Narrative:

Approximately an hour and a half into the flight we were notified that a gentleman seated in first class was having difficulty breathing; showing some signs of discomfort; and was being attended to by two physicians traveling on the flight. Blood pressures and vital sign were taken. His bp was 140/90 which; according to his wife; was normal for him. His pulse; according to the physicians was weak and they requested he be placed on oxygen which he refused. His wife informed us that he had a 40 to 50 percent blockage going to one side of his heart; that he was allergic to penicillin; and that he had nitroglycerin with him. The doctors on board had him take the nitro and continued recommending that he use the bottled oxygen. A call to medlink was made from the cockpit through our dispatcher. Medlink recommended that the gentleman be placed on oxygen for 30 minutes; be given an aspirin with something sweet to drink; and to continued using nitroglycerin. Upon my request the gentleman begin using oxygen.medlink requested that we report back with them in 30 minutes. After complying with medlink; the two physicians and nurse continued their monitoring of patient who at first appeared to be resting comfortably. Approximately 15 to 20 minutes after being placed on oxygen; the purser notified me that the gentleman appeared to be breathing very shallowly; was sweating; and had a grayish skin color. The on board doctors once again sprang into action and recognized the individuals condition was turning worse. Bp was dropping and no pulse could be found. The aed was used; and cardiac massage immediately commenced. The on board doctors were recommending an immediate divert. Medlink was once again contacted and given the updated condition of our passenger. Medlink was told that the aed unit was used twice and that cardiac massage was be implemented. Medlink recommended that epinephrine be immediately started and a medical divert to landing take place. The doctors attempted to start an iv with the medication recommended by medlink. It is my understanding that difficulties; because bp was low and pulse non existent; manifested themselves. Other procedures were required and used. I was told that our on board physicians felt that the gentleman had died; but they continued in their resuscitation attempts; each taking turns. This procedure continued throughout our approach and landing. As the two physicians; nurse; continued working on the gentleman our flight attendants continued working at comforting the gentleman's wife and our other passengers in the immediate area as well as the other cabin areas.I along with the other pilots as well dispatch began working on the medical divert only 160 nms away. The FMS's were reprogrammed for a flight; descent; and approach to our divert airport. An overweight landing was going to be made. Landing distance was determined using full flaps; and overweight landing procedures as spelled out in the QRH were followed. Medlink; notified the airport of our medical emergency and had the paramedics and well and medical equipment standing by. Because our landing was going to be significantly overweight; emergency fire crews were also called upon to be standing by. The flight attendants prepared the cabin for quick approach as well as normal landing. Medical attention continued throughout the approach and landing and up until airport medical crews arrived. It is my understanding that the airport medical crews continued the medical resuscitation for 10 to 15 minutes and then determined or confirmed that our passenger had died. Because the airport physician; who arrived with the paramedics; marked our passengers death as unnatural; the airport police as well as the investigative police became involved. Tensions within the cabin of our aircraft rose quickly. I explained to a female investigating officer that the doctors; nurse; as well as any other that attended to the medical careof our passenger did so under the instructions of medlink. The medical procedures that were carried out were those that medlink had recommended and that no one on my aircraft did anything outside the parameters of those instructions. If fault was to be found they would have to contact medlink. After approximately 2 hours I was informed by the airport police officer in charge that everything was ok and our passengers were allowed to deplane. The female investigating officer politely explained to me that when a passenger dies in flight that it will normally be reported by their doctor as unnatural. I guess I am to assume that dying in flight is not natural. She apologized for the inconvenience and than asked to see the cockpit to which I complied. My crew; both pilots and flight attendants; performed in an exemplary manner. My first officer and relief pilots shared the planning work load. They began doing what was needed immediately. QRH procedures for an overweight landing; clearances; as well as cabin to cockpit communication were equally shared like a fine precision watch runs. Our dispatcher; worked the weather problems on his end making my decisions and divert easier. My flight attendants kept our passengers content and comfortable filling on board requests as they were made. All of my crew members acted compassionately and professionally for which I would like to extend my thankfulness.

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Original NASA ASRS Text

Title: Captain describes the events surrounding a passenger illness and death resulting in a diversion during an international flight.

