Date: 202001
Local time of day: 1801-2400
Location: ZZZ.ARTCC, US
Flight conditions: VMC
Weather elements / visibility: Rain
Aircraft: B757 Undifferentiated or Other Model
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Other All
Airspace: Class A ZZZ; Class B ZZZ
ATC / advisory: Center ZZZ
Reporter organization: Air Carrier
Reporter function: Captain; Pilot Flying
Reporter qualification: Flight Crew Air Transport Pilot (ATP); Flight Crew Multiengine; Flight Crew Instrument
Human factors: Time Pressure; Workload
Anomaly: Flight Deck / Cabin / Aircraft Event Illness / Injury; Ground Incursion Taxiway
Detector: Person Flight Crew
When detected: In-flight
Result: Air Traffic Control Provided Assistance; Flight Crew Diverted; Flight Crew Landed in Emergency Condition; Flight Crew Requested ATC Assistance / Clarification; General Physical Injury / Incapacitation
Contributing factors: Human Factors
Primary problem: Human Factors

Narrative: First Officer incapacitated during cruise. Advised ATC; contacted Dispatch and MedLink. Coordinated with ATC; Dispatch; MedLink; and onboard volunteer doctors. Determined ZZZ was best diversion point. Requested clearance to ZZZ and vectors to final. Briefed flight attendants and passengers. Uneventful approach; landing; and taxi in.In cruise; Between ZZZ1 and ZZZ2 at FL360 the First Officer told me he 'didn't feel right'. When queried; he described symptoms which neither he nor I believed would allow him to continue to work the flight; and which required immediate medical assistance. I called the Purser and told him that the copilot was incapacitated and would be leaving the flight deck. I asked him to look for volunteer doctors and to look for any deadheading pilots even if traveling offline. The flight attendants came up and helped the First Officer off the flight deck.I advised ZZZ Center; told them I was single pilot and we would be likely diverting to ZZZ3 or ZZZ and that I would get back to them.I instructed one of the Flight Attendants to stay on the flight deck and to sit in the right side control seat while I waited for word on whether we had any doctors or pilots on board. We located several doctors who began assessing the First Officer; but no other pilots were on board. I told the Flight Attendant that she would be remaining with me on the flight deck through arrival and landing. I asked her to turn up the comm speaker on that side and I selected interphone on the right side comm panel. I then handed her the pedestal hand set and asked her to communicate with the Purser and doctors in the cabin and to record that information while I was talking to ATC and Dispatch. We did find a Flight Attendant Supervisor on board; so I told the Flight Attendant to have the Supervisor take over her job in the cabin.I then contacted Dispatch and briefed them on the situation. I asked for the best divert and was advised ZZZ would be best due to lower ceilings and visibility in ZZZ3. I then asked for and got direct ZZZ from ZZZ Center.The following represents a timeline of the subsequent events and my actions:* Put ZZZ in active waypoint for FMC and engaged LNAV to head there* Asked Dispatch to put me in contact with MedLink* Had interphone; ATC; and Dispatch receivers all up on my headset and speaker; switching between transmitters when I needed to talk* Turned up Dispatch comm on my speaker so the Flight Attendant in the right seat could hear and relay MedLink questions as needed to the doctor(s) in back (she did a great job in that role)* Determined time to touchdown; 45 mins* Made PA; told [passengers] we were diverting to ZZZ for a medical emergency* Made Purser aware of time to touchdown* Began putting in reminder circles around ZZZ on the fix page (125nm; 100nm)* Got pilot discretion descent to FL280; recruised the FMC immediately and started descent so I wouldn't forget* Changed destination in FMC to ZZZ* Got ZZZ ATIS* Dispatch pushed ZZZ landing data for [Runway] XXC to printer along with new flight plan and fuel burn data* Determined we would be 5300 lbs.overweight for landing and agreed with Dispatch that this was warranted* ATC passed to ZZZ Center* Told ATC I wanted vectors to final [Runway] XXC and progressive taxi to gate once on ground* ZZZ Center advised gate would be XX (they got this info from company)* Switched iPad EFB to ZZZ and reviewed [Runway] XXC ILS and taxi chart for perhaps 2 mins* Set up approach for [Runway] XXC and cleaned up FMC by extending 2nd to last fix on the approach (automatically loads correct final extension course)* Received pilot discretion descent clearance to 14;000 ft. but too far out to start down; so put in a 75 mile ring as a reminder on the fix page and also asked ATC to remind me if it appeared I had forgotten to start down* Told ATC I would monitor freq but would be working another radio* Personally talked to the doctoron the aircraft and wrapped up the call with Dispatch and Medlink; insuring we were doing what we could on the aircraft for my First Officer; and checked that an ambulance would meet us* Called Purser and finalized time to landing* Had the Flight Attendant in the right seat continue to monitor the medical situation with First Officer* Told her that I was going to brief her on the approach as if she were another pilot so that I would be in my normal habit pattern and wouldn't miss anything* Elected CAT I ILS to manual landing as this is what I'd normally do (tried throughout the event to stay with long established habit if possible)* Briefed ILS XXC to ZZZ* Set approach speeds and autobrakes* Ran descent checklist (reset landing cabin altitude)* ATC called at this point just as we were passing the 75 nm circle.