VS301 DEL-LHR 22 Mar 08 (Upper)

This is a Trip Report from the Upper Class cabin

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Hi again,
Now for the return trip. Weather in Delhi by now was getting really uncomfortable at 35-37c in the day and 16-20c at night. Had completed all the jobs we came for. Had had a wonderfully relaxing stay at Hotel Imperial in Janpath. Luckily, we had both avoided the dreaded 'Delhi Belly' this time. Time to head for dear old Blighty.Tipped all the doormen and porters (everyone waits expectantly!). Major hassle at reception as the Nationwide Visa card payment would not go through[:I]. This despite having sent an email 2 days before to the building society asking for it to be processed as we were on holiday in India. Could not get through by phone despite repeated attempts. Had to rummage through the packed bags to get out the Virgin Amex, which luckily worked. i had specifically taken the Nationwide card as they do not charge for transactions abroad. Must contact them on return.

Travelled to the IGI airport in style & comfort in a large SUV called the 'Ford Endeavour'. Being a holiday for 'Holi' (festival of colours), the roads were eerily empty. Never seen such a sight on Delhi's roads! Couldn't find the VS helpers who are apparently meant to be outside the entry gate. Believe me, it makes a difference to the level of one's Blood Pressure to have these chaps take over the luggage. After complaining to one of the ground staff, not one but three helpers materialised as if by magic. Suitcases had to be scanned and security taped. Thankfully, this time no one wanted me to open a carefully packed heavy suitcase. Didn't leave batteries in the camera flashgun, unlike last time; lesson learnt the hard way.

As on the outward journey, (just our luck), someone was having trouble at UC counter. The girl had to guide him to some place at the other end for what seemed like a hefty payment. No one left. Meant going back and queueing at the PE counter. Formalities completed, left to fill in the embarcation card, which is identical to the disembarcation card filled on entry to India (why it cannot be filled once with a new date and signature at exit escapes me)[:(]. Anyway, off to immigration, another smile-free zone[:(], and then to security. After passing through the personal and hand baggage scans, we couldn't find the UC lounge. On asking a security chap, we were informed it was on the other side of security check, and we were not allowed back unless they tore off the stamped labels on our hand baggage, and that too with the express permission of the senior officer. Had to go find this chap, who was quite sympathetic, and who blamed the check in staff for not telling us that the security check should be done at the time of boarding only. Duly tore off the tabs and had 'Cancelled' stamped on our boarding cards, looking very sheepish by now[:I].

Found the 'Clipper Lounge' which wasn't worth the effort. It is a small and basic place. Only one small toilet for both sexes, almost impossible to lock, causing plenty of embarassment all around. Very few snacks, no service, sandwiches so tiny they looked like canapes. At least it was quiet. Now we had no baggage tags of course, and woe betide anyone who tries to board without properly stamped tags, as anyone who has been through IGI airport will vouch[:(!]. Had to plead for new tags from Virgin when they came to announce boarding. Went through security check all over again; this time they wanted me to open my case and wanted to look at my PDA and camera (in case they contained some highly sophisticated explosive device); was chided for carrying my mobile phone in my pocket rather than putting it in the tray, having passed me through previously without question. BP at explosion point by now[:(!]. Got to the gate bypassing the long queue of econ pax, getting glared at. Then we had the usual medley of passport, boarding card and baggage tag checks at every 50 yards; in case we had somehow slipped through all the previous checks; saw some poor souls sent back to get 'proper' stamps. Finally allowed to board the aircaft and turn left with a sigh of relief. It has always been thus at Delhi. Having travelled regularly for 20 years, I wait for the day when things will improve, as promised by large hoardings everywhere[V]. Had seats 2A and 3A, got ourselves settled with a glass of bubbly, and waited for the palpitations to settle. UC was half empty for a change, probably because of it being 'Holi'. Taxied out on time and smooth take off. normally there is no queue, but there were 2 planes ahead and two behind on this day; it seems domestic traffic is expanding exponentially.

Had some cashews and a G&T, followed by delicious lunch, a chicken curry with rice and parathas (Indian bread). Tucking into lunch when we heard the dreaded announcement 'would anyone medically qualified make themselves known to the crew'. Debated with oneself for a few seconds, hoping someone else would come forward. I am only a paediatrician after all; what if its a heart attack or a stroke; I wouldn't have a clue, not having dealt with adults since medical school, which was some 25 years ago.

Then the inevitable guilt kicks in, and one walks up to the stewardess, who seems to be ever so thankful. Takes me to the chief stewardess, who is on her first assignment under supervision. Told it was only a lady having an asthma attack and they had found a nurse, so it was all under control. Panic over, headed back to finish lunch.

