Document ID: FAA-2000-7119-0416
Agency: faa
Document Type: Rule
Title: Emergency Medical Equipment
Posted Date: 2013-09-27T04:00Z

[Federal Register Volume 78, Number 188 (Friday, September 27, 2013)]
[Rules and Regulations]
[Pages 59623-59624]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-23522]

-----------------------------------------------------------------------

DEPARTMENT OF TRANSPORTATION

Federal Aviation Administration

14 CFR Parts 121 and 135

[Docket No. FAA-2000-7119]
RIN 2120-AG89

Emergency Medical Equipment

AGENCY: Federal Aviation Administration (FAA), DOT.

ACTION: Final rule; notice of policy change and availability.

-----------------------------------------------------------------------

SUMMARY: This action supplements the preamble published in the Federal 
Register on April 12, 2001 (66 FR 19028). The FAA has reviewed data for 
automated external defibrillators and enhanced emergency medical kits 
to amend the ``no go'' provision. Data show that allowing these items 
to be incomplete, missing, or inoperative for one flight in accordance 
with the FAA master minimum equipment list does not adversely affect 
aviation safety. This action provides notice of the data finding and 
makes available the corresponding policy change for the one-flight 
relief for use of emergency medical equipment.

DATES: This action becomes effective September 27, 2013.

FOR FURTHER INFORMATION CONTACT: Gregory J. Janosik, New Program 
Implementation and International Support Branch, Air Transportation 
Division, Flight Standards Service, Federal Aviation Administration, 
800 Independence Avenue SW., Washington, DC 20591; telephone: 202-267-
8166; facsimile: 202-267-5229; email: Gregory.Janosik@faa.gov.

SUPPLEMENTARY INFORMATION: In the final rule entitled, ``Emergency 
Medical Equipment,'' published on April 12, 2001 (66 FR 19028), the 
preamble states that automated external defibrillators (AED) should be, 
and enhanced emergency medical kits (EMK) should remain, ``no-go'' 
items. See 66 FR 19033. That final rule's preamble also states that the 
current provision under Sec.  121.279(a), with adoption of Sec.  
121.803(a) without the words ``unless authorized by the Administrator'' 
would remain until the FAA developed more experience with the enhanced 
EMKs and AEDs. Id.
    As described in the background section, the FAA has data obtained 
from the airline industry to demonstrate that use of the emergency 
medical equipment required by Sec.  121.803(a) would rarely be used on 
back-to-back flights and therefore has allowed relief for one flight 
with an incomplete, missing, or inoperative Emergency Medical Kit (EMK) 
or automated external defibrillator (AED). A copy of Master Minimum 
Equipment List (MMEL) Policy Letter (PL) 73, Revision 5, Relief for 
Emergency Medical Equipment, is available for review on the Flight 
Standards Information Management System found on the FAA's Web site at: 
http:// fsims.faa.gov/. A copy will also be posted to the docket for 
this action.

Background

    FAA PL-73, MMEL Relief for Emergency Medical Equipment, was 
originally issued on March 4, 1994. The PL was created to provide 
standardized MMEL requirements for the deferral of approved emergency 
medical equipment, including EMK, First Aid Kits (FAK), and AEDs 
required by 14 CFR Sec.  121.803. The purpose of the PL has remained 
consistent throughout its five revisions, although the relief specifics 
have been further defined. Revision 1 reformatted the PL to conform to 
PL standardization requirements. Revision 2 expanded the relief for 
FAKs to include relief for all emergency medical equipment. Revision 3 
clarified that emergency medical equipment in excess of the regulatory 
requirements can be inoperative. Revision 4 provided three-flight 
limited dispatch authority for all incomplete, missing, or inoperative 
EMKs, FAKs, and AEDs that do not meet the minimum regulatory 
requirements. Revision 5 reduced the limited dispatch authority 
available from three flights to one flight in all situations.
    On April 6, 2001, the FAA issued the final rule requiring certain 
aircraft operating under part 121 to carry EMKs, FAKs, and AEDs. See 66 
FR 19028. The final rule's preamble reflected the FAA's long-standing 
position that emergency medical equipment items are ``no-go'' items and 
AEDs should also be considered ``no-go'' items meaning that if they are 
not operating pursuant to the regulatory standard then the flight 
should not be permitted to takeoff. In that final rule, the FAA also 
indicated

