Narrative:

About an hour after departure we requested our oceanic clearance via ACARS. Shortly thereafter we received clearance on nat C at FL350. Oceanic entry was normal. The first indication that we had that anything was amiss was a phone call from the relief pilot; from the cabin. He alerted us to a possible medical situation with a passenger in the cabin. We then contacted the purser and got preliminary information that there was a younger male passenger complaining of great pain and swelling in his legs. At this time I directed the first officer to monitor the service interphone for further information from the purser. I contacted dispatch and asked for a 3 way with md. Shortly thereafter communications was established via satcom with dispatch and md. The relief pilot re-entered the cockpit. Further information was received from the cabin that the swelling was increasing; and the passenger could no longer move his toes. This was relayed to md; and at this time md stated that in his opinion the passenger needed to be taken to the nearest suitable airport. Discussion between the flight crew and dispatch agreed that ZZZZ was the nearest suitable airport; and dispatch agreed to start working on ground facilitation. I contacted gander and declared a medical emergency stating we would be making a right turn direct and maintaining FL350. Gander instructed us to report 60N; which was the northern boundary of the nat tracks; track a. At the time of the turn to ZZZZ; we were at 58N; on track C; about 31W. First officer was still on service interphone with the cabin. Before starting the turn to ZZZZ; I made a blind transmission informing other aircraft of our emergency and intended diversion; and asked for all positions and altitudes. We received several replies; and I was able to determine there were no traffic conflicts at FL350 and initiated the right turn off nat C to ZZZZ. First officer advocated a descent to FL34.5. I considered this; but decided that since there was a report of an aircraft at FL340 and none at fl 350; maintaining fl 350 would be the safest course of action. By this time; first officer was back in the loop on air to air; and I was in discussion with the purser; who was now in the cockpit. First officer informed me that there was another crew; on VHF common; that was strongly suggesting that we initiate a descent to below the nat tracks. I firmly believe that would have been the worst thing we could have done and compromised safety; inasmuch as we still had to cross nat B and nat a; and there was much traffic behind and below. I reported 60N to gander; clear of the nat tracks. About 300 NM from ZZZZ I contacted center; made a position report; and stated our emergency. He was expecting us; as he had been alerted by gander. Center issued us an ATC clearance direct ZZZZ; maintain FL350. Shortly thereafter; we were in radar contact. We had to take a delay vector and dirty up early in the pattern at ZZZZ to get below maximum landing weight. First officer made an uneventful landing in good VMC conditions. The passenger was deplaned in ZZZZ. We were on the ground a short time for servicing; then made an uneventful departure. In closing I would like to add one statement. We spend much time in training on how to depart the nat tracks during an engine-out situation with drift down; and the procedure is pretty cut and dried. Little to no discussion is given to departing the nat tracks with a perfectly good flying airplane; yet medical emergencies are our greatest cause of oceanic diversions. I firmly believe our crew executed the diversion in the safest possible manner!

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Original NASA ASRS Text

Title: B767 flight crew diverted from NAT TRACK without clearance and without changing altitudes for medical emergency. The First Officer advocated descending 500 FT in compliance with the Atlantic 1/2 diversion panel.

Narrative: About an hour after departure we requested our Oceanic Clearance via ACARS. Shortly thereafter we received clearance on NAT C at FL350. Oceanic entry was normal. The first indication that we had that anything was amiss was a phone call from the relief pilot; from the cabin. He alerted us to a possible medical situation with a passenger in the cabin. We then contacted the Purser and got preliminary information that there was a younger male passenger complaining of great pain and swelling in his legs. At this time I directed the First Officer to monitor the service interphone for further information from the Purser. I contacted Dispatch and asked for a 3 way with MD. Shortly thereafter communications was established via SATCOM with dispatch and MD. The Relief Pilot re-entered the cockpit. Further information was received from the cabin that the swelling was increasing; and the passenger could no longer move his toes. This was relayed to MD; and at this time MD stated that in his opinion the passenger needed to be taken to the nearest suitable airport. Discussion between the flight crew and Dispatch agreed that ZZZZ was the nearest suitable airport; and dispatch agreed to start working on ground facilitation. I contacted Gander and declared a medical emergency stating we would be making a right turn direct and maintaining FL350. Gander instructed us to report 60N; which was the northern boundary of the NAT Tracks; Track A. At the time of the turn to ZZZZ; we were at 58N; on Track C; about 31W. First Officer was still on service interphone with the cabin. Before starting the turn to ZZZZ; I made a blind transmission informing other aircraft of our emergency and intended diversion; and asked for all positions and altitudes. We received several replies; and I was able to determine there were no traffic conflicts at FL350 and initiated the right turn off NAT C to ZZZZ. F/O advocated a descent to FL34.5. I considered this; but decided that since there was a report of an aircraft at FL340 and none at FL 350; maintaining FL 350 would be the safest course of action. By this time; First Officer was back in the loop on air to air; and I was in discussion with the Purser; who was now in the cockpit. First Officer informed me that there was another crew; on VHF common; that was strongly suggesting that we initiate a descent to below the NAT Tracks. I firmly believe that would have been the worst thing we could have done and compromised safety; inasmuch as we still had to cross NAT B and NAT A; and there was much traffic behind and below. I reported 60N to Gander; clear of the NAT Tracks. About 300 NM from ZZZZ I contacted center; made a position report; and stated our emergency. He was expecting us; as he had been alerted by Gander. Center issued us an ATC clearance direct ZZZZ; maintain FL350. Shortly thereafter; we were in radar contact. We had to take a delay vector and dirty up early in the pattern at ZZZZ to get below maximum landing weight. First Officer made an uneventful landing in good VMC conditions. The passenger was deplaned in ZZZZ. We were on the ground a short time for servicing; then made an uneventful departure. In closing I would like to add one statement. We spend much time in training on how to depart the NAT Tracks during an engine-out situation with drift down; and the procedure is pretty cut and dried. Little to no discussion is given to departing the NAT Tracks with a perfectly good flying airplane; yet medical emergencies are our greatest cause of oceanic diversions. I firmly believe our crew executed the diversion in the safest possible manner!

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.