Now, the idea of stock auto-injectors on-board is attracting high-profile support.
On July 21, 2019, Senate Minority Leader Chuck Schumer (D-NY) held a press conference saying it was time for the Federal Aviation Authority to require that all U.S. airlines include epinephrine auto-injectors – not just an epinephrine vial and syringe – in airline medical kits. “To keep the traveling public safe in the air, the FAA must update their medical standards and enhance outdated regulations by mandating epinephrine and EpiPens onboard all flights,” Schumer said.
It recently came to light that the FAA has an exemption in place until 2020 that allows airlines to forego purchasing epinephrine, in any form, for their medical kits. Schumer and Senator Tammy Duckworth (D-IL) sent a joint letter to the FAA demanding that the aviation agency rescind that exemption.
First Anaphylaxis on Flight
Schumer was supported at the conference by Dr. Mikhail Varshavski, a doctor known on TV and Instagram as “Dr. Mike”. Varshavski spoke of a recent flight from New York to Tel Aviv in-flight in which an Atlanta man, with no previous known allergies, began to experience anaphylaxis. Varshavski stepped forward to assist, and was surprised to find that instead of an epinephrine auto-injector, this flight’s medical kit contained only an epinephrine vial at the concentration for a heart attack, along with a syringe. He had to troubleshoot correcting the dosage.
“This is way too high of a dose. Had I given him the full syringe instead of spilling half of it on the floor, his heart could have stopped,” Varshavski said at the conference. The man recovered, but there were certainly tense moments. Varshavski told Fox News: “Had we left the situation to deteriorate we would have risked having to open his airways with an incision.”
Ordeal in the Skies
Among those taking action is college student Alexa Jordan, who said when she began to suffer anaphylaxis on a flight, a crew member said there wasn’t an auto-injector on-board. She had her own and used it, but spent most of the flight alone and frightened in the restroom. (The airline disputes her version, saying an auto-injector was offered, but Jordan stands by her recollection.)
Jordan launched a petition in 2019, calling for the revival of the Airline Access to Emergency Act of 2015, which failed to get liftoff. She has amassed an impressive 114,000 signatures. [Update: in 2021, the petition reached over 178,000 signatures.]
At the July 2019 press conference, Schumer said: “We all know that millions of Americans‚ – over 30 million – have food allergies, and if you go into anaphylactic shock, the solution is an EpiPen.” Schumer, who used the best-known of the auto-injectors’ brand name, noted that, on the ground “an ambulance or doctor is quite nearby. If you’re on the plane and there is no EpiPen, it could be fatal.”
While cost is sometimes raised as an issue for stocking auto-injectors, a June 2019 study pegged the total cost at $2.4 million, or eights cents per at-risk passenger.
Previous Epinephrine In-Flight Issues
The summer 2019 experiences with in-flight anaphylaxis call to mind some the previous in-flight incidents and epinephrine concerns:
- In 2014, Houston allergist Dr. Patricia Leonard helped with a child’s first-time anaphylactic reaction to cashew aboard a transatlantic flight headed to Newark. She needed two doses of epinephrine to gain control of the 4-year-old’s symptoms and, on this flight, only a vial and syringe were available. She has questioned whether most medical professionals would know the dose of epinephrine to draw up for a child so young.
- In 2018, Canadian allergist Dr. Donald Stark shared with Allergic Living another issue with epinephrine vials in the air. While assisting in an anaphylaxis emergency on a flight, he cut his fingers on one. “We got adrenaline [epinephrine] vials from the emergency kit while in some turbulent air. Trying to break open the top of a glass vial in order to draw up adrenaline is tricky.”
- Also in 2018, New York City nurse Kellie Hopkins stepped forward to assist a child who was having his first-ever anaphylactic reaction. When told there was no auto-injector in the medical kit, she resorted to polling other passengers to find an auto-injector, and two were volunteered. Like Leonard suggested, she worried about calculating the correct dilution of the medication for a child if she had to use the vial in a time-sensitive situation.
- As far back as 2015, the American Academy of Allergy, Asthma and Immunology (AAAAI) called for the addition of epinephrine auto-injectors to aircraft, and recommended crew to be trained on the symptoms of a severe allergic reaction and how to administer an auto-injector.