KADENA AIR BASE, Japan -- The 18th Medical Group Critical Care Air Transport Team (CCATT) holds a unique role compared to other CCATTs in the Air Force. Serving out of Kadena Air Base, Japan, the team is made up of 11 individuals – three physicians, three nurses and five respiratory therapists – and is responsible for the entire Pacific Air Force area of responsibility.

Typically, respiratory therapists work in environments such as clinics with cardiology or pulmonary specialties, sleep lab units, cardiac catheterization labs and primarily, intensive care units (ICU). However, Kadena has no cardiopulmonary clinics or ICU and the therapists’ primary mission is supporting the CCATT – making their team different from any other team out there.

“The thing about Kadena is it’s the only active base in the world where this is the primary mission,” said Senior Master Sgt. Matthew Worsham, 18th Healthcare Operations Squadron superintendent and PACAF functional manager for the respiratory care practitioner career field. “The only focus is flying critical care transport missions throughout the Pacific – typically you only do this in deployed settings.”

Having less critical care options in the Pacific means less resources and often a lower echelon of care. For the CCATT, this means more missions; they’re responsible for going in to pick up the patient and getting them to a higher echelon of care wherever that may be whether it’s within the Pacific region or stateside.

With an average of 60 missions a year, the team sees many different medical scenarios and has to be ready to go at a moment’s notice.

“Our job varies on mission profiles so we could have anywhere from a 30-minute notice to knowing about the patient for a week or two,” said Master Sgt. Jensen De Nijs, superintendent of PACAF CCATT.

Since the team is on call 24/7, continuous day-to-day prep is key to being ready for the next mission.

“We don’t have any kind of logistical or admin support so every time we fly, in between missions we’re double checking our gear sets and making sure all the equipment is ready, ensuring the supplies are good to go, maintaining our flight records and being prepared to fly for the next mission,” explained Worsham.

During missions, the team consists of a critical care physician, critical care nurse and critical care respiratory therapist.

“We are a package deal,” De Nijs said. “Every mission we go on, it’s three individuals that go and we can take up to six patients. Not all of our patients are respiratory related but in case of an emergency, we’re there; we know what to do, we know where all the stuff is, we know how to manage the logistics of the mission and any in-flight patient requirements.”

The respiratory therapists also ensure they train to understand the skills needed outside of their primary roles.

“We work very closely with our physician and nurse counterparts to learn their roles because if someone was to fall out or if something happened in flight … we have to step in and do things outside of what our typical specialty is,” Worsham explained.

Due to the team’s geographic location, a mission day can be anywhere from 24 to 36 hours long. The team often finds themselves flying for four to six days straight – sometimes with back-to-back missions.

Missions are flown primarily on KC-135s but the team also finds themselves on C-17s and C-130s from time-to-time depending on the location and available aircraft. Despite the unpredictable and sometimes constant flying, the CCATT isn’t considered aircrew and have learned to rest when they can, where they can – carrying camping gear to catch up on sleep on aircraft, in hospitals and at airports.

“We’re considered operational support flyers – not aircrew – so we don’t have any crew rest regulations. We can literally fly a full mission profile and if there’s a critical enough patient out there and we get a phone call … we get on a plane and start heading that way,” Worsham said.

Although the team is an Air Force team, the CCATT supports missions for anyone with a military tie. Care is provided for members of all military branches, dependents, retirees and even contractors. Although it’s not typical, as the primary asset in the PACAF region – with the right levels of approval – the team could provide care and transport for a critical patient with no military affiliation.

While missions typically vary in complexity, the COVID-19 pandemic hasn’t really changed their mission profile – just their precautions and means of travel.

Every patient is tested prior to being transported by the team whether they’re exhibiting symptoms or not. If a patient tests positive, then a separate, high infectious disease team is takes over the transport, De Nijs explained. The team mitigates their risk of exposure by wearing protective equipment for the duration of the flight and when visiting hospitals.

Despite the CCATT currently being restricted to flying on military aircraft only – slowing their return process – they’re still just as dedicated to providing the crucial care only they are capable of in the region. Whether it’s a well-known area or somewhere unknown to most, the team values every mission just the same.

“There’s not a lot of hospitals in the Pacific that have critical care or ICU inpatient services and even the ones that do are limited in their capabilities,” Worsham explained. “Depending on the severity of injury or issue, if our response time isn’t fast enough to get them out, literally the worst case scenario could occur – there’s a lot on our shoulders from the time we’re called to the time we drop off the patient.”



Note: Master Sgt. De Nijs has PCSd from Kadena Air Base since the time of the interview.