Doctor’s Anaphylaxis: Airline Emergency Kits Need EpiPens


Imagine you're on a flight when you notice hives spreading across your skin, and moment later you feel short of breath. Next your throat starts to constrict and you're gasping for air. That was the situation for Dr. Lindsey Ulin, a physician at Boston's Brigham and Women's Hospital, on a Southwest flight. Dr. Ulin recognized she was having an anaphylactic reaction, even though she'd never had one before and had no known anaphylactic allergies.

She paged the flight crew and asked for an EpiPen, only be told that the kit didn't have one, only epinephrine vials that had to be measured and dispensed via a syringe, which the flight crew couldn't administer. There are multiple steps involved:

  • The 1 mL epinephrine vial has to be opened
  • A 5 mL syringe has to be used to draw up 0.3 mL to treat a patient with an allergic reaction, but this is a tiny does that's difficult to even see
  • Then the needle must be swapped out, because a blunt needle is used to draw up the epinephrine from the vial, but an injection needle is needed to get it into the patient
  • Needless to say the above steps aren't easy in a flight emergency environment, especially if there's turbulence

Fortunately for Ulin, there just so happened to be one person with medical training on the flight, a Texas doctor, who was able to dose and administer just enough epinephrine to keep Ulin stable until the flight landed and she could be met by emergency medical services at the gate.


Airline Emergency Medical Kits are Woefully Inadequate

Sadly, Southwest isn't an anomaly; virtually all U.S. airlines only have epinephrine in vials in their emergency medical kit, which require someone with medical training to administer, instead of Epipens, which the patient, flight crew, or another passenger could safely administer because it's pre-dosed and just has to be jabbed into the middle of the outer thigh.

Why? Because Epipens cost more than epinephrine vials, and the FAA hasn't mandated that airlines carry Epipens in their emergency kits, even though the FAA has the authority to regulate what must be carried in these kits. And yet despite repeated calls for the FAA to require EpiPens, the FAA has declined.

“Having to depend on a medical professional being on your flight or crowd-sourcing for life-saving supplies is not an emergency preparedness strategy,” Ulin noted. “I was lucky with how my story ended, but somebody else won’t be.”

And while Epipens are the focus of this post, many airline emergency medical kits also lack other essential items, such as an automatic blood pressure cuff and glucometer as this doctor discovered on an international Delta Air Lines flight.


Anaphylaxis Can Occur in an Adult With No Known Allergies

Before you dismiss this with “that could never happen to me,” don't be so sure. My own husband had an anaphylactic reaction in his twenties to something that he'd had many times previously, throughout childhood, and which had never before caused an allergic reaction. If it can happen to this doctor, to my husband, and to other people, it could happen to you or someone you love.


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