A trio of Senate Democrats want EpiPens to be a mandatory component of in-flight emergency kits on US commercial flights.
Senators Want EpiPens Mandatory On Flights
In a note to the Federal Aviation Administration signed by Elizabeth Warren (D – MA), Chuck Schumer (D – NY), and Ed Markey (D – MA), the US Senators panned a “glaring gap” in current regulations governing in-flight emergency kits. These kits, which must be fully-stocked and boarded before a commercial flight can legally take off to or from the United States, include several life-saving items including epinephrine in syringes “designed to be used primarily in the event of a cardiac emergency.”
But as of now, there is no requirement that the kit contains an epinephrine auto-injector, such as an EpiPen, that makes it easy for anyone to administer. As the Senators argue:
While epinephrine may be administered through a traditional injection by a trained medical professional, auto-injector devices are commonly used in emergency situations and offer a quick-to-use, pre-measured method that a layperson can use to immediately administer the necessary treatment.
This gap, the Senators claim, leave Americans at risk:
The glaring gap in FAA’s regulations disregards the widely-accepted guidance by medical professionals who stress the importance of epinephrine auto-injectors in treating anaphylaxis, and puts airline passengers at risk.
While some airlines claim they stock EpiPens, there is currently no mechanism to verify this and there are pecuniary concerns at play. As noted by Dr. James R. Baker Jr., the Director of the Mary H. Weiser Food Allergy Center at the University of Michigan, on GMA:
“The reason epinephrine in auto-injectors are not routinely stocked on planes is that they’re given very short shelf lives. So in fact, they have to be replaced continuously and they cost much, much more than regular epinephrine. The fact that the airlines would have to … go in and replace the auto-injectors in these kits, and the expense of that really precludes a lot of airlines from doing this.”
EpiPens can run $650 to $750 each without insurance and have a shelf-life of 12 to 18 months, which is a cost that certainly can add up for airlines.
CONCLUSION
Three US Senators are proposing mandatory EpiPens on US commercial flights. The FAA has promised to respond to their letter.
In any case, passengers are always advised to bring their own EpiPens in case of emergency. But with food allergies seemingly more prevalent than ever, it might not be a bad idea for airlines to have back-up options in place.
Should EpiPens be mandatory onboard US commercial flights?
image: Tony Webster / Flickr
Big 3 could just purchase them abroad for pennies on the dollar.
Are you suggesting generic substitutes from the Gobi desert ?
Not at all. Drug manufacturers charge astronomical prices in America because they can. In Europe, for example, the same drugs from the same manufacturer are significantly cheaper.
I am not a doctor so not sure on the implications of having it or not but it sounds like a good idea. Now, I would be careful to not suddenly, due to politicians mandating things, we turn the planes into a flying Walgreens since now other medicines and devices will be required for people that may have other needs.
Well said . Also , how about rattles and noise-makers for children’s entertainment at nighttime ?
What’s next? Narcan?
What happened to personal responsibility?
How about deodorant on low cost airlines?
Typical government overreach that we will all pay for. No way airlines will add expenses without passing it on to consumers.
Most US carriers already carry Narcan and FAs have already been trained on it’s administration.
Just another step on the race to the bottom.
Sorry to hear this.
Dave, what happens if you don’t *know* you have a life threatening allergy to a certain food until you eat something at 40,000 feet over the Pacific?
What happens if, as is sometimes the case, one Epipen isn’t enough?
Do you even know the slightest thing about anaphylaxis?
What happens if you just die at 40,000 feet? Certainly has happened occasionally, life goes on for everyone else. You can’t prepare for every situation, shit happens. I don’t want to pay for “maybe’s”, especially the odds someone doesn’t know they have an “allergy” and then just happen to eat something in flight that triggers said “allergy”.
Hopefully in this case the flight is to Vegas because odds are better than hit a jackpot than this fantasy happens.
A very good friend of mine was flying to AMS on Delta this past summer and spent most of the flight texting with his wife. Suddenly he stopped texting and she thought the internet went down. Next thing she got was a call from the US Embassy in the Netherlands informing her husband died during the flight. He had a heart attack and nobody noticed until the FA asked him to move his seat up for landing and he didn’t. Absolutely nothing would have saved him.
Narcan is already available – I have recently used on a passenger
Bottom line..
How common is it to have a newly diagnosed (on that flight) food allergy on a plane? Is it virtually zero?
Another comment mentioned Narcan. The case for that is stronger.
How about requiring emergency contraception on trans Pacific flights due to the delay in getting it on arrival?
How about requiring an MRI machine and also ventilator?
Well said . How about dental pliers if a tooth needs to be removed ? How about a sewing machine to repair a rip in one’s trousers ? How about a can of WD-40 if there is a squeaky wheel on a cart ? How about less seats for a more comfortable flight ?
I can’t believe I’m saying this, but Chuck Schumer is right.
