Are you prepared for an in-flight medical emergency?

Allergic reactions and other medical emergencies can happen anywhere, including 31,000 feet in the air. In fact, one study estimated that one out of every 604 flights involves some sort of health problem. The most common ones? They involve fainting (32.7%), gastrointestinal issues (14.8%), respiratory (10.1%), and cardiovascular (7%) symptoms.

And even if a doctor is on board who can help out if a passenger experiences anaphylaxis, a heart attack, or a seizure, the plane itself may or may not be carrying all the tools and supplies needed to take care of certain in-flight emergencies.

Earlier this year, for example, family physician and YouTube personality Dr. Mikhail Varshavski (aka Dr. Mike) famously rescued a fellow passenger on a flight to Israel. The man, who had no history of allergies and therefore had no reason to carry his own EpiPen, went into anaphylactic shock. The onboard medical kit contained epinephrine for heart attacks, but that dosage is too high to administer to a patient with anaphylaxis. Dr. Mike figured out a way to make it work, and the passenger made a full recovery. 

But the fact is many airlines are not currently required to carry EpiPens (or any epinephrine at all), thanks to a four-year exemption granted by the Federal Aviation Administration to 50 specific carriers. The exemption also applies to three other medications: atropine, dextrose, and lidocaine. This exemption was created with the overall best interest of the public in mind due to frequent manufacturer shortages of drugs used in emergency situations. Most medications in aviation emergency supply kits end up expired and discarded, and ground-based emergency responders use the drugs much more frequently. The exemption was created to be able to divert the drugs in short supply to ground-based services first. This exemption expires in January 2020.

While this doesn’t mean your flight definitely won’t have these supplies; it means there is no guarantee they will be on board.

What medical supplies are airlines required to carry?

According to the Code of Federal Regulations, all U.S.-based domestic and international flights must be equipped with the following items in preparation for in-flight emergencies: 

1. Between one and four first-aid kits, depending on the number of passenger seats
2. Lots of bandages, splints, and wound-care equipment
3. A stethoscope
4. CPR masks, a resuscitation device, and other respiratory equipment
5. An IV administration kit
6. Needles and syringes
7. Painkillers, antihistamines, and aspirin
8. A bronchodilator
9. Nitroglycerin
10. An automated external defibrillator

While these supplies are certainly useful and necessary, they won’t cover every issue that could come up in flight. That means it’s up to you, as a traveler, to be prepared, particularly if you have known issues (like food allergies), explains Norman Tomaka, a clinical consultant pharmacist in Melbourne, Florida, and spokesperson for the American Pharmacists Association. “We don’t want [travelers] to have a false sense of security,” Tomaka says. 

Instead, expect the best but prepare for the worst, says Sandra Gawchik, DO, co-director of the division of allergy and immunology at Crozer-Chester Medical Center in Chester, Pennsylvania. “The key is when you travel you want to make sure that you have your medicine with you,” she says. “You don’t want to have it in the overhead bin, you want to have it readily available.”

This applies to rescue inhalers for asthma, EpiPens, and any other medication that you would need quick access to in an emergency situation, she says. She also recommends making sure your travel companions know where to find your medication and how to use it.

What medical supplies should you pack?

Depending on your condition, you should consider including some—or all—of these items in your carryon luggage.

1. EpiPen (or two)

If you have severe allergies you probably already know that one is not enough—two EpiPens are essential, Dr. Gawchik says. That’s because while one dose will relieve anaphylaxis, symptoms could return in three to eight hours. If they do, and you’re still in transit, you’ll need a second shot.

2. An antihistamine, like Benadryl

Anaphylaxis isn’t the only symptom of an allergy. In fact, hives and itching are much more common. A dose of Benadryl can help. The downside? It could make you sleepy (which might not be that big of a deal, particularly if you are on a red eye flight). Also, be sure to turn down the in-flight cocktail as Benadryl and alcohol don’t mix.

3. Anti-itch cream (hydrocortisone)

Hydrocortisone cream is fast-acting and should bring relief in the event that you experience a minor skin-related allergic reaction, Tomaka says.

4. OTC painkillers

Nothing can make a flight drag on like a headache (well, aside from an overly chatty seatmate). Yes, acetaminophen is probably one of the medications on airplanes that you could get from the flight attendant—but it is much easier to reach into your carryon bag for your headache remedy of choice.

5. Anti-diarrheal medication 

If you start feeling ill from that bad hotel buffet an hour into your flight, you are going to wish you had some Imodium at the ready. Remember: persistent GI problems can lead to dehydration, and dehydration can quickly become a bona fide medical emergency.

6. Blood sugar monitor

It you have diabetes, be sure to carry whatever it is you normally use to keep your blood sugar in check, including your blood sugar monitor. A blood sugar crash on board a flight can be extremely dangerous, especially if your flight isn’t carrying dextrose. You should avoid this possibility at all costs.

7. Copies of your prescriptions

Finally, make sure all of your medicine on flights are labeled with the original manufacturer or pharmacy label, advises Tomaka. He urges travelers to bring copies of all prescriptions along with them and notes from your doctors. With EpiPens in particular, he suggests notifying the flight crew that you are carrying one so they can be prepared for the unlikely event that you would need to use it.

When you’ve packed the right items, you can relax and enjoy an in-flight movie, knowing that even if the worst happens, you’re prepared for it!