Date: 201507
Local time of day: 1201-1800
Location: ZZZZ.Airport, FO
Flight conditions: VMC
Light: Daylight
Aircraft: Widebody Transport
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Cargo / Freight / Delivery
Flight phase: Parked; Initial Approach; Descent; Final Approach
ATC / advisory: Center ZZZZ; Tower ZZZZ
Reporter organization: Air Carrier
Reporter function: Pilot Not Flying; First Officer
Reporter qualification: Flight Crew Air Transport Pilot (ATP)
Human factors: Confusion; Communication Breakdown; Distraction; Workload
Second reporter function: Pilot Not Flying; Relief Pilot
Anomaly: Deviation / Discrepancy - Procedural Other / Unknown; Flight Deck / Cabin / Aircraft Event Illness / Injury
Detector: Person Flight Crew
When detected: In-flight; Pre-flight; Taxi
Result: General Physical Injury / Incapacitation
Contributing factors: Human Factors; Procedure
Primary problem: Human Factors

Narrative: Our Crew met downstairs in the lobby for van ride to airport. The Captain seemed in good spirits; alert and completely normal. We rode over to Customs and while waiting processing; I had a conversation with the Captain about a Thallium Stress Test that he had coming up next week. He explained the procedure to me in detail. He seemed completely normal at this time.About an hour before departure I was sitting in the International Relief Pilot (IRP) seat and noticed that the Captain was having difficulty inputting information into his iPad. I said to him 'isn't that frustrating when you can't get the iPad to work for you?' He said 'I am very frustrated'. I was not able to put my finger on it but something seemed off with the Captain. While the First Officer (FO) was getting the ATC clearance I noticed that the Captain was writing the clearance down on a piece of paper that was loosely attached to the yoke. The writing was not legible. I asked the First Officer to step off the flight deck and we talked about our observations of the Captain. We agreed that something was not quite right with him but neither one of us could identify what it was. We decided to discuss it with the Captain. I sat in the IRP seat and the FO sat in the right front seat. I told the Captain that we wanted to speak with him. He turned to me and I explained our concerns and what I had seen concerning the iPad and Clearance. The Captain said that he was very tired and that he had not slept well. He said that it was not the first time that he had had problems with the iPad. Regarding the Clearance; the Captain pointed out that the paper he was writing on had no backing and was hard to write on. I again asked the Captain if he was OK. He seemed very sincere and said 'fellas; I am fine; I am just tired.' I looked at the FO and through our gazes we reached a consensus that his explanation seemed logical. I felt the Captain's explanation of the events was satisfactory and that he was fit for flight. Flight Deck preparations were completed. Taxi out and takeoff were completed without incident. Once airborne I asked the Captain on two occasions if he would like to take a break to get something to eat. He refused both times and said that he was planning to get some sleep after we arrived. I arrived back on the flight deck about 40 minutes prior to touchdown. Once the descent started I noticed that the Captain was missing radio calls and struggling to keep up with his duties as the non-flying pilot. The First Officer called for the landing checklist and the Captain ran the descent and approach checklist. The First Officer had to physically take the checklist and point to the landing checklist for him to find it. He missed all of the non-flying pilot calls on the approach. As the First Officer landed and rolled out; the Captain seemed to suddenly come back to normal. He authoritatively took control of the aircraft at 60 knots and followed the tower taxi instruction all the way to the ramp. He approached the ramp at a higher than normal speed but did not seem to have trouble controlling the aircraft laterally. After stopping; setting brakes; and engine shutdown; the Captain seemed to fall asleep. Woke up 10 seconds later and then fell asleep again about 30 seconds later for a little longer period of time. Both First Officers and I had a discussion about what we had observed. We felt that the Captain was suffering some sort of physical ailment possibly something to do with low blood sugar. A decision was made to ask the Captain to report off sick and seek medical attention. When confronted; the Captain; became belligerent with us and refused to address the issue. I left the upper deck went down the main deck and called the Duty Manager. Thru the Duty Manager; instructions to call EMS were relayed to me. EMS was called.


Second narrative: Upon taxi in; as the PNF-Captain taxied to the blocks; I noticed two men on the left side of the aircraft signaling emphatically to slow down the taxi. All three First Officers told the Captain to slow down. After blocking in; I noticed the Captain fall asleep in his seat waiting for the block in time on the FMS. The three First Officers told the Captain we were concerned for his health; we thought something with him was not right; and that he should call in sick. The Captain refused. Two First Officers went to inform the company of the situation; while I asked the Captain if he was feeling well. He said he was tired; and his eyes were red since he had Lasik surgery. I told him his face was red; and I was concerned for his health. I then asked him to raise his arms above his head; which he did; and to smile; which he did; checking for stroke symptoms. At that time; the Air Base Flight Surgeon and Emergency Services arrived.


Synopsis: Three First Officers questioned a Captain's physical condition prior to flight; but agreed to accept his behavior as fatigue. Upon arrival; with company's concurrence; the Captain was removed by ambulance for a suspected; but unknown medical condition.