Apolegetic chief stewardess comes up a few minutes later to inform me that the lady was no better, and they had discussed with their medlink in States, who had advised a steroid injection; would I give it? Time to assess the patient myself; duly followed the FSM to the rear end of the aircraft, to find an elderly Indian lady (around 75 I guess) chugging away looking pretty grey, with hubby (looking even more frail) fast asleep next to her. A quick assessment showed her to be having a severe asthma attack. Trying to use a stethoscope in the confined space over the noise of the engines is pretty iffy. Her pulse was steady though. She was able to talk in short bursts. It emerged that they had cut short a trip to India for a marriage, due to her asthma worsening. They hadn't told anyone prior to check in, probably worried that they would not be allowed on board. In fact she had been unwell for 3 weeks. Then she happened to mention that she had been provided with an oxygen concentrator at home for the past 2 years which she needed to use for a few hours everyday! None of this was known to the crew. I suggested she would benefit from a steroid injection. No way was she having an injection, and when poor hubby intervened he was told off in no uncertain terms! We compromised that she would try a nebuliser (to open her airways) and I would review in a few minutes. We got her moved to UC so I could keep a better eye on her and they could both be made a bit more comfortable. We were using up oxygen cylinders at the rate of one every half an hour. I now know that the flight carries 24 cylinders, which could last 12 hours if she didn't deteriorate and if there was no other emergency. She did get worse, and I was getting a bit worried whether she would make it. This time she did not protest about the injection, and I saw for the first time, the insides of the medical box that is carried on board. A lot of good stuff, but some important things missing, others not easy to find. Found and administered the injection, and she slowely started to improve. Wanted to take off the oxygen and lie down, both not recommended in her state; had to decline firmly; luckily she trusted my 'medical skills'. Throughout the rest of the flight, she needed repeated checks from all of us (felt part of the crew by now!), but stayed stable, and the threat of diverting to another airport in Europe was averted. We got priority clearance to land at LHR which was no bad thing, and lots of gratitude from the crew, which got a bit embarassing[:I]. Not much rest though, and I can now appreciate how tiring a trip like this can be for the smiling boys & gals. Hats off to you[^]. Asked for paramedics to board on landing, and gratefully handed over the patient, who was recovering well by now, with a recommendation that she be taken to hospital(they were planning to drive down to Southampton!). Got offered 15000 air miles as a thank you, gratefully accepted. Disembarked uneventfully; no Revivals Lounge at 6pm; would have really liked a shower and rest. Got on the coach to Parking Express instead. Drove over 2 hours to get back home completely shattered. Should have had lots of strong coffee in retrospect, but made it home safely. Fell into bed[|)][|)][|)]; leaving bags as they were; only to sit up wide awake at 2am (7.30 am in Delhi time). Took another day to recover fully, hence the delay in writing this report. Hope i haven't bored you all to tears, but it was the most exciting time I've had on a plane; and thought someone out there would like to know about it! Hope the frail old lady is recovering well; I feel her time here is limited. She did give us all a big fright. Hope she is not planning any further trips in the near future!
Best wishes
Raj

[mitchja]

Gosh what a TR, thanks Raj [:)]

I too, hope the lady makes a full recovery [:)]

Regards

Crikey! What a superstar! No wonder you were knacked ... just goes to show how sometimes it is necessary for the crew to make such announcements.

[honey lamb]

Wow! What a TR and as slinky said, what a superstar! [oo] We hear these announcements but unless we are seated near to the patient we rarely know what is going on, but to get a full blow by blow account is great.

Have you contacted VS about the items in the medical box which you state are important but are missing? I'd like to be sure they are there if I ever have a medical emergency.

Sounds like an interesting flight, and something that I would dread happening when I fly. Surprised it was only 15,000 miles though, since you had a pretty disrupted flight and that doesn't really get you that much in terms of rewards (but think it is the maximum you can get from the FSM on board though). Well done for all the hard work!

Good effort Raj!

I've never been called on, in-flight.
Do they have a pulse oximeter?

[HighFlyer]

What a really interesting trip report Raj. I tip my hat to you. I guess many of us do not realise how often those with medical skills may get called upon whilst travelling. It ccertainly wasnt boring in the least - i just hope you managed to grab some time for yourself to relax during the journey.

