A medical practitioner

… read with interest an article on your blog Accessing medical supplies on an aircraft (August 9, 2017)  and I was wondering if you might be kind enough to let me know if you might be able to help with my query.

I was recently in Canada at a conference and was told by some apparently knowledgeable people that one of the reasons why many commercial airplanes do not carry ‘stock’ Epipens for emergency use to treat allergic reactions is because in many jurisdictions, Epipen is a prescription item and therefore its use by a non-healthcare professional or patient who has been prescribed the Epipen depends on the law of the country the aeroplane is flying over at that time. Thus, the Epipen could only be administered by a healthcare professional on board in many countries and not by the aircrew.

I was hoping that given your expertise/interest in this area, you might be able to help clarify the situation?

I do think the answer is largely in that earlier post but I’ll clarify it with specific reference to the epipen.

First it’s not the country that the aircraft is overflying that will be relevant, it will be a mix of the laws of the departure port, the arrival port and most importantly the law of the country where the aircraft is registered that is relevant.

It’s been discussed before that in Australia adrenaline is a schedule 3 drug.  That means a person does not need a prescription to obtain an Epipen from a pharmacist but it does mean it has to be supplied by a pharmacist, not from someone who bought it from a pharmacist – see Drugs in a private first aid kit (September 22, 2018).

In that earlier post (Accessing medical supplies on an aircraft (August 9, 2017)) I noted that aircraft do carry drugs and have access to medical advice to obtain authority to use those drugs.  The recommended kit list from the International Civil Aviation Safety Organisation includes ‘Epinephrine 1:1 000’.  The regulation of international air carriers is a complex interplay of Commonwealth and State laws to give effect to the international obligations that Australia has entered into.  I’m not going to try and find the specific rules that allow aircraft to have scheduled drugs in their medical kit.

As noted in that post

ICAO [the International Civil Aviation Safety Organisation] recommends that aircraft carry ‘accessible and adequate medical supplies’. There is no standard of what that means but they do recommend ‘one or more first-aid kits for the use of cabin crew in managing incidents of ill health’ and ‘for aeroplanes authorized to carry more than 100 passengers, on a sector length of more than two hours, a medical kit, for the use of medical doctors or other qualified persons in treating in-flight medical emergencies’…

It would appear that like many things the issue is risk management.  It is up to airlines to assess the risk of a medical emergency which must take into account the nature of their operations.  They will then carry appropriate medical and first aid supplies.

If we limit the discussion to Australian aircraft then they may chose to carry Epipens if they decide that is the appropriate response to the risk.  They may prefer to carry adrenaline in other forms or not all.  Where they do carry adrenaline it is a schedule 3 drug so it is appropriate that where it is carried on the aircraft it is only made available on the approval of a medical practitioner or pharmacist.  It may not require a prescription but it is ‘pharmacy only’ medicine, not an unscheduled drug.