* Started down to 14;000 ft.; recleared to 13;000 ft.* ATC advised icing present on approach to ZZZ* Briefed the flight attendant that I would like her to remind me to turn off the wing and engine anti ice switches after we broke out of the clouds on final (I pointed them out; and she was able to remind me)* Reset altimeter passing FL190* Flew 300 kts. in the descent until 10;000 ft. to get F/O on the ground* Double ding on chime and verbally confirmed cabin ready passing 16;000 ft. (early; to shift workload away from 10;000 ft. where I'd have to remember to slow down)* Handed to ZZZ Approach* Continued descent to 5;000 then 4;000* Good; reasonable; conservative speeds were assigned by ATC throughout descent and approach below 10;000* Configured flaps myself as we decelerated through max flap SOP speeds* Flaps 20 and gear down (myself) at G/S intercept* Early Landing checklist (myself) at this point to shift workload from later busier time (final deceleration and final flap configuration nearer FAF)* Set TD zone elevation* 2;500 ft. call out made by me and answered by me* Slow to target and final flaps outside FAF* Over to tower* 1;000 ft. call made and answered by me* Set the missed approach altitude* Broke out at 800 ft.* Auto pilot off* Missed making the 500 ft. call* At 100 ft. auto throttles off* Touchdown and rollout uneventful* Made XX taxiway off of XXC* I quickly found it was VERY difficult to clean-up; taxi; talk; and navigate simultaneously on the ground at ZZZ* Ground wanted a right turn; but I made a left on X taxiway; they then cleared me via a revised route; and helped me the rest of the way in; calling turns* Would suggest that if I could do it over; I'd have stopped; set the brake; cleaned up the aircraft; reviewed the taxi route with ground control; then set out again* As it was; ZZZ Ground was very good; flexed to my degraded capability; and called my turns from there on in* Asked the flight attendant to watch outside as while I was switching freqs for obstacles and other aircraft as I was momentarily distracted by the tuning of radios* Parked at XX met by ambulance* Shut down right engine and started APU* Once APU running; shut down left engine* Ran parking checklistThe above timeline represents only my perception of the events and my performance. I suspect that there were many things I missed; but I'll probably never know what they were. I believe this uneventful outcome was in great part due to outstanding help from my crew; from ATC; and from Dispatch; and perhaps to my reliance on habit and doing things just as if there were still a pilot monitoring on the flight deck. I went to the extent of verbalizing both sides of the SOP call outs; and verbally briefing approach as just two examples.My Flight Attendant 'copilot' was a great asset and performed remarkably well in her delegated task of communicating with the cabin. More than that though; the presence of another person; properly trained or not; was still very useful from a CRM perspective. There are small bits of workload and reminders that can be shared with any reasonable crew member; and she did a great job for me.The main lesson learned for me was after landing. As stated above; I would advocate that a pilot in this situation stop after exiting the runway and set the brake. One could then easily clean up the aircraft; review the taxi route (or arrange for a tow; if the crew positions were reversed) and then set off for the gate after a mental reset. I had my First Officer on my mind though; and I had some continuation bias working. I wanted to get him to the gate; and this is where leaning heavily on the familiar procedure (keep rolling and clean up on the fly) probably wasn't the best choice. It never occurred to me ahead of time that stopping for a minute would have been safer for all of us. It worked out just fine; but in retrospect; this is where I felt the most vulnerable: on the taxi-in at ZZZ. The controllers sensed this; after that initial wrong turn; and they babysat me for the rest of the way in; which was appreciated.




Synopsis: B757 Captain reported that the First Officer became incapacitated during cruise. The flight continued as a single-pilot operation and made a successful diversion and landing.