Thanks,
Sarah

A really interesting TR, thank goodness you were onboard.
I think you should have been given squillions more miles.
Well done.[^]

A medical colleague of mine flying on Qantas was asked to sign a disclaimer before using the drugs in the medical box! Having saved the plane from being detoured with the cost of overnight accomodation etc, they still wouldn't let him use the shower in the first class lounge when they landed because he was travelling down the back!! It was a few years ago so things have clearly improved and your help was obviously appreciated by the crew. Perhaps when VS process the 'incident' form they will write formally and increase your original airmile offer.

Great TR and well done for rising to the occasion, I am sure the patient and her family are very grateful.

Excellent report must have been shattered, but I suppose exciting for you having the whole decision if to go see, then being called upon having to skip from working with pediatric to the geriatric. Was rewarding in the end I guess for you making the right decisions keeping her alive as well as with the miles as well.

Thanks for all the responses folks, but I am no superstar; would have preferred to have been left alone with a G&T[:I] and let someone else get all the glory..
It was a worrying time, but also an exciting one.

Luckily, though I only deal with kids, I specialise in respiratory problems. I am glad it wasn't anything else. I am sure the lady suffers from severe chronic lung disease, and didn't give us the whole story.

As far as FF miles go, 15000 was the maximum they could give me.

As for the medical kit, the glaring omission was a pulse oxymeter (something you clip on to the finger which tells you how well oxygenated your blood is). Without this vital kit, you are left to rely entirely on how the patient looks, in a dimly lighted and congested environment. It certainly helps to know early if your treatment isn't working, before the patient collapses completely. Apparently, VS are going to have them soon. Was I glad when the paramedic put one on her and the reading was fine! The kit has only three doses of nebulised Salbutamol (to open up the airways) which we got through in about 5 hours. I think the steroid injection was what saved her life. I would have preferred to have given it into a vein, but the crew had instructions from the medilink to give it into the muscle (works slower). Luckily, no one mentioned indemnity, and the chief stwardess was happy to follow my instructions. Did submit a written report, which asked for all my qualifications.

I wonder why the revivals lounge is not open in the evenings; the crew assured me it would be. I have never had the pleasure of using it prior to the long drive home, as I have been using VS301 for many years now, and it arrives late in the day. Maybe it is only meant for the overnight traveller.

I am assured by my medical colleagues (on the doctors.net fora) that this sort of callout is quite frequent. I have probably just been lucky so far.

Best wishes; still finding the jet lag a problem: up at 4am[B)][B)]
Raj

[RichardMannion]

Thanks for an interesting TR. I would expect VS Customer Relations to at least give you enough miles for a one-way reward flight in Upper. I've seen more given out for far less than what you did. You were on holiday, had paid for your ticket and were severely inconvenieced.

Now call me cyncical or unsympathetic, but I'd ban the passenger from flying on the airline again. That is just deliberate piss-taking by knowing your medical needs and not declaring them. Would have been interesting if the plane had needed diverting, me wonders if they had adequate insurance as I bet that wouldn't have paid out given her existing condition and failure to declare. And even more controversial, both times I've seen this kind of thing onboard, the ill passenger is moved to Upper along with their partner - sorry but I don't like medical scenes at the best of time and don't really want to see that kind of thing when I'm travelling in a premium class. I know some will disagree, just like the split opinion when BA moved the dead passenger to an empty F seat next to fare paying passengers.

Thanks,
Richard

Originally posted by gingerflyer
Sounds like an interesting flight, and something that I would dread happening when I fly. Surprised it was only 15,000 miles though, since you had a pretty disrupted flight and that doesn't really get you that much in terms of rewards (but think it is the maximum you can get from the FSM on board though). Well done for all the hard work!

Yip, considering the nature of the incident, the disruption to your trip, and the enormous financial benefit to VS for not diverting, I'd say at the very least a free return trip in UC would be in order.

Cheers, Howard

I have seen a letter from an airline to a Physician who had saved a patient with a pre-existing condition from dying on the plane advising that they felt it was his professional duty to assist if required and take full responsibility for treatment offered. We did informally discuss the possibility of marketing 'emergency care packs' for the medical profession that would include consent documents for the airline and patient and/or next of kin to sign to ensure the Doctor/Nurse can look after the patient whilst protecting their own registration at the same time.

Originally posted by Jacki
I have seen a letter from an airline to a Physician who had saved a patient with a pre-existing condition from dying on the plane advising that they felt it was his professional duty to assist if required and take full responsibility for treatment offered. We did informally discuss the possibility of marketing 'emergency care packs' for the medical profession that would include consent documents for the airline and patient and/or next of kin to sign to ensure the Doctor/Nurse can look after the patient whilst protecting their own registration at the same time.

