Date: 202109
Local time of day: 0001-0600
Location: ZZZ.Airport, US
Aircraft: A321
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Cruise; Descent
ATC / advisory: Center ZZZ
Aircraft component: Air Conditioning and Pressurization Pack
Component problem: Malfunctioning
Reporter organization: Air Carrier
Reporter function: Captain; Pilot Flying
Reporter qualification: Flight Crew Air Transport Pilot (ATP); Flight Crew Instrument; Flight Crew Multiengine
Human factors: Communication Breakdown; Situational Awareness
Anomaly: Aircraft Equipment Problem Less Severe; Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Flight Attendant; Person Flight Crew
When detected: In-flight
Result: Air Traffic Control Provided Assistance; Aircraft Equipment Problem Dissipated; Flight Crew Overcame Equipment Problem; Flight Crew Requested ATC Assistance / Clarification; General Flight Cancelled / Delayed; General Maintenance Action
Contributing factors: Aircraft
Primary problem: Aircraft

Narrative: Roughly 2:30 into our flight I/We were informed by the #1 (flight attendant) [name 1] that our 3 other FA's(Flight Attendant) 'were not feeling to well' I asked some basic questions and asked to be updated as more info became available. Minutes later a rest room break and crew meals were coordinated and Name 1 came in the cockpit. During her time in the cockpit she once again told me that over all the other 3 FA's where 'not feeling well' I suggested hydration; inquired about ingestion of food and suggested portable O2. We talked about the possibility of contact with MedLink and even initiated several attempts on both of our iPads and quickly found out that both phone apps were not working. As she left the cockpit I once again asked to kept informed. I then proceeded to transfer radios and the aircraft to FO (First Officer) while I pursued alternate communication methods (VHF Press To Talk) Once communication was established with [company] I passed on the information of 'not feeling to well' gave [employee info] and requested to have medical personal to meet us upon our arrival into ZZZ (ETA at this time 70 minutes) I asked to be patched to MedLink to obtain some guidance. On my conversation with the medlink rep I gave the broad explanation that I had been told (This due to the lack of the [medical form]; I had requested from Name 1 at her earliest availability; in her absolute defense I understood she was alone handling the initial situation; not to mention later with the Pax occurrence) Simultaneously we had coordinated with ATC Direct routing and had gotten a Direct destination. VHF Press To Talk Communication issues arose and several calls were dropped/disconnected. I then was informed that a female pregnant passenger 'was having trouble breathing and did not feel well' At this juncture I verified all systems related to atmosphere conditions in the aircraft and requested even further decent from altitude to alleviate cabin altitude environment in the cabin.After several inquiries to Name 1 and Name 2 of possible scenarios including unfamiliar smells; I informed them that all relatable cabin atmospheric condition indications were normal and that we had the lowered the cabin Alt by 2;500 feet to alleviate the possible situations (to which I was told they 'felt better'). I continued my efforts to communicate with MedLink and once again requested [medical] sheets. (ETA at this point is apron 50 minutes) Considering the information that was passed along and the proximity to ZZZ and com issues I asked Name 1 to prioritize the [medical] Sheets because I would not have enough time (Proximity and Com. Issues ) to address all 4 situations! I was informed that Name 2 was feeling better and was actually present in the last several Inter-phone communications. At approximately ETA 35 minutes I was handed 3 [medical] forms to proceed communications with MED Link. The com issues continued (comm bleed communications etc etc) on top of the high load working environment; as ATC was starting to bring down the aircraft from Altitude. I started to feel out of the green and decided that due to the proximity of our destination; the expeditious handling (ATC) and the last information relayed to us with adjectives that signaled to stability and no apparent incapacitation; to desist with MedLink and concentrate on the arrival. (Also a Medical professional on board had addressed the patients and used the medical kit on Name 1 initiative.An emergency was not declared and landed uneventfully. We made a PA prior to reaching the gate asking the Pax to remain seated so Med personnel could come on board an attend the patients. On arrival at the gate and after shut down checklist items I proceeded to the galley to access the situation. There were several law enforcement officers meeting us initially and talking to the FA's (all 4) [name 1] then told me they had been authorized to deplane so a deplaning process commenced only to be halted 30 second laterby an apparent intervention of a Med Professional who had just arrived. The Main cabin door of the aircraft on both ends was very crowded with no regards to social distancing; I was overhearing and watching as the medical Professional was interviewing all 4 flight attendants. After the health state questions were answered and 'stability' was diagnosed; the Medical professional rushed off; (I assumed and concurred) advised Name 1 that a medical intervention or continuance would be better suited after deplaning. The female Pax patient was also at the cabin door; I had a brief conversation with her as to how she was feeling; to which she answered 'Much better now thank you.' I proceeded back to the cockpit to establish external electrical power and write in the logbook the need to re service all 3 O2 bottles that were used during the flight. By this time in the deplaning process a Maintenance employee had come on board; I told him that I was writing up the O2 bottles (he knew they were used in the flight) I stood in the cockpit door as the deplaning continued and also had a brief exchange of words with Name 3 and Name 1 in regards to their condition and coordinated follow up actions with Medical personnel. Which both acknowledged. I then expressed my concerns and hope you feel better sentiments. I would like to point out that at NO POINT in this entire situation and after queries on my behalf; was Crew incapacitation informed to me or First Officer. The use of FUMES AND ODORS IN THE CABIN was also at NO POINT reported/mentioned; nor we as the front end crew perceive such . In any of those situations I would have not hesitated to [request priority handling] and divert to nearest suitable airfield do to the obvious reasons. In two occasions in the many cabin inter phone communications I inquired about 'crew incapacitation' and my intentions if that were the case. As the other two crew members in the flight neither First Officer or myself had any symptoms of any kind from the start to the end of the flight. First Officer and myself crosschecked our physiological conditions and deemed we did not require any medical assistance of any kind and proceeded to conclude our duties.[A contributing cause] Air Phone App not working. Broad Communication.  This situation had very Broad Human Physiological State communications breakdown due to the inability (at no ones fault) to have Professional medical evaluations in-place. And all seemed to line up to make things worse and get the entire team out of the green in several different moments and several times. I am not satisfied with the lack of SOPS that we all succumbed to once the aircraft was met at the gate by a Overwhelming amount of personnel. As I watched the medical professional interview the 'Patients' In this case 3 out of 4 FA'S (not the Passenger) considering my/our stable health state I knew I had no place to interfere or nothing to contribute. The well being of the 'Patients' was my main concern and I judged the Medical Professionals to be their best alternative at that moment. The lack of functionality of the Phone App was impacting unwarranted and complicated this situation immensely.




Synopsis: Air Carrier Captain reported a passenger and flight attendants felt ill during flight which was complicated by communications issues with Medlink. Passenger and flight attendants were treated by medical personnel on arrival at destination.