Alfonso Mejia, MD, MPH, is a busy man. The hand specialist is a clinical associate professor in the department of orthopaedics at the University of Illinois at Chicago (UIC), program director and vice head of the UIC Orthopaedic Surgery Residency Program, and an active member of the AAOS Diversity Advisory Board. He is also a volunteer SWAT medic.

Dr. Mejia provides Tactical Emergency Medical Support (TEMS) for the South Suburban Emergency Response Team (SSERT). SSERT is a multijurisdictional SWAT team comprising 34 police departments, serving approximately 600,000 citizens in a 150-square mile area south of Chicago.

When he dons his bulletproof gear and gun, Dr. Mejia looks the same as every other member of the team. “Although I am allowed to use my gun just like any police officer, my primary role is to provide emergency medical care to suspects, victims, and members of the SWAT team at the scene and to facilitate, when necessary, transfer to a hospital,” Dr. Mejia explained.

Learning the ropes
Dr. Mejia’s involvement with tactical medicine began in 2000 when a friend who is an SSERT member asked if he’d be interested in starting a TEMS unit for the team.

“One of the things that motivated me to agree was the incident at Colorado’s Columbine High School the year before,” he said. “Because bombs may have been in the building, emergency medical services (EMS) personnel were not allowed to enter the school. EMS cannot enter an area until it is secure. But TEMS can. That’s their purpose—to provide emergency medical support under potentially dangerous conditions during SWAT operations.”

That summer, Dr. Mejia began training, both with SSERT and the police academy. “It was a big time commitment—about 50 hours per month. After 13 months, I took and passed the police test and became a certified part-time police officer,” he said.

Dr. Mejia also attended basic SWAT school for marksmanship training. “My class included SWAT operators and members of the Drug Enforcement Agency and the Secret Service. We were taught to shoot handguns and rifles to meet FBI qualifications. I had the highest average of anyone in my class and received the top shooting award,” he said.

Dr. Mejia has also completed multiple basic and advanced TEMS courses, hostage rescue training, and Counter Narcotics and Terrorism Operational Medical Support training. To maintain his skills, he trains with the SWAT team 2 days every month.

Trading scrubs for armor
SSERT is a very active SWAT team. Most of its 50 to 70 operations each year are high-risk drug warrants, with occasional barricaded gunman and hostage situations, according to Dr. Mejia.

“I’m a volunteer—my medical career obviously takes precedence. The SSERT paging system is hooked up to my cell phone. If I can respond, I do,” Dr. Mejia said. “I am not the only medical person on the team; we also have several paramedics. But since they are not sworn police officers, paramedics are not armed. Being armed allows me more mobility during an operation. Most of the time, a paramedic can’t move without security from the team.”

Executing a high-risk warrant can be very dangerous; the suspects often have a history of weapons use or violence. Before serving the warrant, therefore, the team meets for a tactical briefing.

“We usually brief in the early morning hours in a neighboring town to avoid raising suspicion,” Dr. Mejia explained. “During the briefing, we go through a layout of the house and diagram our approach. We like to conduct our operations when the suspects are not at peak alertness—when they are either still asleep or drowsy. That makes it safer for everyone involved. An ideal operation is one where no one gets hurt.”

During the operation, every member of the team has a role, Dr. Mejia explained. For some, it is breaching. Their entire role is to open the door(s). Others are in charge of containment—making sure the suspects don’t flee and preventing unauthorized persons from entering the building.

“I’m usually the driver or passenger of the armored vehicle,” Dr. Mejia said. “Once the suspects have been apprehended, I examine them to make sure they are not injured . I treat minor injuries on location. For more severe injuries, I arrange transfer to a hospital for timely care.

“SSERT’s job is to secure the scene,” he continued. “Once that is done, detectives come in to search and interrogate the suspects. At that point, we return to the briefing location and debrief about what went right and what could have gone better during the operation.”

In addition to debriefings, Dr. Mejia noted other similarities between SWAT operations and surgery. “I share a lot of things that I’ve learned from SWAT with my residents, including the phrase ‘slow is smooth, smooth is fast.’ If you slow down and learn to do an action smoothly, you’ll find that you can actually complete it in less time. I think that’s very appropriate to surgery. I teach my residents to slow down during surgery and to be more careful. Rushing only leads to more problems.

“It’s also important to know what to do if something goes wrong,” Dr. Mejia added. “We talk a lot about that in SWAT. For example, what if the door can’t be breached—what is the secondary breach? Orthopaedic surgeons need to have a contingency plan as well.”

Finally, Dr. Mejia shares with his residents a concept that he learned from a Dallas SWAT member: “If you are thinking outside of the box on a regular basis, your box is not big enough. You need to build a new box—one large enough to contain real-life situations.”

Maureen Leahy is assistant managing editor of AAOS Now. She can be reached at leahy@aaos.org