[[Page 59624]]

that the ``no go'' policy would remain in effect until the agency 
develops more experience with the equipment. Consistent with the 
regulation, the FAA issued Advisory Circular (AC) 121-33B which 
restated the policy that ``EMKs and AEDs are `no-go' items and must be 
carried as indicated on the'' MEL on January 12, 2006. The AC indicated 
that the air carrier may elect to carry redundant equipment to ensure 
that after use of the equipment in flight, the minimum required 
equipment is still on board the aircraft.
    However, on April 12, 2006, the FAA issued Notice 8000.320, which 
allowed MMEL relief for EMKs and AEDs, despite the contrary statements 
in the rule and AC discussed earlier. The FAA allowed the MMEL relief 
based on data collected from major air carriers, beginning in 1998 that 
showed using an EMK on back-to-back flights was rare. The notice also 
determined that ``a large number of passengers may be at more risk at a 
diversion airport than they would be if MMEL relief'' was available 
allowing the aircraft to be dispatched to its intended destination. 
This notice, which reversed previous FAA policy as stated in the 
preamble to the 2001 final rule, was not published for public comment 
before its issuance. It was eventually cancelled after 12 months on 
April 12, 2007.
    On April 18, 2006, soon after the release of Notice 8000.320, the 
FAA released PL-73, Revision 4, MMEL Relief for Emergency Medical 
Equipment. Consistent with Notice 8000.320, this revision granted 
limited dispatch authority for aircraft with EMKs, FAKs, and AEDs that 
did not meet the minimum requirements of 14 CFR Sec.  121.803. PL-73, 
Revision 4 authorized an air carrier to complete up to three flight 
cycles (3 flights) without the required equipment allowing time for the 
air carrier to repair or replace emergency medical equipment. PL-73, 
Revision 4 remained in effect until June 15, 2011.
    PL-73, Revision 5 was released on June 15, 2011. Revision 5 
resulted from a review conducted by FAA Flight Standards Service, which 
concluded that the MMEL relief offered by revision 4 was not consistent 
with regulation and was counter to the FAA's established position that 
EMKs and AEDs are ``no-go'' items. Revision 5 allows only one flight 
cycle (1 flight), in any situation, for an air carrier to obtain the 
minimum required emergency medical equipment on board the aircraft. 
However, upon review of the policy, the FAA concluded that revision 5, 
though more restrictive than revision 4, is still not consistent with 
the regulation nor does it comply with the intent of the regulation as 
expressed in the preamble. Because revision 5 was a shift in the FAA's 
stated policy, the public should have been notified and provided 
opportunity for comment before adopting the new policy.
    The FAA's position is that although the preamble to the rule is 
clear that EMKs and AEDs are ``no go'' items, as contemplated by that 
final rule. Our experience has led us to conclude that relief should be 
allowed in limited circumstances. However, it is foreseeable that 
required medical equipment may be used during a flight, and the pilot 
will divert the aircraft to a location where the utilized medical 
equipment cannot be replenished or replaced. Therefore, the FAA has 
determined that allowing the air carrier to conduct one flight so that 
the aircraft can fly to a location where supplies are available would 
allow passengers on such a flight to reach their destinations without 
adversely affecting safety. As discussed earlier, air carriers have 
presented statistical information about EMK usage on aircraft to the 
FAA, which indicates that once an EMK or AED is used during a flight, 
there is only a remote possibility that it would need to be used on the 
next flight.
    Airlines for America (A4A) recently resubmitted that data along 
with an analysis of EMK use to support its position that three-flight 
relief would be acceptable. A4A's analysis was based on the likelihood 
of using an EMK on the first successive flight and extrapolated that 
data to conclude the likelihood of using an EMK on three consecutive 
flights would be 1: 3.8 x 10-\13\. The FAA evaluated A4A's 
analysis and determined that the conclusion regarding use on three 
consecutive flights was not statistically valid. The FAA notes that 
A4A's analysis failed to consider that the likelihood of needing to use 
an EMK on any of the three successive flights would be the same as 
needing it on the first flight. A4A's letter has been placed in the 
docket associated with this notice.
    The probability of needing an EMK does not decrease because an EMK 
was opened on the first flight. We believe, therefore, that the 
probability of needing the EMK on subsequent flights would be 5.5 x 
10-\5\ to 7.8 x 10-\5\ (3 times as high as the 
one-flight case). Therefore, because there is a relatively low 
probability of needing the EMK on any particular flight, we are 
allowing one-flight relief to air carriers with an inoperative EMK or 
AED so that if the flight lands at a location where the equipment 
cannot be repaired or replenished, the airplane can move to a location 
where such services are available. However, because the probability of 
needing to use an EMK on subsequent flights does not diminish, we do 
not believe that three-flight relief would be acceptable.

    Issued in Washington, DC, on September 18, 2013.
John S. Duncan,
Director, FAA Flight Standards Service.
[FR Doc. 2013-23522 Filed 9-26-13; 8:45 am]
BILLING CODE 4910-13-P