Bringing Good Medicine to Bad Places

Nov. 26, 2007 — -- 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.

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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.