The Federal Aviation Administration (FAA) is planning to rip up a decades-old rulemaking that tells airlines exactly what should be included in their on-board emergency medical kits and First Aid kits, giving them flexibility to decide what is (and isn’t) included, so long as the contents can be used to treat nine major life-threatening conditions.
The history of the FAA requiring airlines to equip their planes with medical equipment dates back nearly eight decades, when, in 1949, the federal government required carriers to have First Aid kits, with basic supplies like Band-Aids and bandages.
It wasn’t until 1986, however, that the FAA required airlines to stock a more comprehensive emergency medical kit on board, containing prescription-only medications and basic diagnostic equipment. The contents of these kits were meticulously prescribed, although the FAA now says a standardized list fails to keep up with advances in medical science.
In fact, the last time this list was updated was back in 2001, at which point, the required number of items in the emergency medical kit grew to 64, more than double the 32 required items from the 1986 list.
Today, the First Aid Kit (FAK) must contain: sixteen adhesive bandage compresses, 1-inch; twenty antiseptic swabs; ten ammonia inhalants; eight bandage compresses, 4-inch; five triangular bandage compresses, 40-inch; one arm splint, noninflatable; one leg splint, noninflatable; four roller bandage, 4-inch; two adhesive tape, 1-inch standard roll; and one bandage scissors.
And the Emergency Medical Kit (EMK) must contain: one Sphygmomanometer; one Stethoscope; three sizes of cricopharyngeal airways; four syringes of sizes necessary to administer the required medications; six needles of the sizes necessary to administer required medications; one 50 percent dextrose injection, 50cc; two epinephrine 1:1000, single dose ampule or equivalent; two diphenhydramine HC1 injection, single dose ampule or equivalent; ten nitroglycerin tablets; one set of basic instructions for the use of the medications in the kit; and one pair of protective nonpermeable gloves or equivalent.
The FAA is now proposing to eliminate these lists altogether (contained within Appendix A of 14 CFR part 121) and instead give airlines the flexibility to choose what goes in their FAKs and EMKs, so long as the contents can be used to treat these nine major medical emergencies:
- Chest pain and cardiac emergencies
- Airway and breathing emergencies
- Loss of consciousness
- Major bleeding
- Opioid overdose
- Hypoglycemia
- Gastrointestinal emergencies
- Anaphylaxis
- Childbirth
In the yet-to-be-published notice of rulemaking, the FAA says it is making this change because it is seeking to “promote modern medical practices by allowing assemblers of kits to follow the most up-to-date medical advice and make changes as necessary when designing the contents of each kit to treat the life-threatening conditions”
The proposals stem from the FAA Reauthorization Act of 2024, in which Congress directed the FAA to reevaluate the contents of FAKs and EMKs, with a particular focus on opioid reversal medications.
Until now, the FAA has not required airlines to stock medication like Narcan, although Southwest Airlines, United, Alaska Airlines, Delta, American Airlines, and Frontier already voluntarily stock opioid reversal medications like Narcan or its generic, Naloxone.
The proposed rulemaking would, for the first time, require all airlines to stock some sort of opioid reversal medication on board, along with items to deal with childbirth, such as a delivery pack.
The FAA says it built this proposal on the back of recommendations from the Aerospace Medical Association (AsMA), although the agency did reject some of AsMA’s recommendations. For example, AsMA suggested that airlines be required to stock some medications in FAKs rather than EMKs.
The reason? Because flight attendants are permitted to use items from the FAK without oversight of a medical professional, whereas items in the EMK can only be given by a healthcare professional or by a flight attendant with the guidance of a medical professional.
The FAA rejected this recommendation, saying it would require flight attendants to need to undergo medical training. Instead, FAKs will be limited to containing supplies “sufficient to provide adequate medical supplies to address injuries such as abrasions, lacerations, sprains or strains, and fractures.”
Perhaps one of the biggest implications of this proposed rulemaking is that airlines will not be required to stock EpiPens on board to treat life-threatening allergic reactions. Campaigners have long called on the FAA to force airlines to stock life-saving epinephrine autoinjectors or nasal sprays, rather than the ampules that need to be injected by a medical professional.
Only a handful of airlines, including Southwest, currently voluntarily stock EpiPens or their generic alternatives on board. In most cases, though, flight attendants must rely on an off-duty medical professional being on board to administer epinephrine with a syringe.
The FAA, however, says its proposals will give airlines more flexibility to stock their FAKs and EMKs with the latest medications. It will also avoid airlines needing to apply for costly exemptions when a certain medication is in short-supply, allowing airlines to find an alternative that can do the same thing.
Furthermore, the FAA claims the changes will allow airlines to save 15% per First Aid Kit, although the agency wasn’t able to quantify potential cost savings for its proposed changes to Emergency Medical Kits.
