Kim Blumenthal, a Yale-trained immunologist, had no idea that U.S. airlines were required to carry emergency medical kits on most flights.
But when she needed to treat a young child suffering a severe allergic reaction on a plane, a flight attendant brought out a kit filled with a strict list of drugs and diagnostic tools. Blumenthal then responded to a medical emergency on another flight. And it happened again.
Three times in five years, always while on vacation with her family, Blumenthal answered the call, “Is there a doctor on board?”
So she got to know what’s inside a plane’s medical kit. And she was alarmed.
One stethoscope seemed to be made of plastic, she said. A blood pressure cuff looked disposable. A blood-sugar monitor was outdated. And the epinephrine — an essential medicine for allergic reactions — came in glass ampules that she would need to break open and draw up in a syringe, while calculating the correct dose on the fly.
“The kits were really disappointing and archaic,” she said.
Doctors and medical advocacy groups have been pleading for years with the Federal Aviation Administration to modernize the mandated contents of emergency medical kits, whose requirements haven’t changed in more than two decades.
They have pressed lawmakers for better life-saving tools and newer drugs such as epinephrine autoinjectors and nasal sprays for opioid overdose reversal. And supporters thought they’d scored a major victory when a 2024 law included a provision requiring the FAA to finally address the issue.
But the FAA’s new proposal for the contents of medical kits — revealed in August, with its comment period closing Monday — has left many in the medical community and some lawmakers stunned. For them, it’s become a lesson in the potential perils of pushing for change.
“This is not acceptable. We hope this is not final,” said Jenna Riemenschneider of the Asthma and Allergy Foundation of America, which has advocated on the issue for nearly a decade.
What the FAA has proposed
Emergency medical kits are not optional equipment; an incomplete kit can ground a flight.
The current kits — often stored in containers resembling tackle boxes or duffle bags — are stocked with 64 items, including CPR masks, syringes and drugs to treat various emergency conditions.
But the FAA wants to abolish the list of required medicines and equipment and replace it with a “performance-based requirement.”
Airlines would be free to stock the kits with whatever they want so long as they are prepared to treat nine conditions, including cardiac arrest and allergic reactions, according to the FAA. No specific drugs or tools would be mandated. Even epinephrine, considered best-in-class for life-threatening allergic reactions, would no longer be required.
The FAA said the goal is “to increase flexibility” for airlines and cut costs.
But the agency’s proposal also mostly ignores the recommendations from its own expert panel, created under the 2024 law to advise the FAA on the new kits.
“We were surprised that the standards didn’t get raised — they got lowered,” said J. Allen Meadows, a former president of the American College of Allergy, Asthma and Immunology. “We don’t like it.”
The American Medical Association has also objected, writing to the FAA that while it supports the desire to modernize medical kits, the proposal “goes further than modernization requires.”
Last month, Senate Minority Leader Chuck Schumer (New York) and Sen. Tammy Duckworth (Illinois), both Democrats, wrote to major U.S. airlines warning that the FAA’s proposal “will reduce public safety and trust when flying by increasing ambiguity, subjectivity and opacity of [the kit’s] components.”
Airlines for America, the trade association for U.S. passenger and cargo airlines, declined to comment on the FAA’s proposal.
An FAA spokesperson also declined to comment, citing the open comment period. The agency has already received more than 1,500 public responses. The agency is required to consider the comments before making a final decision.
The debate over the kit’s contents
Medical emergencies at 30,000 feet in the sky occur with surprising frequency.
A study published in 2025 found that 1 in every 212 flights involved an incident serious enough that flight crews called to consult with a ground medical team. The emergency medical kit was used in nearly 1 in 4 of these cases. And aircraft were diverted 1.7 percent of the time to deal with the health crisis, most often for heart or neurological problems.
The focus on what’s inside the emergency kits began with concerns about anaphylaxis, a sudden and life-threatening allergic reaction. Epinephrine is the best option. For now, the kits are required to carry ampules of the drug in two concentrations: one to treat allergic reactions and the other for heart problems.
But the ampules can be tricky to use. Epinephrine autoinjectors and more recently developed nasal sprays are much easier to deploy, especially if no doctor or nurse is on the flight, advocates say.
“It’s shameful,” said Lianne Mandelbaum, founder of the advocacy group No Nut Traveler. “For food allergies there is only one medication proven to work. Epinephrine. That’s a nonstarter to not include an EpiPen.”
A few airlines, including Delta, JetBlue, Southwest and American Airlines, say they voluntarily carry autoinjectors in their medical kits.
But they are not required to do so.
Advocates also hoped to add nasal spray naloxone, the opioid overdose reversal drug.
In 2024, Duckworth and other lawmakers inserted a provision in the FAA reauthorization bill requiring the agency to take action.
The bill gave the FAA two years to begin drawing up a plan for changing the emergency medical kits, noting that the agency should consider whether the kits needed to at least include drugs and tools “that can practicably be administered” to treat children and pregnant women, along with opioid overdoses, anaphylaxis and cardiac arrest.
The FAA’s expert panel was led by the Aerospace Medical Association, which delivered a report in April 2025.
Paulo Alves, the panel’s co-chair and global medical director for the aviation health firm MedAire, said some of the suggested changes were small. The panel wanted to expand the types of injection needles contained in the kits and drop stethoscopes — airplanes are filled with so much sound and vibration that they’re almost useless.
The panel also wanted to add items such as a digital thermometer, automatic blood pressure cuff, pulse oximeter, and drugs to treat convulsions, vomiting and psychosis.
And Alves’s group suggested adding naloxone nasal spray and epinephrine autoinjectors.
None of the suggestions made it into the FAA’s proposal. Instead, the list of items is presented as options for airlines to consider.
“I was really surprised,” Alves said.
But he said he eventually came around to support it. The FAA’s plan would allow airlines to adjust to medical advances without waiting for new rulemaking.
“The more I think about it, I think this is an evolution,” he said. “The enforcement of that, I don’t know how that will play out — it will require some medical oversight.”
Others said some minimum standard is still needed.
The National Association of EMS Physicians called flexibility “a sound regulatory philosophy” but suggested that the FAA use its expert panel’s list as the floor for what should be inside an emergency medical kit.
Blumenthal said her experience with the medical kits left her concerned about what she’d find the next time she was on a vacation flight with her family and needed to respond to a medical emergency.
“I worry that they’re going to just use the cheapest things,” she said, “not the easiest or best.”
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