Narrative: Approximately an hour and a half into the flight we were notified that a gentleman seated in First Class was having difficulty breathing; showing some signs of discomfort; and was being attended to by two physicians traveling on the flight. Blood pressures and vital sign were taken. His BP was 140/90 which; according to his wife; was normal for him. His pulse; according to the physicians was weak and they requested he be placed on oxygen which he refused. His wife informed us that he had a 40 to 50 percent blockage going to one side of his heart; that he was allergic to penicillin; and that he had nitroglycerin with him. The Doctors on board had him take the nitro and continued recommending that he use the bottled oxygen. A call to Medlink was made from the cockpit through our Dispatcher. Medlink recommended that the gentleman be placed on oxygen for 30 minutes; be given an aspirin with something sweet to drink; and to continued using nitroglycerin. Upon my request the gentleman begin using oxygen.Medlink requested that we report back with them in 30 minutes. After complying with Medlink; the two physicians and nurse continued their monitoring of patient who at first appeared to be resting comfortably. Approximately 15 to 20 minutes after being placed on Oxygen; the Purser notified me that the gentleman appeared to be breathing very shallowly; was sweating; and had a grayish skin color. The on board doctors once again sprang into action and recognized the individuals condition was turning worse. BP was dropping and no pulse could be found. The AED was used; and cardiac massage immediately commenced. The on board doctors were recommending an immediate divert. Medlink was once again contacted and given the updated condition of our passenger. Medlink was told that the AED unit was used twice and that cardiac massage was be implemented. Medlink recommended that epinephrine be immediately started and a medical divert to landing take place. The doctors attempted to start an IV with the medication recommended by Medlink. It is my understanding that difficulties; because BP was low and pulse non existent; manifested themselves. Other procedures were required and used. I was told that our on board physicians felt that the gentleman had died; but they continued in their resuscitation attempts; each taking turns. This procedure continued throughout our approach and landing. As the two physicians; nurse; continued working on the gentleman our flight attendants continued working at comforting the gentleman's wife and our other passengers in the immediate area as well as the other cabin areas.I along with the other pilots as well Dispatch began working on the medical divert only 160 NMs away. The FMS's were reprogrammed for a flight; descent; and approach to our divert airport. An overweight landing was going to be made. Landing distance was determined using full flaps; and overweight landing procedures as spelled out in the QRH were followed. Medlink; notified the airport of our medical emergency and had the paramedics and well and medical equipment standing by. Because our landing was going to be significantly overweight; emergency fire crews were also called upon to be standing by. The flight attendants prepared the cabin for quick approach as well as normal landing. Medical attention continued throughout the approach and landing and up until airport medical crews arrived. It is my understanding that the airport medical crews continued the medical resuscitation for 10 to 15 minutes and then determined or confirmed that our passenger had died. Because the airport physician; who arrived with the Paramedics; marked our passengers death as unnatural; the airport police as well as the investigative police became involved. Tensions within the cabin of our aircraft rose quickly. I explained to a female investigating officer that the doctors; nurse; as well as any other that attended to the medical careof our passenger did so under the instructions of Medlink. The medical procedures that were carried out were those that Medlink had recommended and that no one on my aircraft did anything outside the parameters of those instructions. If fault was to be found they would have to contact Medlink. After approximately 2 hours I was informed by the airport police officer in charge that everything was OK and our passengers were allowed to deplane. The female investigating officer politely explained to me that when a passenger dies in flight that it will normally be reported by their doctor as unnatural. I guess I am to assume that dying in flight is not natural. She apologized for the inconvenience and than asked to see the cockpit to which I complied. My crew; both pilots and flight attendants; performed in an exemplary manner. My First Officer and Relief Pilots shared the planning work load. They began doing what was needed immediately. QRH procedures for an overweight landing; clearances; as well as cabin to cockpit communication were equally shared like a fine precision watch runs. Our Dispatcher; worked the weather problems on his end making my decisions and divert easier. My flight attendants kept our passengers content and comfortable filling on board requests as they were made. All of my crew members acted compassionately and professionally for which I would like to extend my thankfulness.

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.