For several years the Navy SEALs have reigned as media darlings, with dozens of insider books published by former operators and Hollywood movies dramatizing their exploits. But the Air Force has its own group of special operators, the Pararescuemen or PJs—highly trained medics and fighters whose job is to rescue injured military personnel and occasionally civilians from battlefields and other extreme environments.

Their exploits almost never become public, but recently the Air Force granted National Geographic a rare interview with Master Sgt. Ivan Ruiz, a 19-year veteran and recipient of the Air Force Cross.

Between the roar of F-15s taking off from a base in Lakenheath, England, Ruiz spoke via Skype about the life of a PJ and the night of December 10, 2013, when two of his teammates were wounded after his unit raided an enemy compound in the Afghan village of Mushan in Kandahar Province.

This interview has been edited for length and clarity.

Your Air Force Cross citation mentions a grenade that landed right next to you but didn’t go off.

One of the special forces guys and I were exchanging gunfire with two Taliban insurgents who were inside a mud hut. I had to reload, it was dark, and I was wearing night-vision goggles, so I couldn’t see anything except for my rifle. My teammate yelled, “Grenade!” and I heard what sounded like a rock landing in front of me. Immediately we both fell flat on the ground and tried to cover each other up. It was kind of comical because he was trying to get on top of me and I was trying to get on top of him, so we were pretty much fighting each other. Then we realized, hey, the grenade didn’t even go off. So we got back up and once again started engaging the threat.

That kind of exploit isn't the first thing that comes to mind with the title "pararescueman." Explain what PJs do.

We’re tactical rescue and recovery specialists who deal with everything from high-angle mountain rescue, to rescue out on the combat field, to confined-space urban rescue. We deal with humanitarian situations such as earthquakes, tsunamis, and hurricanes. During Hurricane Katrina, PJs were hoisting down, searching through buildings, then pulling people out.

We’re very experienced with aircraft, and we have all kinds of jumping capabilities, including jumping into the ocean with rubber boats to do search and rescue, as well as infiltration missions. On top of all that we’re divers and shooters, and we have medical capability. We’re kind of the out-of-the-box thinkers of the military team.

View Images Ruiz learned about the PJs when a neighbor in San Antonio passed the selection course. A normal day can involve a wide variety of training activities, from practicing emergency medical procedure to moving a 500-pound object. Photograph by Senior Airman Christopher Callaway, U.S. Air Force

What’s a typical day in the life of a PJ?

Each squadron does business slightly different from the next, but the teams focus their day-to-day training based off the tasks they’ve been assigned. For the most part, all PJs focus on shooting, small-team tactics, communications, medicine, technical rescue—which includes using rope systems, extrication, and confined-space rescue—and infiltration, which is mainly parachuting. We also have to stay current on scuba diving.

Are there any special tools or equipment you guys use?

We use breaching tools for getting personnel or sensitive items out of crash sites or vehicle explosions. We also use power saws to do the same in collapsed structures or confined-space scenarios. We specialize in “dirt medicine” so a lot of the trauma tools we use are smaller and don't have the same capabilities as ones you would find in an ambulance or surgical room. We do all of our training in full tactical gear, and when we train at night we wear night vision devices.

You guys are also trained in mountain rescue. How does that fit into your job?

Technical mountain rescue training is one of the most dynamic, challenging, and complex parts of our training pipeline. While the classical sense of mountain rescue involves high-angle scenarios on a mountain, it can also be in a ship, in a cavern, in a well.

A normal day of mountain rescue training starts with physical fitness, because our job requires us to be in peak physical shape, then we practice skills like knot tying, setting climbing anchors, and mechanical advantage systems. As we progress with the basics, harder and harder scenarios are invented to push the limits of our ability to problem solve. One day we will have to move a 500-pound object, the next we might have a survivor dangling 300 feet on a sheer rock cliff. Even more so than other skillsets, mountain rescue is a perishable skill and must be constantly refreshed in order to maintain proficiency. There is always a new piece of gear, a new tactic, and we have to constantly adapt to those changes.

View Images Ruiz treats a child for an infected eye while deployed in Afghanistan. Part of the PJs' mission is to respond to humanitarian crises, such as earthquakes, hurricanes, and tsunamis. Photograph courtesy Ivan Ruiz

Why did you choose to become a PJ?

In high school in San Antonio there was a guy who lived on my street who went through the pararescue course. He came home one weekend and told me all about it and from that point on I was sold.

What was the most difficult part of becoming a PJ?

The hardest part for me was paramedic school. I wasn’t a good student in high school, so I really had to change my way of thinking. I stayed up late studying, woke up early studying. The selection course itself is physically demanding and a huge part of it happens underwater. Take the air away from somebody, and you really see how they react under stress. The individual needs to complete a given task before they come back up for air. If they do one thing wrong, they get stressed out and things start to snowball. You can imagine what happens after that.

Do you think your PJ experience has helped you in any way to be a better dad?

No. They are two totally separate things, and I do try to keep them separate. Sometimes I don’t do a good job at that, and my wife lets me know when I’m not. My mind being elsewhere is really the big thing or becoming frustrated with the kids. PJs don’t have the luxury of being patient. If we need it to happen, we make it happen. But you know that’s not how families are raised.

How would you feel if someday your son said, “Hey dad, I want to be a PJ”?

I would be worried. There’s no way I can sit here and not think that there’s a really good chance that something’s going to happen to him. It really is just rolling the dice and playing the odds. When [my wife] Maria and I met it really was funeral after funeral [of fellow PJs].

Does your wife ever say, “Hey, you’ve got four kids here, maybe you should pull back”?

Really this is the only thing I’m good at, and she knows that. She definitely supports me. She holds the house down and raises my children. I can’t do what I do without her.