A flight’s medical kit held epinephrine only at the strength used for cardiac arrest, in a device the doctor who answered the call had never used. Samara Friedman, MD, a pediatric orthopedic surgeon in private practice, was on a long flight when the call came: is there a doctor on board? A 20-year-old college student had eaten the meal, found nuts in it, and could not find her auto-injectors. A nurse had already given her an allergy pill. When that did not help, the nurse said, "Maybe it’s a panic attack. Why don’t you sit down, relax, and see how things go?" Dr. Friedman took a history. The student’s throat was itchy, her nose was running, her pulse was fast. No hives and no wheezing, and nobody could say yet whether it was anaphylaxis. Her reasoning is worth saving. If it was anaphylaxis and went untreated, the ramifications could be disastrous. If it was a panic attack, the cost was a painful shot with minor side effects. With limited resources on an airplane, she says the right call was unquestionably to give the epinephrine. The flight kit did have epinephrine, but not in an auto-injector and not at a concentration meant for anaphylaxis. It was the cardiac arrest kind, in a device she was completely unfamiliar with. "I had to MacGyver this epinephrine." She got it into a needle and syringe and converted the dose herself. The injection came out to about 10 times the volume of an auto-injector, because the concentration was 10 times more dilute. Within minutes the itchy throat and runny nose resolved and her pulse returned to normal. Her point is the system, not the rescue. In a flight of 300 or 400 people, she says, there are at least three or four who cannot eat the food. She says an airline could afford auto-injectors: "They probably prefer not to, and they just push that off to you, the doctors that have to deal with it when the issue arises." As an orthopedic surgeon she uses maybe three or four medications in her practice, and she says she would not have known the proper anaphylaxis dose offhand without a personal reason to know it. An auto-injector, she says, could be used by a flight attendant, a paramedic, or a nurse. What should an airline medical kit hold so that anyone on board can use it? Listen to the full conversation on The Podcast by KevinMD. Link in the replies. Search "The Podcast by KevinMD" wherever you listen to podcasts. #FoodAllergy #ThePodcastbyKevinMD