Helping the SWAT team as a physician

Mark A. Merlin, D.O., EMT-P, FACEP

Education

Undergraduate: University of Pittsburgh

Med school: Philadelphia College Of Osteopathic Medicine

Merlin is the CEO and Founder of MD1, vice chairman of emergency medicine at the Newark Beth Israel Medical Center and founder of the N.J. EMS Fellowship Program. In addition, Merlin is one of the foremost authorities in out-of-hospital physician responsive services.

MD1, Inc. is a nonprofit corporation that brings the emergency room to the patient. It deploys highly trained physicians to the sites of crashes, accidents, strokes, heart attacks, natural disasters, mass casualties and other emergencies.

The physicians work as part of a team to make sure the most critical patients are alive when they reach the hospital. Merlin is also the team leader of the Tactical Physicians for the New Jersey State Police TEAMS Unit (SWAT team).

What do you like about being a SWAT team physician?

Every day is different. You never know what to expect. You never know where you’re going and who you’re going with. Everything can be fine one minute and crazy the next.

You have to do a lot of planning, know your environment and your team of officers very well. You have to think outside of the box. A doctor treating patients outside of the hospital by definition is thinking outside of the box.

It’s a completely uncontrolled environment. You have to worry about who’s behind you, who’s surrounding you, who are the good guys versus who are the bad guys. It’s a set of skills that you don’t learn in medical school or in the emergency department. You have to think of everything differently. The treatment is completely different outside of the hospital versus in.

What’s the most challenging part of the role?

Well, there is a lot of paperwork involved for those few moments of craziness, but I don’t think there’s any aspect of it that I don’t like. It’s interesting and constantly changing. Many of the things at the hospital are very routine. A physician does similar things on a daily basis.

Outside of the hospital, there’s so much variety every time you go on a job. You never know what’s going to happen or how you’re going to need to take care of a patient. You need to know how to shoot a weapon, how to put on a vest, when it’s safe to go into a house versus not.

It’s a combination of multiple specialties all rolled into one. That’s what the challenge is.

What surprised you about being a SWAT team physician?

I didn’t anticipate that I would learn so much on a daily basis. I didn’t anticipate there would be so much information I would need to know about what’s going on outside of the hospital.

For example, street drugs, the weapons being used, the types of ammunition, the long hours of training that SWAT teams put into a few minutes of an assignment. I didn’t anticipate the training would go on for days, months, years—and it never stops.

How can other physicians get involved?

If you’re a physician who is already trained in emergency medicine or critical care medicine, then you generally do one year of training called an emergency medicine services training fellowship. Part of that training is learning about SWAT teams and being a SWAT physician.

After you finish the training, you go on several SWAT missions. Once that’s completed, a physician can stay on a SWAT team or go with a law enforcement organization and accompany them with all of your medical equipment on their assignments.

You need to know how to form good relationships with law enforcement. Any interactions you have with local police departments are valuable. Any training you have outside of the hospital such as military, EMT or paramedic will be valuable as well.

If police departments learn about the skills and abilities that SWAT physicians have, they become more engaged and want to have these types of doctors at their side every time they go into a mission. They know that the outcome can change by having us about.