Trauma surgeon Dr. Dave Ciraulo doesn't always do his best work in the operating room.
Then again, few doctors find themselves in situations in which their patients may have been their assailants just minutes earlier. But these scenarios are not uncommon in the life of SWAT doctors like Ciraulo.
"I remember a call where a suspect had barricaded himself in a building with two AK-47s," Ciraulo said. "As the SWAT team was evacuating the officers, they had to shoot the suspect. Within a minute and a half, I began resuscitating him."
It's not unlikely for SWAT doctors to find themselves walking the fine line between saving lives and protecting their own lives -- with deadly force.
"There have been a few times I have been the shooter and then a few seconds later, I have to change gears and get the guy's chest open and control bleeding," Ciraulo said. "When that role changes, I'm the doctor.
"It is difficult to put into words, but at the time, it is very automatic. When the dust settles, I don't necessarily think about the 'bad guy' as being 'bad' -- he's a person and I feel bad that he got hurt."
These physicians, who are part of Special Weapons and Tactics, or SWAT, teams, often receive much of the tactical training of the officers in the team. But they bring to the scene the medical support that could save the lives of their team members and others.
Before the Columbine school shooting incident in 1999, the presence of doctors in such teams was rare. However, today most tactical teams, including police forces, SWAT teams and military teams have a doctor on board.
"[The Columbine event] really brought things to the forefront," said Ciraulo, who is also attending physician and professor of surgery and critical care at Maine Medical Center in Portland. "In building a specialty team, one has to ask the question: How do you get medicine into environments that aren't safe?"
Unfortunately, it seems many environments -- including office and school buildings -- are becoming increasingly unsafe.
"In my final year of residency, a good friend of mine's wife was killed in an office shooting," said Dr. Matthew Sholl, another SWAT doctor and attending physician in emergency medicine at Maine Medical Center.
"They had just had a baby. The perpetrator was a disgruntled worker with an AK-47. He started shooting randomly at people in the office, and she was killed," he said. "What hit me was, I couldn't imagine being a SWAT officer and going into that kind of situation without medical care on scene."
Police support the idea.
"Having the medical expertise on the team is a plus for everyone involved -- both officers and suspects," said Mike Williams, assistant chief of the Chattanooga, Tenn., Police Department and former SWAT team commander.
A heated debate has developed over whether or not arming doctors is appropriate. Upon graduating from medical school, doctors take an oath to "first do no harm."
But in the dual roles demanded of them in the world of tactical medicine, this line is sometimes crossed.
"When you're out there, it's like the 'military physician model,'" said Ciraulo. "Your first mission is to protect yourself, your team and the people you're trying to rescue. At that time, you're functioning more as on officer. The role changes when someone becomes a victim."