrine device in 2022 to treat a young woman with worsening symptoms of nut anaphylaxis. In error, the passenger with a known allergy didn’t have her auto-injectors with her.
Act’s Epinephrine Wording Matters
Thanks to physicians speaking out, pressure built to improve the EMKs for anaphylaxis. Dr. Kimberly Blumenthal tells me: “I am thrilled to see the FAA has specifically called out anaphylaxis in their update.” On two different flights over ocean in 2022, the Massachusetts General allergist was called up for allergic reaction emergencies. In both cases, there was no epinephrine auto-injector in the EMK. Blumenthal resorted to polling passengers to ask who had one.
Blumenthal notes the high prevalence of food allergy and the need for readiness. “It is highly important that medical kits on board contain appropriate anti-allergic medications, including injectable epinephrine,” she says.
The FAA reauthorization act renews the aviation regulator’s funding for five years. It will improve many consumer protections and reflects a commitment to prioritizing passenger safety.
Of particular significance is the reauthorization act’s language that requires the FAA to move forward with rulemaking on airlines’ emergency medical kits. The language marks a pivotal shift. In the 2018 FAA Reauthorization, it was only required for the FAA to review the kits.
The FAA got the Aerospace Medical Association to evaluate the kits and the association recommended epinephrine auto-injectors for their ease of use. The FAA’s Office of Aerospace Medicine then endorsed the recommendation.
Despite the FAA receiving these recommendations in 2019, no rulemaking was begun to update the kits. This is why the words of the reauthorization act matter. It compels the FAA to issue a final rule on emergency kit contents within two years.
The new FAA act also introduces crucial consumer protections for families traveling with children. Specifically, it ensures that families with small children can sit together without additional fees. For parents of children with food allergies, this provision is vital to prevent unwitting allergen exposures.
Airplane Medical Kits & Safer Skies
“We expect our planes to have standard safety equipment like seatbelts, and there’s no reason consumers shouldn’t have the same expectation for emergency medical kits on our flights,” notes Duckworth.
The senator’s leadership on this provision in the FAA bill was first sparked by Alexa Jordan’s distressing in-flight anaphylaxis experience in 2019. Jordan is one of her constituents. Duckworth says she began looking into in-flight allergy issues “to help prevent more incidents like this.”
The FAA Reauthorization Act of 2024 takes a proactive approach to in-flight medical readiness. Soon, it should ensure airplane emergency kits reflect a commitment to passenger safety and well-being.
By 2024, we have the right tools to stock airline EMKs. It’s been a long time coming, but soon, the skies will be safer for those with food allergies.
Lianne Mandelbaum is Allergic Living’s airlines correspondent, and founder of the nonprofit NoNutTraveler.com.
Related Reading:
From 2022: Why Your Plane’s Medical Kit May Lack Epinephrine
Senators Urge FAA: Get Epi Auto-Injectors Onto Flights
Nuts on Planes: from Jack Fowler’s Scare to Flying with Snickers
