Narrative:

Approximately 300 miles east of ZZZ at FL360 the #1 flight attendant called and informed me about an ill passenger. An urgent care doctor responded to her call for assistance. The passenger complained of chest pains and a sore back. Passenger is 61 years old. His vital signs were blood pressure 130/90; no known medication; no known history of heart problems. The doctor used our medical kit and administered nitro to passenger. After observing passenger for period of time; the doctor felt that passenger was suffering from a strained back muscle. The doctor did not feel that it was necessary to land immediately and the passenger should be able to continue. I called dispatch and had them contact the on call doctor with this information. Dispatch and the on call doctor agreed with this diagnosis. I discussed with dispatch our options if the situation should worsen. We decided that ZZZ would be our first alternate and ZZZ1 would be the second with our destination as the third. Directly overhead ZZZ; passenger complained he was feeling dizzy. With this new symptom; the doctor felt we should land immediately. I declared a medical emergency with center and initiate a descent into ZZZ. We accomplished our descent and before landing checklist in a timely fashion and landed at ZZZ. Upon arrival at gate; the gate agent was unable to open the L1 door. This is due to the fact that I had missed resetting the cabin altitude from our original destination; to the much higher altitude of ZZZ. I set the pressurization system to manual and open the outflow valve to about 2000 ft per minute. I felt I needed to do this to expedite getting the L1 door open so the paramedics could attend to passenger. Please consider adding to the normal procedures descent checklist/emergency/procedures checklist a step; which requires us to verify the actual landing altitude.

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Original NASA ASRS Text

Title: B757 Captain reports diverting to high altitude airport with sick passenger. The new field elevation was not set into the pressurization system and the aircraft arrived at the gate pressurized. The door cannot be opened until cabin altitude was raised to field elevation.

Narrative: Approximately 300 miles east of ZZZ at FL360 the #1 Flight Attendant called and informed me about an ill passenger. An urgent care doctor responded to her call for assistance. The passenger complained of chest pains and a sore back. Passenger is 61 years old. His vital signs were blood pressure 130/90; no known medication; no known history of heart problems. The doctor used our medical kit and administered nitro to passenger. After observing passenger for period of time; the doctor felt that passenger was suffering from a strained back muscle. The doctor did not feel that it was necessary to land immediately and the passenger should be able to continue. I called Dispatch and had them contact the on call doctor with this information. Dispatch and the on call doctor agreed with this diagnosis. I discussed with Dispatch our options if the situation should worsen. We decided that ZZZ would be our first alternate and ZZZ1 would be the second with our destination as the third. Directly overhead ZZZ; passenger complained he was feeling dizzy. With this new symptom; the doctor felt we should land immediately. I declared a medical emergency with Center and initiate a descent into ZZZ. We accomplished our descent and before landing checklist in a timely fashion and landed at ZZZ. Upon arrival at gate; the gate agent was unable to open the L1 door. This is due to the fact that I had missed resetting the cabin altitude from our original destination; to the much higher altitude of ZZZ. I set the pressurization system to manual and open the outflow valve to about 2000 FT per minute. I felt I needed to do this to expedite getting the L1 door open so the paramedics could attend to passenger. Please consider adding to the normal procedures descent checklist/emergency/procedures checklist a step; which requires us to verify the actual landing altitude.

Data retrieved from NASA's ASRS site as of April 2012 and automatically converted to unabbreviated mixed upper/lowercase text. This report is for informational purposes with no guarantee of accuracy. See NASA's ASRS site for official report.