Date: 201901
Location: ZZZZ.ARTCC, FO
Weather elements / visibility: Snow
Aircraft: B777 Undifferentiated or Other Model
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Cruise
Airspace: Class A ZZZZ
ATC / advisory: Center ZZZZ
Aircraft component: Exterior Pax/Crew Door
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
Second reporter function: Pilot Not Flying; First Officer
Anomaly: Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Illness / Injury; Ground Event / Encounter Other / Unknown
Detector: Person Flight Attendant; Person Flight Crew
When detected: Aircraft In Service At Gate; In-flight
Result: Flight Crew Diverted
Contributing factors: Human Factors; Company Policy; Equipment / Tooling; Procedure
Primary problem: Human Factors

Narrative: Approximately 2 hours after departure we got a call from the cabin crew that a passenger in the aft cabin was having a seizure and they were asking for medical professional assistance from the passengers. The only two volunteers from the cabin to come forward stated they were a Paramedic and a Nursing Assistant. As the patient was not fully conscious and traveling alone getting medical history information to answer the Medlink doctor's questions was difficult. The volunteers were having a hard time getting basic vital signs and difficulty removing the passenger's jacket to get a blood pressure reading. They were eventually able to get vital signs and a glucose level. The patient awoke and they were able to get him to drink fluids.The patient gave some history information. Claimed to have never had a seizure before; was alert; communicative; felt good and wanted to continue to [destination]. This was relayed to Medlink. The medical volunteers were comfortable with him continuing but; more importantly; the Medlink doctor was good with him continuing. A short time later dispatch advised us that our patient was denied boarding on yesterday's flight due to being inebriated. About 2 hours later the patient had seizure number two. We immediately got dispatch and Medlink back on line along with waking the two FOs [First Officers] in the bunk. The patient was non responsive and was bleeding from the mouth. After much confusion the nursing assistant was able to start an IV. The recommendation from Medlink was not to continue and to work on getting on the ground. With no good options ahead we got a clearance to return to [our departure airport] and headed back in that direction giving us more divert options. One of the relief FO's went back to observe the volunteers and noted they seemed to be over matched. Medlink requested the patient be put on the floor and turned on his side. That never happened; they had him leaning on his side in the seat. He was now somewhat responsive and I was hopeful we could press onto [the departure airport]. The FO said the patient responded non-verbally because of the oxygen mask but was clearly responding. I went back to the cabin to talk to the responders. I asked the paramedic if she thought we could continue 3 hours to [the departure airport] and she stated she did not want to land in a snowstorm. I assured her anyplace we land would be safe and I am just looking for a medical opinion. She thought we should land sooner. I returned to the flight deck; talked to dispatch and Medlink. The Medlink doctor was aware of all the information including the patient's current vital signs and the skill level of the volunteers. The Medlink doctor was not comfortable continuing to [the departure airport] and wanted the patient on the ground as soon as possible. Of the options ahead ZZZZ was suggested by Medlink and dispatch. They had a coordinated response team available there. While not my first choice there was no current operational reason not to go there. Medical personnel would be waiting and the weather was suitable. We got an amended clearance and diverted to ZZZZ. Apparently putting the second divert into the ACARS (first one being [the departure airport]) would cause some unforeseen communication problems later. We coordinated a fuel dump to arrive at landing weight as to not have to generate an overweight landing inspection at ZZZZ. Uneventful approach and landing. Taxied to an icy snow covered FBO ramp positioned to be able to taxi back out. The medical responders were waiting. The medical team boarded the aircraft evaluated the patient and removed him. We began setting up for the departure. The ACARS would not initialize. There was some issue with putting the second stop in the system and they were trying to find a work around. We manually loaded the ACARS but could not pull data due to aircraft number mismatch. At this point we were still able to get ACARS messages but soon that would alsostop. We had dispatch force weights; takeoff data etc. to our printer. Working then with [Maintenance Control] to defer the [issue]; some O2 bottles and two status messages we would soon be able to depart. Subsequently the Flight Attendants called from the back. They are not able to arm door 3R. We go back and the arming handle will not move. All the others handles move smooth and easily. We inform [Maintenance Control]. Not deferrable; stating there is a mechanic on field I will get him to you shortly. [Local personnel] says we don't have a mechanic on the field.  I have always been and will always be a team player. We need everyone to make this work. I value and respect what our employees do and who they are; but the lack of a true understanding of my role and responsibilities is frankly unacceptable. I signed a release for this aircraft; I am totally responsible for the wellbeing of these passengers; and there is nothing I take more seriously. My interpretation of the reality of the situation should have a major impact on the formulation of any plan here. Below are some of the unrealistic examples I was given throughout the night by the planners none of which had any relevance to our reality; which as indicated was clearly expressed. Company planners thought they could find rooms when [contrary] firsthand information was being given which resulted in more wasted time. Operations is now trying to put a rescue mission in place; which keeps falling apart due to Crew member legalities. There are many moving parts to set up a recovery flight. I understand the problems that are going to be encountered which is why I asked to start this process. I again started calling the dispatcher as no one had reached out to crew in the last two hours. The operations manager calls me on my cell to update me. (I am ecstatic) she realizes the tough situation we are in they have ordered food and drinks. She said the recovery aircraft is at the gate ready to go. It has 3 pilots; 4 mechanics; 4 ramp people; 3 customer service agents and blankets for passenger transfer. I suggest that when the aircraft arrives we send the mechanics over and if they can fix the door quickly they could avoid the difficult and lengthy passenger transfer across the ramp and use this airplane to transport. All agreed that will be the plan. We fueled our airplane per dispatch request so it would be ready to go if needed. We responded to the inbound crews request for parking position information; snow bank issues. etc. Our lavs were approaching full. The lav truck was frozen but they could use their lav cart and get the lavs about half empty; which would be sufficient for the short flight. We advised the inbound crew. After landing the mechanics and the customer service agents came onboard our aircraft. The mechanics were unable to repair the door. The passenger transfer would [require] assistance to getting down and up the stairs. After all the passengers transferred we ensured there was sufficient fuel to run the APU all night to keep the airplane and systems warm due to no hangar availability and closed up the airplane.[One hour after the crew left for the hotel] operations calls me to tell me they had transferred the containers and the bags but left the cargo on our aircraft and the rescue aircraft was about to taxi out.  He asked me if he could call load planning to find out where they wanted the remaining cargo placed in the aircraft for our next day departure load distribution. There was a blizzard moving in by nightfall and he wanted to accomplish that now. He did not want to pull the equipment out in the am in the heavy snow. I obviously agreed.There were a lot of positive things here.1. [Operations Control had] great communication; excellent use of information and resources.2. [The FBO was] totally focused on our needs. The competence and work ethic of everyone working our issue was outstanding. [Their staff] were amazing along with the young man that drove us to and from the hotel. He turned out to be the same man in an open bucket de-ice rig spending 3 plus hours de-icing our return aircraft in -25 degree temperature.3. My three First Officers; not one complaint. Doing whatever was necessary at any time. Never overreacting to angry; upset passengers. Always showing sympathy and understanding.4. The Passengers; Outstanding and true troopers under very difficult circumstances. I would cycle through the cabin at intervals to make sure they were seeing a pilot. Noticing the dozens of cell phones recording everything. They mostly came out to film passenger's yelling along with recording working on the cabin door.


Second narrative: [Report narrative contained no additional information.]


Synopsis: B777 flight crew reported an international diversion for an ill passenger and challenges after landing due to aircraft; facility; manpower and communication issues.