Dinosaurs like me who remember the late-'70s television series S.W.A.T. and those of the action-flick viewing public who saw its offspring, the fall 2003 action-thriller S.W.A.T., have a definite idea about what a special weapons and tactics team – the elite of law enforcement – is all about. As a result, it may come as a surprise that one of the greatest frustrations for Dr. Dan Field, a volunteer with the Sacramento County Sheriff Department's Special Enforcement Detail(SED) is having to "hurry up and wait." Of course, the work can be exciting – it's just not over-the-top, Hollywood-style exciting.

Field, an ER doctor at Kaiser Permanente in Sacramento, has been volunteering with the Sacramento SED for about four years. Why? Several reasons. First, and foremost, payback. "I'm trained to save lives, and there are people who are out there every day putting their lives on the line for the community – putting themselves between us and our worst nightmares – and I want to support that." Indeed, Field is amazed at the lengths the SED officers go to to preserve life – their own, the public's, and the suspect's. When situations drag out, Field admits that his typical ER doc personality – get it done now, my way – quietly stews. "I'm more hawkish. Of course, I don't say it out loud. But it's hard when you want to do something but you can't."

Field also feels there is a very specific challenge to the work – being able to take emergency medicine outside of the hospital. "Can we only provide care inside our high-tech department? Or can we step forward out of our safe environment and provide care? We have to push ourselves outside of our comfort zones."

And, yes, there's the rush: "Putting on the equipment, the tactical vests, and running in to apply your craft. That's exciting."

Like all SWAT teams, the Sacramento SED is on call 24/7. According to the Sacramento County Sheriff Department's website, the SED attends about 14 call-outs and 40 pre-planned events per year. Call-outs include situations such as barricaded suspects and hostage takings. Pre-planned events include situations such as executing high-risk arrest warrants and performing meth lab raids.

So suppose there's a call-out – what happens? All members of the SED, including the volunteer medical staff, are paged. The pager shows the coordinates of the event, and all available members of the team drop what they're doing and drive to the site. They always carry their gear – helmets, gas masks, tactical vests – in the trunks of their cars, and they dress out of their car at the scene. As the police officers create a perimeter – clearing civilians from the area and locking it down – the attending medical staff (usually paramedics but sometimes a doctor) divide the medical responsibilities and report to the command post officer. If there is one medical person onsite, then that person is stationed in the armored vehicle with officers. If there is more than one, the others are usually in the command center, a trailer equipped with communications and computer equipment, located outside of the view of the suspect. They stay until the situation is resolved – usually four to 12 hours later.

So while the police are doing their thing, what does Field do? He waits. He stays out of the way. He is onsite to handle emergencies that may result from incident-related trauma or medical emergencies, such as airway problems, chest wounds, and significant bleeding. He also monitors the situation for risk of heat, cold, and dehydration. And he provides medical consultation regarding the subject and any hostages. "I have to subjugate my ego and take-charge personality as an ER doctor to the well-being of the team. I work very hard to make sure they don't spend time thinking about me. I make sure I come in with useful information."

Field provides a profile of a suspect from a medical standpoint, not a psychological standpoint. Similarly, any hostages are assessed from a medical standpoint. He gives the example of one situation when the hostage was an elderly man with heart problems and diabetes. (The information about a hostage's health can usually be provided by family or neighbors.) The SED officers wanted to know what impact acting, or not acting, could have on the hostage. Field assessed the man's situation concerning his diabetes, and spoke with the hostage's cardiologist. With the information Field gained and the advice he provided, the officers changed their plan to one more in line with the hostage's best interests. For instance, the team was considering using flash bang grenades to knock out the suspect, but since the hostage had a pacemaker, they wondered what effect the flash and bang would have on him. Field laughs and explains that the two doctors decided the hostage's heart (thanks to the pacemaker) would be better able to handle the shock of the event than their own.

Though Field is a Level 3 reserve sheriff's deputy, and occasionally trains with the SED team members, he is unarmed at the scene. As a result, Field always has a bodyguard. If he needs to leave the armored vehicle to attend a patient, the guard goes with him.

Field initially heard about volunteering with the SED via a notice that a fellow doctor and SED volunteer Alan Galitz posted at work. And, Field comments, the screening process to join SED as a volunteer – including subjecting himself to psychological testing and a session with a psychiatrist – was harder than it was to become a doctor.

In his work with the SED, Field most frequently attends "single barricaded suspect" calls and "single barricaded suspect with hostage" calls. He can go for months without a call, then, he remembers, one Sunday there were three.

Kaiser Permanente helps to make Field's volunteering possible. If he has to attend a SED call while on shift, or is on a SED call and his shift is approaching, he can call in the backup ER physician. Kaiser also paid for Field's tactical vest, which cost more than US$700, and all the supplies he needs for his work with the SED.

Overall, Field says, his work with the SED is "hours of boredom punctuated by seconds of terror." So what were his moments of terror? Two situations that were – literally and figuratively – potentially explosive. In one case, the SED was raiding a highly flammable meth lab, and they were not sure what was a safe distance from a possible explosion. The second case involved a man who was barricaded in his house, had turned the gas on, and was walking around with a lighter. In the end, nothing blew (in either situation), and Field and the rest of the SED team went home to their families.

And Field's wife and three children, though very proud of him, hope his volunteer work doesn't get any more exciting than that.