Do-It-Yourself (DIY) Medicine at 30,000 Feet: Use of EpiPens
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In July, when Matt Faraco, a 26-year-old from Atlanta, noticed his hands beginning to swell and his throat beginning to close while on a flight to Israel he didn’t know that he was experiencing the onset of anaphylactic shock. He’d never before had trouble with the kind of allergies that can cause such a life-threatening reaction.

Now Faraco owes his survival to a celebrity TV and YouTube Doc, Dr Mike Varshavsky, who People magazine in 2015 dubbed “The Sexiest Doctor Alive.” Varshavsky happened to be on the same plane and responded to flight attendants’ call for a physician’s help. The right medicine to treat anaphylaxis – epinephrine - was immediately available to him because it is part of the plane’s “enhanced” medical kit. But it could only be administered by a licensed doctor or by another trained medical personnel working under the direction of a doctor via the plane’s radio. Thus, had Varshavsky or some other medical professional not been on the plane Faraco may well have died anyway.

The event happened just weeks after Rob Houston, a long-time lobbyist in Washington, D.C., had begun putting together a plan to form a new activist group with the aim of getting Congress to require all commercial aircraft to begin carrying pre-packaged epinephrine injection devices that anyone, not just doctors and medical personnel, can administer. Houston, whose 10-year-old daughter Catherine has dealt with a severe and potentially deadly peanut allergy all her life, formed the Coalition for Lifesaving Epinephrine Access and Responsibility (CLEAR) earlier this year after a series of well-publicized cases of anaphylaxis events aboard commercial airliners.

“It’s one thing to pass a mandate that airlines equip their planes with EpiPens,” Bell said.

“We likely will follow what’s happening in schools,” she explained. “Every state now has laws requiring schools to stock EpiPens, though the rules vary widely. We’ll be looking at the best practices among those to see what will work best.”

Prior to the late 1990s epinephrine was not available in any form on commercial flights. But as part of its unilateral effort to place Automated External Defibrillators onboard all its planes American Airlines also created enhanced medical kits stocked with a wider array of medical instruments and medicines than ever before. Congress thereafter ordered the FAA to create new rules requiring all airlines to carry AEDs and the enhanced medical kits on their planes.

Dr. David McKenas, American’s chief medical officer at the time, and the driving force behind the introduction of AEDs and enhance medical kits to the airline world, said he and his team considered and rejected the idea of including epinephrine devices in those enhanced medical kits out of concern that they might be mistakenly administered to someone exhibiting symptoms similar to anaphylactic shock but who actually was experiencing some other serious medical issue.

“You could be giving them something that would make their situation worse,” McKenas said. “We consciously chose to make epinephrine vials, along with syringes and needles, a part of the kit because that way it would require a doctor or trained medical professional to be involved in determining what the patient was experiencing. I still would be hesitant even today making it possible for a non-professional to make that decision.”

McKenas said it’s always best for those who have such allergies to “be responsible and carry your own EpiPens, or carry EpiPens for your children travelling with you.”

“I think it would be helpful,” Lockey said. “Could an EpiPen hurt someone? Ninety-nine percent, ‘No.’ Now, if it were given to someone with really severe coronary artery disease it theoretically could hurt them. But that would be an extremely rare case, especially in an airplane (where someone with severe coronary artery disease is very unlikely to be). But in the other 99% of the cases it definitely could save the person’s life. At 30,000 feet you don’t have a good option. They could very well die before you get to a hospital and run lab tests to determine what the problem is.

S S and 8 others like this
Dr. M●●●●●v D●●●i
Dr. M●●●●●v D●●●i Internal Medicine
Unfortunately disposable prefilled epinephrine (adrenaline in our country) is not available even on the land, forget about at 30-40000 feet. We have tried suggesting to many pharma. companies with no success.
Sep 29, 2019Like