If I were qualified to administer such assistance, I am sure I would. However a response from an airline such as this is just the sort of reason I would tell 'em to shove it next time.

Cheers, Howard

Wow what an eventful flight for you and thank you for the detail TR, it was very interesting to read. I would let customer service know the things missing and would expect more of a reward than 15K.

Thanks Dominic

Wow thanks for the TR.

I can understand your worry over helping out. Do you travel as Dr Rrao56 or just Mr? After all had all gone from bad to worse then you would have been liable and most probably VS would have been all to quick to point this out to the pax involved (to save their butts). It is a very difficult call to make and one that a lawyer who I work with who is also a qualified doctor hates to make.

Raj, thank you for the TR it was most interesting.

Top marks to you for helping the sick lady and the VS crew [y]. You could have easily just stayed in your seat sipping G&Ts!

Hope the jetlag has disappeared?

[Darren Wheeler]

In my view, it's better to something than nothing.

Medical professionals have malpractice cover and provided they are not negligent or reckless, should not face any repercussions.
First aiders, provided they are not doing anything they have not be trained to do are covered likewise but may not have any insurance etc.
Joe public, again, provided they are not negligent of reckless in any actions they take, would be covered under the general 'Good Samaritan' principles.

In such a circumstance, any one who has a relevant 'Duty of care' such as a Doctor, paramedic etc. might find themselves in a whole heap of trouble for doing nothing when there is a clear need.

Originally posted by Darren Wheeler
In my view, it's better to something than nothing.

Medical professionals have malpractice cover and provided they are not negligent or reckless, should not face any repercussions.
First aiders, provided they are not doing anything they have not be trained to do are covered likewise but may not have any insurance etc.
Joe public, again, provided they are not negligent of reckless in any actions they take, would be covered under the general 'Good Samaritan' principles.

In such a circumstance, any one who has a relevant 'Duty of care' such as a Doctor, paramedic etc. might find themselves in a whole heap of trouble for doing nothing when there is a clear need.

Agreed, although once the ambulance chaser button's pressed and the lawyers elbow in, common sense takes a seat on the wing, and the good samaritan is left both cashless and without a job. Admittedly that's extreme but it takes allsorts.

H

All very relevant points and every clinician will want to help in the right circumstances. However they too have families and defending a Medical negligence claim is stressful and takes up an enormous amount of time, particularly if all other parties involved do not co-operate fully. It will be argued that it is the responsibility of the Doctor/Nurse to determine safe practice, but in reality the pressures of diagnosing and treating a patient during a flight are often unreasonable with equipment and assistance that falls far short of the optimum clinical environment - no defense but totally understandable given the circumstances.

I think this TR has superbly highlighted the real issues surrounding on-board medical assistance.

[buns]

Raj

I do hope that you have managed to get some well earned rest after your marvellous intervention[oo][oo]

I think Richard hit the nail on the head about the fact you were having to deal with a pre-existing condition which was not declared that could have had potentially fatal consequences for the patient[V][V]
It would be nice to think that the FSM's Report would be picked up by VS Management who would properly show their gratitude for your actions

buns

All Medically Qualified Volunteers are covered by indemnity insurance against medical malpractice whilst providing assistance to someone in good faith (other than their own families) onboard VAA aircraft.

Thanks for all the comments and the ensuing lively discussion. Most medical colleagues in my position would have done the best they could and worry about possible negative consequences later. At least in the UK, I haven't heard of anyone being sued over a 'good samaritan' act yet. Things maybe a bit more difficult across the pond. Of course, I had already had my champagne and was well into my G&T by the time the call went out. Wonder how that could influence any potential legal challenge[ii]. I too strongly feel that the passenger should have declared her pre-existing medical condition, and appropriate measures could have been put in place beforehand, which could have involved a refusal to board till her condition improved. We did use up more than half the oxygen cylinders, more could have been stocked had VS known of the need, similarly, we ran out of nubulised Salbutamol, a potential lifesaving drug in these circumstances. As far as moving her to UC is concerned, this was done purely for our convenience, as it was extremely difficult getting access, and assessing her in the confined space in Economy. Hopefully, we didn't inconvenience the UC pax too much[:)], other than seeing this weird chap going up and down the aisle every few minutes, which could have been put down to a problem with sphincter control[:o)].
Raj

[Darren Wheeler]

Originally posted by Tinkerbelle
All Medically Qualified Volunteers are covered by indemnity insurance against medical malpractice whilst providing assistance to someone in good faith (other than their own families) onboard VAA aircraft.

Thank you for that. Good to know in case the need arises. [y]