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Georgia.“ It’ s a very different environment. Docs are used to being in charge, and you can’ t take that attitude. You’ re just a small cog in a big wheel. At the end of the day, you don’ t want to get anybody hurt. In times of stress, when the shit is hitting the fan, the last thing you want is to lose your cool. You always have to remind yourself,‘ This is not my emergency.’”
Dr. O’ Brien shared one account of his time as a SWAT team medic, a day that had a profound effect on his vision and respect for the men and women involved. He began,“ There was a guy who had held a woman hostage for days. He’ d repeatedly raped her. He was heavily armed. She escaped and told the story, so SWAT was going to arrest him.
“ As they make entry into the house, I’ m kneeling by the van at the corner of the property. I hear three bursts of automatic fire and then,‘ Medic up!’ Holy crap. We’ re on. I didn’ t know what I was expecting to see. I go through the living room and get to a hallway. SWAT is still clearing the place. There’ s a guy that’ s deader than hell in the hallway. I was struck by a few things. First, I was very impressed with how quickly this guy had died.”
“ A little bit of background,” Dr. O’ Brien offered,“ This suspect was waiting for us. But he was in the act of cleaning his guns. We happened to hit him at that exact moment where the gun was disabled. If that gun had been together, it would have been a different story.”
“ But, I found myself impacted by the environment around me. I should have kept my focus on delivering care. I looked down the hallway, and had one of my most profound moments in SWAT,” he said with a small crack in his voice.“ The rest of the house isn’ t clear, and there’ s a SWAT guy blocking the hall. His job is to take a bullet for me. There’ s a guy here who had raised a gun to the officer, and they shot him. And yet you’ ve got a SWAT guy standing there, willing to shield me from anything while I take care of someone who just tried to kill one of their officers. That’ s amazing.”
Although Dr. O’ Brien has worked in separate capacities with police, fire and EMS, the recent surge in active shooter scenarios is driving those three organizations into closer collaboration than ever before.
“ Fire has an untapped resource for those scenarios. All firefighters are EMTs. They aren’ t often used in that capacity, but if crap happens and you’ re all of a sudden looking at 30 or 40 casualties and the scene isn’ t safe, how do you deal with that?”
Dr. O’ Brien explained that in the event of an active shooter, SWAT 30 LOUISVILLE MEDICINE
Grandaughter KyLee and daughter Kirsten
would hunt for the aggressor. After them would follow firefighters protected by armed law enforcement to identify and treat injuries and casualties. Once the scene is stabilized, the SWAT medic would help with the victims.
As a collaborator with each department, Dr. O’ Brien helped to shape the plan that’ s in place today and has presented this Louisville model internationally, advising other countries on steps of the process including how to incorporate firefighters into an active aggressor scenario.
That’ s just one example of how in the last two decades, Dr. O’ Brien’ s work has expanded outwards from Louisville. For example, he served for many years as the state medical advisor, and had an opportunity to travel overseas helping other countries strengthen their emergency services.
In late 1999, Turkey was struck by a devastating earthquake which resulted in thousands dead. Just a few months later, Dr. O’ Brien and a team of physicians from across the country were on a plane bound for Turkey. The objective was to help design a comprehensive disaster plan so nothing that catastrophic would happen again without a planned medical response.
“ A very progressive group of Turkish physicians said one issue they had both during and after the earthquake was a lack of hospital disaster plans,” he said.“ So we were invited to a university in Izmir, Turkey. There we presented our hospital emergency plan, and it was one of the great successes of my career.”
At the beginning of the week, Dr. O’ Brien and the other Americans were explaining their plan to“ a room full of physicians who had just seen firsthand what chaos looks like. By the end of the week, they had developed and exercised a national hospital disaster plan. That became their national model and a publication. Being a part of that was powerful for me.”
The year 2008 was a transitional one for Dr. O’ Brien. He stepped down as state medical advisor and had surgery to remove prostate cancer. For the first time since the 1970s, he wasn’ t providing direct medical oversight anywhere.“ I thought,‘ Wow, this is quiet.’ So I looked to what I had enjoyed in the past and asked how I could reignite that. I thought back to that Turkey visit from 2000 and wondered if I could explore international work through my EMS experience. Because if there’ s one thing the US knows, it’ s how to screw up EMS. We’ ve made every mistake you can, so if I could short circuit some of those mistakes for others that would probably be very worthwhile.”
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