Date: 201606
Local time of day: 1201-1800
Location: ZZZ.ARTCC, US
Flight conditions: VMC
Light: Daylight
Aircraft: A321
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Cruise
Airspace: Class A ZZZ
ATC / advisory: Center ZZZ
Reporter organization: Air Carrier
Reporter function: Pilot Flying; Captain
Reporter qualification: Flight Crew Air Transport Pilot (ATP)
Human factors: Other / Unknown
Anomaly: Aircraft Equipment Problem Less Severe; Deviation / Discrepancy - Procedural Published Material / Policy; Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Flight Attendant
When detected: In-flight
Result: Flight Crew Diverted; Flight Crew Landed As Precaution
Contributing factors: Human Factors
Primary problem: Human Factors

Narrative: Established at cruise we got a call from the back about an unconscious female passenger. I was told a paramedic was onboard. I asked about baseline medical information; pulse; B/P; medications; med. history; etc.; but Flight Attendant (FA) said she had no information yet. I suggested she gather that information; plus the lady's name and age and use the phone in the aft galley to call Med Link to get a medical consultation established and to keep me posted. After about 5 minutes I called back to FA to assess matters. She told me the connection to Med Link was 'busy' and she could not get through. She also said the ill passenger was now conscious and suggested there was no longer a need for Med Link assistance. I disagreed; mentioning that the passenger was in fact unconscious for some time and could re-enter that state or perhaps go into convulsions or suffer from some other medical malady and that we needed medical oversight for her through Med Link. I told FA I would take over the Med Link consultation and I obtained the following information which I passed on: Passenger name; female; age 59; with no known medical conditions. pulse 61. B/P 113/76; taking no medications; no alcohol intake recently; sufficiently hydrated; passenger now conscious and lucid. In consultation with Dispatch and Med Link it was decided to continue flight to [destination].About 3 hours into the flight we got another call from the back about an unconscious female. This time it was [a different] passenger and once more [the] paramedic came forward to offer his services. FA's initial report to me was that [the] passenger was unconscious; she had just given herself an insulin injection. Slumped over in her seat she had vomited in and around her seat; including the floor; and she had urinated on herself. At the time I was told the paramedic was not able to get a B/P reading on her. (Later; on the ground; it was established the B/P cuff was not operating properly and became one of the MEL items referenced).Since I had difficulties communicating to Dispatch and Med Link on the flight deck phone; I decided to get a phone patch with ARINC for this second consultation. I designated [the First Officer] the FP once again and asked him to take communication duties and to [notify ATC] and to begin navigating direct to [a nearby alternate] while initiating a descent. While in conference with Dispatch and Med Link I was not able to get the baseline medical information as before; everything was happening so fast; but it was decided a diversion was necessary considering she had a diabetic condition with a history of heart disease. I informed the FAs using the all-call function we were diverting for the emergency medical situation; to prepare the cabin for a normal landing; and that we would be on the ground in about 12 minutes. Following that; I briefed the passengers in like manner; then got back to assisting with the approach preparations and appropriate checklists.We landed [and] were directed to a hardstand parking position on the ramp. EMT personnel were a bit tardy getting to us. There was no EMT vehicle there to greet us. After air stairs were brought to the aircraft; EMT personnel from under the terminal began to approach us on foot. Once onboard they got vitals [on the ill passenger]. By that time an EMT vehicle had arrived to transport her to [the] hospital.I thought once our ill passenger was on her way to hospital we would be on the ground another 30 minutes or so. We did not require a pushback crew as we could expect to start engines and turn out of hardstand on our own power. I remember briefing the passengers of this and everyone relaxed a bit waiting for our re-release from Dispatch and our fuel.As events and time unfolded temperatures; and along with it; tensions rose. I had been communicating about every 20 minutes to the passengers telling them what I know concerning the arrival of the [maintenance] tech. But after about 3 such talks; it appeared we were off in our expectations; this created anxiety and some degree of anger coming from the passengers due to lack of progress. It is important to note at this juncture that the outside air temperature on the ramp was reported as 93 degrees F with high humidity. And as we all know the real ramp temperature was probably higher. With 187 bodies in the cabin; plus crew; it was impossible to control cabin temperature properly with just APU bleed air. But we did our best. After traffic flow slowed down through door 1L; we cracked the door closed to try to keep cool air in. Bottled water supplies were exhausted during this wait time. In the 3 aircraft zones temperatures read: Cockpit 96 degrees; Fwd 88 degrees; and Aft 82 degrees. That was the best we could hope for with everyone onboard and the aircraft on hardstand exposed to the late afternoon sun.I estimate the contract [maintenance] tech arrived about 1:30 after our arrival. He had been talking to [Maintenance] beforehand as he arrived at the aircraft. Passenger unrest was climbing. One male passenger announced he had 'had it'; swearing at the FAs I am told. He grabbed his roll-aboard bag and left the flight. He was escorted into the terminal. Our 3 hour [ramp limit] time was fast approaching as our ramp delay had been long indeed. I knew First Officer (FO) and I were good duty-time wise; nowhere near timing-out. But I checked with the FAs on duty-time all four were OK.I heard through our hang-up was due to the fact that the contract [maintenance] tech was not certified to sign off write ups in our AML. I immediately called [company] to verify this. This was true; but they were trying to get the tech a one-time authorization from the FAA to allow him to sign off our MELs legally.My FO and I were not kept in the loop in this matter. We were making PA after PA without the accurate information needed so we could in turn give better and more accurate briefings to the passengers. This necessarily affected our decision-making as well.I made the announcement passengers could deplane based on the new critical information I now had. Almost everyone elected to leave the over-heated confined quarters onboard to go into the air conditioned terminal to get something cold to drink; perhaps get a bite of food; recharge their iPads and smartphones; etc. Passengers had been on the aircraft continuously for approx. 6:50 at that point. As circumstances would have it; two things happened as we were deplaning; First; the contract [maintenance] tech arrived after having complied with [requirements] by filling out and returning via e-mail some type of application/registration form. He also returned our legally signed off AML. Second; I received the first of 3 telephone calls from [the] Operations Manager. More about our conversations later.With all but 6 or 7 passengers in the terminal taking a well deserved; well needed break; I got together with station personnel to discuss our exit strategy. They estimated about 50 minutes would be needed to turn the flight before they could get to us with our requirements. I adjudged this to be near perfect for our passengers' terminal break.The passengers on their return to the aircraft had a different attitude; you could tell by their body language and demeanor as they approached. The break energized them. There were more smiles; chatting going on; even a few 'selfies' were taken. It was quite a different scene than when they first walked off. It was my hope that we may have deflected a number of passenger complaints to the company by our actions and demonstrated that we had their back in this unusual situation. The elderly lady had diabetic and heart preexisting issues. The flight was perhaps too much for her.I do not believe there is anything we; as an airline; can do to prevent a circumstance such as this.




Synopsis: A321 Captain reported diverting to an alternate airport because of a seriously ill passenger in flight.