The Federal Aviation Administration (FAA) requires airlines to carry certain lifesaving drugs onboard every flight, but in recent years, a growing number of airlines have received exemptions for planes to fly without all the drugs because of shortages, Roni Caryn Rabin reports for the New York Times.

From drug shortages to drug spending trends—what executive's need to know about pharmacy

Drug shortages lead to exemptions

Under FAA regulations, every airplane must have a medical kit that stocks:

• Two doses of epinephrine, one to treat allergic reactions and one to treat cardiac arrest;
• Atropine, which is used to treat a slow heart rate;
• Dextrose, which is used to raise low blood sugar in patients with diabetes; and
• Lidocaine, which is used to treat irregular heart rhythms, though the drug is used less often than it used to be, Rabin reports.

However, because of nationwide drug shortages, FAA has granted an increasing number of airlines exemptions to the regulations. Early exemptions allowed airlines to carry kits missing one or two drugs, Rabin reports, but by January 2016, over 50 airlines had been granted four-year exemptions from having to carry all five drugs in their medical kit.

There is no data on how many airplanes at any given time may be flying without the drugs, Rabin reports. However, FAA said the request process is public and all decisions about exemptions are posted on the Federal Docket Management System.

FAA said it approved the exemptions in an effort to preserve the nation's supply of those life-saving drugs. For instance FAA said without the exemptions medical kit suppliers "would be exacerbating the nationwide shortage by procuring drugs that are not likely to be used, which diverts usable lifesaving drugs" from ambulances, emergency medical workers, and hospitals.

Ross Feinstein, a spokesperson for American Airlines, said the airline is "in compliance with FAA regulations, but [has] exemptions when we are unable to obtain these drugs due to market availability."

Meanwhile, Brian Parrish, a spokesperson for Southwest Airlines, said Southwest "does not currently utilize any exemption for our emergency medical kits."

Experts criticize exemptions

While some experts agree that it is rare for flights to experience in-flight emergencies, others note that there's limited data tracking such incidents. Rabin cited one study published in JAMA, which found that an in-flight emergency occurs every 604 flights, and that there are anywhere from 260 to 1,420 in-flight medical emergencies every day worldwide.

And physicians say allergic reactions, particularly in children, are among the most common in-flight emergencies and warned against airline exemptions from carrying epinephrine.

Sherif Badawy, a pediatrician at Lurie Children's Hospital of Chicago, said that the most common in-flight emergencies involve either allergic reactions or respiratory problems. "You need epinephrine for both of them," Badawy said. He added, "To think you could fly without epinephrine is crazy."

Sandra Schneider, associate executive director for clinical affairs at the American College of Emergency Physicians, said that epinephrine is a "really critical" medication for flights, as some people may experience their first allergic reaction onboard.

Todd Mahr, president of the American College of Allergy, Asthma, and Immunology, said that even if epinephrine is in short supply, "you can usually scour around and find it." He added, "Anaphylaxis kills people. People have anaphylactic reactions on airplanes—they're not always prepared for it" (Rabin, New York Times, 10/3).