Date: 201810
Flight conditions: VMC
Light: Night
Aircraft: B767 Undifferentiated or Other Model
Operator: Air Carrier
Operating under: Part 121
Flight plan: IFR
Mission: Passenger
Flight phase: Cruise
Reporter organization: Air Carrier
Reporter function: Pilot Flying; Relief Pilot
Human factors: Situational Awareness; Physiological - Other; Communication Breakdown
Second reporter function: First Officer; Pilot Not Flying
Anomaly: Deviation / Discrepancy - Procedural Other / Unknown; Flight Deck / Cabin / Aircraft Event Illness / Injury; Ground Event / Encounter Other / Unknown
Detector: Person Flight Crew
When detected: In-flight
Result: Air Traffic Control Provided Assistance; Air Traffic Control Issued New Clearance; Flight Crew Requested ATC Assistance / Clarification; Flight Crew Landed in Emergency Condition; Flight Crew Diverted; General Flight Cancelled / Delayed
Contributing factors: Staffing; Airport; Human Factors
Primary problem: Human Factors

Narrative: Approximately just before the halfway point across the Atlantic; the Captain voiced to me that he thought he was 'passing a stone.' He became very ill; very fast; in what I would describe as extreme pain; as well as nausea and vomiting. It came in waves; and got progressively worse. We brought the First Officer; who was on break; back to the flight deck early. The Captain retreated to the rest seat in discomfort. Due to the awkward switch out; the First Officer sat in the left seat. I remained in the flying right seat as the First Officer was disoriented and needed to be briefed. I remained in the right seat. I briefed the First Officer on the situation; as well as the lead Flight Attendant. Up until this point; the Captain did not want any medical treatment; because he was not wanting to interfere with the flight. When he retreated to the rest seat; his situation became much worse; and a doctor was paged for.I briefed the First Officer that I did not feel comfortable with the Captain returning; at any point; to his seat based on his condition. The First Officer agreed; and the lead Flight Attendant also in a separate conversation expressed the same feeling. The First Officer and I decided he would remain in the left seat; and I continue flying and execute the landing from the right seat. As the Captain's situation got worse; him returning became a non-issue; because he was unable to return to the flight deck and we deemed him incapacitated in the sense that we were now operating without referring to the Captain for decisions because he was being tended to by doctors; was in audible pain; violently vomiting; and all the symptoms of a bad kidney stone. The passengers didn't see anything.The First Officer and I worked with dispatch; medlink; and together formulated a game plan. After a warm compress made no difference; the decision was made by Medlink; the onboard doctor; and us; to divert. The Captain also expressed that he was a '12 out of 10' in pain. Having flown with the Captain before; for him to even admit pain means it's big. For him to now be ok diverting confirmed he clearly was not in good shape. His audible pain and vomiting continued. After considering multiple airports; an airport was decided on due to it being exactly 170 miles in front of the nose; a hub; access to medical care; connecting flights for passengers; and a known airport since we'd now be taxiing the aircraft. It was middle of the night; clear weather; and while we knew this airport is busy; this situation warranted it as a diversion.I [notified] ATC. I was also the pilot flying now and the First Officer took care of the rest of the satellite call with Medlink and Dispatch; worked the cabin aspect; and other Pilot Monitoring duties. ATC was great and we barely had to turn; we received a straight in to the runway. We made sure not to mention the word 'captain' on the radio due to the sensitive nature of the emergency; however after inquiring; ATC did know it was a member of the flight deck crew. We also left the PAs very vague and did not say it was the Captain to avoid panic. We followed the diversion [procedures]; and had a rather uneventful diversion and landing. The First Officer did a great job with a quick taxi - we rolled to the end of the runway; and simply made the left turn to the terminal. That's where the problems began. As soon as we turned onto the ramp; I did not see any blue flashing lights. That worried me; because they knew for the last 25 minutes that we were diverting in with a severe medical emergency; and needed an ambulance. None was inside. To summarize; we waited 40 minutes after touchdown for a simple paramedic in a sedan to come. He gave us attitude; said he just got out of work [very early in the morning]; do not rush him; and he would determine whether or not an ambulance was needed; not us. When he determined an ambulance was needed; we waited almost an additional hour for the ambulance. The final times I recorded looked like this: ON at XX:55Z; IN at XY:09Z; paramedic showed up at XY:35Z; and ambulance at XZ:23Z. Unacceptable.I tried multiple frequencies; begged multiple people; including operations; and Tower even though we were parked at the stand to get help. None was available; and the Captain now appeared to almost be going into shock. People became curious and we tried to keep everyone seated. Excuses from operations; paramedic; and staff was that we were the third flight needing an ambulance that morning. I will not go into more detail as my feelings are beyond strong that the airport failed us on the medical front. It not only was an embarrassment; but the Captain could have become more injured. Finally when the ambulance came; the Captain walked down on his own power. I made sure to cover his uniform and hide his hat/jacket so the passengers wouldn't take photos out the window 'of the sick captain.' He went to a hospital; and we waited a few more hours to wrap up hotel and the logistical aspects. I'd like to personally say our whole crew; dispatch; medlink; ATC; and airport operations staff were all fantastic. A great team effort turned this medical emergency into a smooth rolling practiced procedure.


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


Synopsis: B767 flight crew reported diverting due to Captain's illness.