Anaphylaxis can be a quick killer. On the Appalachian trail a day hiker was minutes into to it and she was so swollen. My hiking partner a combat medic tried to get an airway while I attempted to run for help. About a mile up the mountain. I found a doctor. He had epinephrine and saved her life. I now carry the pen.
However if the medical kit has epinephrine and a syringes for cardiac arrest, I would think someone could administer a dose IM if the kit was so labeled.
This is a gray area. People with allergy flying in a metal tube should already know the risk to carry one. And also a requirement will eventually create a flight delay because the emergency kit doesn’t have the minimum required list of stuff. Or even because someone in the last flight used something that can’t easily be restocked.
I say this as an anesthesiologist, the onboard medication and first responder gear is atrocious. As someone who is asked to help with onboard emergencies, having appropriate medications so I can help passengers should be the bare minimum.
Anaphylaxis is life-threatening on the ground. In the air it can be catastrophic.
It is not the airline’s responsibility to be a flying hospital/pharmacy. Then just carry meds with you if you want to help on board or don’t help at all! You need to stop complaining.
Epi-pens retail for $650 for the two pack cash price before insurance. Generic epinephrine auto-injectors cost $110 for the two pack at CVS cash price and can be offset with a manufacturer coupon to bring the cost down to $10 – limit 3 two-packs. No need for a brand name when the core ingredient is generic.
How about adding to any rule, FAR or law a statement limiting the liability of the airline and its employees, flight attendant training does not make them doctors and I guarantee you a mistaken “diagnosis” by an airline employee would result in a significant financial claim. Its not jus the cost of the equipment that the airlines are concerned with what any of these laws or rules are made, its also the costs seldom seen by the public.
It’s called the Good Samaritan law and it’s been around for ages.
My experience with that law has it failing every time when the case goes in front of a jury. It’s why my company did not provide aircraft for rescue of people, dogs, other pets, etc. without being paid and having a waiver signed by the party requesting the search before takeoff. Public Service agencies are mostly immune from liability but not private companies.
It’s pretty much impossible to kill someone with epinephrine. Misdiagnosis would lead to an elevated heart rate and a bit of hyperactivity in most cases.
U.S. price for epipens is ridiculous. In Australia you can walk into the drug store and buy one for $87 AUD ($58 USD). They are considered normal equipment for kits used by trained first-aiders.
I’m not keen on the idea of a governmental mandate requiring airlines to bring yet another thing on board, adding cost and complexity to an already complex system.
One of the things that tends to happen in both medicine and politics is that folks want to incrementally make things better so they add something, and then something else, and then something else– and next thing you know you’ve got an outrageously big and expensive medical kit that no one can find anything in, with things that rarely get used.
However, in this instance if the airlines are already required to carry epinephrine, I’m in favor of them having two epipens. I have once had to give a patient epinephrine for emergency anaphylaxis without an epipen– the old fashioned way: draw it up in a syringe and inject it. It was a disaster. You need a certain sized syringe and type/size of needle depending on the vial of epi that you have (concentration and size), and we didn’t have the correct sizes which resulted in a frantic but successful attempt to transfer the epi from the vial to the syringe and mate an appropriate needle to it. We had a team of doctors doing calculations to make sure we were getting to dosing right: if you give too much epi the person can die from that too.
That said, what I’d like to see the aviation industry respond with is legislation that limits the size, weight, and inflation adjusted cost of the required medical kit on flights, so that future attempts to require “one more thing” will also require folks to realistically balance what is being added with what is being taken away.
I am someone with a severe peanut allergy, so of course I always carry my own Epi-pens with me where ever I go. It’s important to note however, that epinephrine is not just used to treat severe allergic reactions as a lot of people seem to think.
Epinephrine is also the primary drug used to reverse cardiac arrest and can be used to treat asthma attacks and severe low blood pressure too. You may have watched a medical drama like Grey’s anatomy where a patient is coding on the table and they say “Push one of Epi”. They are talking about the drug epinephrine.
If you were on a flight and went into cardiac arrest for what ever reason or had a severe asthma attack at 35,000 feet, if the airline wasn’t carrying any EpiPens, your only hope of survival beyond a defibrillator would be that another passenger on board was carrying them.
Whilst the airlines may not have any legal responsibility to carry them onboard, I think it would be great if they did, both from a moral standpoint and as a duty of care. I’m not sure why people are getting so upset at the mere suggestion of airlines carrying them. I guess it’s that typical mindset of so many people where if something is not a problem for them personally, they’re just very unsympathetic and indifferent to others who may be effected.
Airlines should absolutely carry EpiPens, it’s a no-brainer. For those skeptical that a person can suddenly develop an anaphylactic allergy, my husband had a sudden anaphylactic reaction in his twenties to something that he’d never been allergic to previously. Thankfully he wasn’t on a flight at the time. He still requires an EpiPen for it, and it saved his life when traveling. Unlike vials of epinephrine, any layperson can administer an EpiPen. The critical thing is to jab it into the patient’s thigh and *hold it there for at least three seconds* (count slowly).