EMER DECLARED -- ACR CREW WITH AN ILL PAX DIVERTS TO ALTERNATE AND KEEPS THE SPD HIGH BELOW 10000 FT. SPD DEV.

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ENRT SJU TO BWI WE HAD A MEDICAL EMER -- ELDERLY LADY WITH SUSPECTED HEART ATTACK. INTERN ON BOARD TERMED CONDITION VERY SERIOUS AND DETERIORATING. I PICKED ORF AS BEST CLOSE OPTION. ATC CLRED US FOR A HIGH SPD CRUISE DSCNT. DID NOT RELIGIOUSLY OBEY THE 250 KTS BELOW 10000 FT SPD RESTR AND ADVISED APCH OF THE FACT. PATIENT CONDITION WAS CONSIDERED CRITICAL AT THIS POINT. SLOWED TO MORE POLITICALLY CORRECT SPDS AT AROUND 5000 FT AND COMPLETED A NORMAL LNDG. COOPERATION BY ATC WAS EXCELLENT; PARTICULARLY BY ORF APCH (WX WAS 500 FT OVCST 1 MI VISIBILITY. LADY WAS TAKEN OFF ACFT BY ADVANCED LIFE SUPPORT MEDICAL TEAM STILL ALIVE. COMMENT: GREAT DIFFICULTY IN ESTABLISHING HF COM FSR RERTE DUE TO FREQ CONGESTION. IT IS NOTHING SHORT OF CRIMINAL THAT IN THIS DAY OF SATELLITE COM WE ARE RUNNING THESE OVER WATER RTES WITH SUCH AN ANTICIPATED SYS AS SSB HF. IT WASN'T GREAT WHEN I WAS IN THE NAVY 35 YRS AGO AND IT SURE AS HELL IS OUTMODED NOW. DIRECT ACFT TO ATC COM TECHNOLOGY IS AVAILABLE NOW AND IT SHOULD BE MANDATED.