Airline emergency medical kits are outdated and often inadequate

FAA mandated airline emergency medical kits to assist passengers with medical emergencies in flight, but the kits are outdated and inadequate to treat many passengers well.

merican Airlines A319 landing at Philadelphia International Airport. Copyright © 2018 NSL Photography. All Rights Reserved.I’ve witnessed three medical incidents on flights over the years and have personally experienced two medical incidents myself. The airline emergency medical kits were inadequate. My emergencies were caused by a severe allergy attack. I ate a dinner served on an international flight, while the other was when I was scalded by hot water spilled on me during meal service.

I’ve learned three important lessons from the five incidents about airline emergency medical kits.

1. The airlines carry medical kits on board their planes, but they may be insufficient for many medical incidents, and their quality may be inadequate.

2. There are medically trained people, including doctors and nurses traveling by air daily, who are saints, and willing to step up in an emergency.

3. Air travelers with known medical conditions must be prepared for problems from those conditions, and all air travelers must be prepared for incidents in which they may suffer injuries.

A study published in JAMA indicates that one of every 604 commercial flights has a medical emergency.

In December 2018, Dr. Christian Martin-Gill and others published “In-Flight Medical Emergencies, A Review” in JAMA, the Journal of the American Medical Association. From the review, we learn that in-flight medical emergencies occur approximately one per 604 flights or 24 to 130 in-flight medical emergencies (IMEs) per million passengers. While that seems like a low number, I assure you that it’s not if you’re the one having the emergency.

Air travelers, particularly those with chronic medical conditions, need to understand that air travel can cause pathophysiological issues for travelers. Commercial aircraft fly at cruising altitudes of 30,000 to 40,000 feet but are pressurized to an equivalent altitude of 5,000 to 8,000. As the JAMA study points out, this pressurization level can lead to “discomfort in patients, especially those with existing upper respiratory tract inflammation or infection, including sinusitis or otitis media.” The lower pressurization of oxygen at altitude can also lead to mild hypoxia in healthy passengers and be more pronounced for passengers with existing pulmonary conditions.

The JAMA study found evidence that air travelers prone to respiratory or vascular problems must consider them when about to fly.

The JAMA study states, “Prolonged sitting and hypoxia may trigger decreased venous flow, systemic inflammation, and platelet activation.” This explains the association between air travel and venous thromboembolism. Blocking a blood vessel by a dislodged blood clot can cause death.

Air travelers prone to respiratory and vascular problems must consider those conditions when they fly.

The FAA has required airlines to carry emergency medical kits since 1986. The requirements since 2004, 18 years ago, have not been updated.

The Federal Aviation Administration (FAA) has required airlines to carry emergency medical kits (EMK) in their planes. The kit’s requirements haven’t been upgraded since 2004. They added the need for airplanes with a capacity of thirty or more passengers to carry an automated external defibrillator (AED) and additional medications. Unfortunately, while the content of an EMK is extensive, it’s incomplete, according to health care professionals. It doesn’t have a quality standard.

This past June, Dr. Andrea Merrill said she assisted in a medical emergency on a Delta Airlines flight. After the flight, she tweeted,

Dear @Delta, I just assisted in a medical emergency in the air. Your medical kits need a glucometer, epi pen, and automatic blood pressure cuffs — it’s impossible to hear with a disposable stethoscope in the air. Please improve this for passenger safety!”

Anyone who’s flown knows plane cabins are noisy. Why does the FAA permit manual blood pressure cuffs that need to be read by stethoscope in emergency medical kits?

Anyone who’s flown knows plane cabins are noisy. Many passengers wear noise-canceling headsets to watch videos and listen to music or audiobooks. Unsurprisingly, Dr. Merrill couldn’t accurately take blood pressure because it was “impossible to hear with a disposable stethoscope in the air.”

Studies have shown that disposable stethoscopes are significantly inferior to standard stethoscopes with disk cover barriers. Why does the FAA allow disposable ones?

There’s also an inherent problem with disposable stethoscopes. In a Mayo Clinic study, doctors compared disposable stethoscopes with regular stethoscopes with disk cover barriers. According to the survey, doctors listening through disposable stethoscopes had an overall diagnosis error rate of almost 11 percent. Doctors using the regular stethoscopes with disk cover barriers had no errors.

Dr. Merrill suggested to Delta that they should put an automatic blood pressure cuff in each of its EMKs. Soon after the incident, Delta Airlines reached out to Dr. Merrill and said they switched to the automatic blood pressure cuffs in August. Good for them, but what about the other airlines?

Dr. Michaela Seigo, a pulmonologist at Temple University Hospital in Philadelphia, said she had a similar incident on Southwest Airlines, stating in June 2022, “I had a similar issue taking a manual BP in the air…turns out the kits are federally mandated, and incredibly outdated. They still have lidocaine in the code kit.”

Dr. Merrill also said the EMK didn’t include a glucometer, an inexpensive device to measure blood glucose levels. I’ve learned from Drs. Merrill and Seigo that air travelers with chronic conditions can’t depend on the airline having the gear or medication they need. They must bring it for themselves.

My two personal in-flight medical emergencies point out airline medical kits are inadequate.

My first medical emergency came from a dinner flying over the Atlantic Ocean. I don’t know what was in the food, but breathing was getting tough. The medical kit at the time had nothing for me. However, I always carry at least two EpiPens while traveling. When this incident happened, it was an Ana-Kit. I grabbed the kit and self-injected. I got close to instant relief. Whew!

My second incident could happen to anyone. The flight attendant was pouring hot water for tea. A passenger pushed her on the way to the bathroom and the hot water flew into my lap. That hurt — a lot. The flight attendant gave me some cloth napkins and helped me get my bag down from the overhead bin. From it, I grabbed my spare set of clothes.I used the napkins to apply cool water to my skin for a while, then put on the fresh clothes. I took some Tylenol, too. Had I not had a change of clothes with me, I would have been sitting in wet clothes for hours. I was okay a few days later.

The FAA must immediately update airline emergency medical kits requirements.

Air travelers can learn from these incidents, studies, and reports from physicians.

Whenever I travel by air I always have at least one full change of clothes, from head to foot, in my carry-on. I also carry all my prescription medications and the over-the-counter medications I use. I also carry a full migraine kit, as I suffer from them. Passengers who use medical devices, such as a glucometer, must also take them in their carry-on. With the FAA EMKs not providing even some basic instruments and medications, air travelers must do it for themselves.

I also call upon the FAA and similar authorities from other nations to immediately review and upgrade their regulations that mandate what EMKs must contain. The airline emergency medical kits should include updated lists of medications, supplies, and medical devices. In addition, they must specify a quality standard for all EMK contents. The contents need to be replaced due to expiration and other problems, plus for devices, specify maintenance requirements.

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