JOINT BASE PEARL HARBOR-HICKAM, Hawaii -- On Nov. 16, 2024, Capt. Jason Pureza, a member of the 624th Aeromedical Staging Squadron Critical Care Air Transport Team, while on call in his civilian capacity, responded to a severe case that tested his training and expertise.
“We boarded the plane, and his vitals were all normal with stable blood pressure, heart rate, respiratory rate, and pulse oximetry. But his altered mental status was concerning,” Pureza recalled.
The patient was a 62-year-old man who had suffered a five-minute seizure. Although he regained consciousness, his cognitive functions remained impaired. Bystanders had performed CPR, and Pureza’s mission was to ensure the patient remained stable during transport.
“Capt. Pureza seamlessly applied the knowledge gained from his Critical Care Transport Course and used it in his civilian capacity during a medical emergency, bridging the gap between ground-based care and the high-altitude demands of air transport,” said Maj. Deborah Lichota, 624th ASTS Critical Care Air Transport Team, OIC. “His exceptional planning, foreseeing every ‘what if,’ ensured that the right equipment was on hand when seconds mattered most. At 25,000 feet, where every decision counts, his ability to adapt and elevate patient care proves that expertise and preparation can make all the difference in saving lives.”
CCATT is a crucial element of the Air Force’s Aeromedical Evacuation System, providing intensive care during air transport. Pureza was trained to stabilize critically ill or injured patients in transit, managing complex cases like multi-system trauma, respiratory failure, and seizures. “We essentially create a portable ICU in the sky,” Pureza explained. “Every decision counts from what equipment to use, medications, and oxygen requirements. We must anticipate every need.”
Pureza’s CCATT training at Wright-Patterson Air Force Base had prepared him for this moment. He learned to calculate ventilatory requirements, anticipate physiological changes, and familiarize himself with the aircraft systems. “You don’t have the luxury of on-the-ground support,” he said. “In the air, you must think fast and act decisively.”
Pureza’s civilian experience as a night on-call critical care nurse practitioner and military experience helped prepare him to handle emergencies independently. He received the call: Midway Island needed to transfer the patient urgently due to limited medical resources. “Midway didn’t have what they needed to manage further seizures, so they reached out for help; they also did not have diagnostic capabilities such as imaging, labs, or, specifically for this case, electroencephalogram to determine etiology or the cause of the seizure,” Pureza said. Shortly after, he was en route to Air Station Barbers Point.
The C-130 arrived at Midway Island with engines running for a quick onload. Pureza transferred the patient to the aircraft without delay. “We received a medical palette from the Coast Guard, including airway supplies, automated external defibrillators, and advanced cardiovascular life support medications from Midway,” he said. “We were ready to keep him stable during the flight.”
Once airborne, Pureza faced the challenges of working in a low-light, noisy environment, typical of a C-130. “We had to be prepared for airway management, seizure control, and vital stabilization. If anything went wrong, I would have to handle it,” he said. CCATT trains its members to work in challenging environments, communicate effectively and account for complications that can occur during flight. Sudden changes in temperature and pressure can directly affect the patient’s condition.
Although the patient remained stable, Pureza knew the risks of further complications. “If his condition deteriorated, I would have had to respond independently. Airway issues or seizure recurrence were potential risks,” he explained. “The training from CCATT, especially flight physiology and advanced en-route critical care, prepares us for high-pressure situations. Managing this kind of care in an ICU is one thing but doing it in the air is a new challenge.”
Pureza also worked closely with the U.S. Coast Guard team to review emergency protocols, including procedures for rapid decompression. “This is high-stakes care. A single mistake can have big consequences,” he emphasized.
They landed at Air Station Barbers, loaded the patient on an ambulance, transported him to Queen’s Medical Center with an Emergency Medical Services team, and escorted him into the emergency department. “The mission was a success, but the real work began when I handed the patient over,” he said. “I’m proud to be part of a team that makes a real difference and always prepared for the unexpected.”
Pureza delivered the patient safely to the Queen’s Medical Center. “It was a relief to hand off the patient to the emergency department team, but I still had to make sure everything went smoothly,” Pureza said, briefing the physicians and nurses on the patient’s condition.
Despite the patient’s stable condition, Pureza was aware that challenges could arise at any moment. “CCATT is not just about medical knowledge; it’s about teamwork, adaptability, and the ability to perform under pressure,” he reflected. “It’s about being there for the patient, no matter the circumstances.”
Pureza’s experience illustrates the unique role of CCATT in providing critical care to remote and isolated locations. “The work we do is invaluable,” he said. “We’re often the difference between life and death for critically ill patients in places like Midway, where medical resources are limited. It’s an incredible responsibility, but one I take pride in.”
As Pureza continues his training and looks forward to more missions, he remains committed to advancing his skills and contributing to future CCATT operations. “This mission was just a small glimpse of what CCATT does, but it fills me with pride knowing I played a part in saving a life,” he said.
Looking ahead, Pureza is eager to expand his expertise and complete his second phase at CCATT advanced, making him deployable and remaining part of this vital team. “It’s a rewarding path, one that involves constant growth and the opportunity to make a real difference in the lives of others,” he concluded. “That’s what drives me.”