WASHINGTON, D.C. – Ahead of the Federal Aviation Administration (FAA) Reauthorization legislation markup, Representatives Chrissy Houlahan (D-PA) and David Valadao (R-CA) sent a letter to their colleagues on the House Committee on Transportation and Infrastructure urging them to include a provision requiring epinephrine auto-injectors, like EpiPens, in aircraft emergency medical kits. The bipartisan letter, addressed to House Transportation and Infrastructure Committee and Aviation Subcommittee leadership, also encourages the committee to include a provision requiring the FAA to review the contents of emergency medical kits on a regular basis. 

“Anaphylaxis and severe allergic reactions can happen at any time and in an instant. We know the best way to immediately treat them when they occur are with epinephrine auto-injectors like EpiPens,” said Houlahan. “Including this life-saving measure on commercial flights is a commonsense decision to prevent in-flight health emergencies from happening.”

Today, during the FAA Reauthorization legislation markup, the Transportation and Infrastructure Committee passed an amendment requiring the FAA Administrator to review and update regulations regarding the contents of emergency medical kits and medical training required for flight crews within 12 months. The amendment, offered by Rep. Eleanor Norton (D-D.C.), also requires the FAA Administrator to consider the costs and benefits of including new medications in emergency medical kits and whether the contents of the kits include medications and equipment that can practicably be administered to address emergency medical needs of children and pregnant women, opioid overdoses, anaphylaxis, and cardiac arrest.

Houlahan continued: “It’s great that there will be a review and update of the contents in emergency medical kits and whether they can be practicably administered in flight. I’m hopeful the FAA Reauthorization will lead to the protection thousands of Americans by FAA using this mandated review to include auto-injectors on commercial flights.”

“Americans who suffer from severe allergies and are at risk of anaphylaxis deserve to have some peace of mind when traveling by plane. Ensuring airplanes have EpiPens on board and our airline crews are trained to administer these emergency medications is a measure that would without a doubt save lives,” said Valadao. “As the co-chair of the Congressional Allergy and Asthma Caucus, I’m proud to join my colleagues in calling for this bipartisan and commonsense reform to FAA regulations that will keep airline passengers safe.”

“The Asthma and Allergy Foundation of America applauds Representatives Houlahan and Valadao for initiating this bipartisan letter to ensure that every passenger aircraft emergency medical kit include epinephrine auto injectors, and we appreciate the 14 Representatives who co-signed the letter,” said Kenneth Mendez, president and CEO of the Asthma and Allergy Foundation of America. “On behalf of the 32 million Americans coping with food allergies, we encourage Congress to adopt commonsense language that will safeguard the lives of individuals who may experience anaphylaxis during a flight.”

Read letter here or below.

Dear Chair Graves, Subcommittee Chair Graves, and Ranking Members Larsen and Cohen:

Thank you for your leadership on the upcoming Federal Aviation Administration reauthorization. We believe this legislation offers a key opportunity to further bolster the safety and security of American passengers. As you continue this important work, we urge you to include necessary, commonsense language to require epinephrine auto-injectors (EAIs) in aircraft emergency medical kits (EMKs), which will prevent entirely avoidable in-flight health emergencies.

As you know, Section 307 of the FAA Reauthorization Act of 2018 required the Administrator to evaluate and, as necessary, revise regulations regarding aircraft emergency medical equipment and first-aid kits. This requirement was addressed via the 2019 Guidance produced by the Aerospace Medical Association Air Transport Medicine Committee as requested by the FAA’s Federal Air Surgeon. The Committee, in consultation with various medical stakeholders, recommended the inclusion of EAIs in aircraft EMKs, stating:

“When available and cost effective, auto-injectors are easier to use and can be used by cabin crew under order from ground medical advisor if there are no health professional on board. The AAP [American Academy of Pediatrics] endorsed this suggestion as well as suggested its availability in pediatric dosage”

In the four years since this guidance was issued, the FAA has unfortunately failed to act to revise its regulations to require EAIs in aircraft EMKs. While the FAA issued a purely voluntary recommendation in 2020 that aircrafts may include additional items in EMKs, without an explicit change to FAA regulations, lives remain at risk. Therefore, we believe legislation is necessary to correct this long overdue medical oversight and implement this clear and lifesaving guidance.

According to the Asthma and Allergy Foundation of America, anaphylaxis, a serious and life-threatening allergic reaction, is relatively common and occurs in an estimated one in 20 to 50 Americans. Studies have also demonstrated that many patients who experience anaphylaxis are not adequately equipped or ready to deal with future incidents. While aircrafts are currently required to carry two vials of 1:1000 single doses of non-auto injectable epinephrine in EMKs, airline crews do not receive training in administering the medication and must rely on trained medical professionals that may or may not be on board the flight and able to assist.

While there is an immediate need to include EAIs in EMKs, we also encourage the Committee to include a provision to require the FAA to review the contents of EMKs on a regular basis. Regular review will ensure that EMKs are stocked with the most up-to-date anaphylaxis rescue medications as new technologies are approved by the Food and Drug Administration and come to market.

The lack of EAIs in aircraft EMKs has led to life-threatening and traumatic health emergencies. However, these emergencies can, and should, be prevented. EAIs are user-friendly, safe, and reliable means to treat anaphylaxis. It is long overdue that FAA regulations be updated to reflect the Committee recommendation, including availability in pediatric dosages. Once again, to protect the safety and wellbeing of American passengers, we

urge you to include commonsense language in the upcoming FAA reauthorization legislation to address this critical issue.

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Houlahan is an Air Force veteran, an engineer, a serial entrepreneur, an educator, and a nonprofit leader. She represents Pennsylvania’s 6th Congressional District, which encompasses Chester County and southern Berks County. She serves on the House Armed Services Committee and the House Permanent Select Committee on Intelligence. She is the recipient of the U.S. Chamber of Commerce’s Abraham Lincoln Leadership for America Award which “recognizes members who demonstrate the bipartisan leadership and constructive governing necessary to move our country forward” and the Congressional Management Foundation’s 2022 Democracy Award for best Constituent Services in Congress.

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