Climbing behind the wheel of the tower ladder truck, O'Rourke is the muscle driving the giant truck answering the call of the smell of gas at a home. He blasts the horn as he heads out into traffic.
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With sirens blaring, he nimbly weaves through traffic like he's never missed a day, although this is one of his first days back after nearly having his arm amputated.
I ask to see his injury now and he shows me his scarred shoulder, arm and forearm.
"I was partially amputated all the way around and into the bicep," O'Rourke said.
In August 2016, he was driving back from a reassignment in the Bronx when he started to make a left turn under an elevated subway.
"The I-beam hits this," he said, pointing to the side view mirrors. "This kind of got torn off, slid right up into my arm." Pointing to his shoulder, he said, "That's where it sliced into my arm into the bicep and partially amputated my shoulder."
FDNY EMTs Cory Christian and Adam Harrow got to Sean very fast.
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"We wanted to make sure the bleeding was controlled," Christian said. "So we stuffed it with a lot of dressing. Lots of gauze. Wrapped it real tight toward the body to keep and maintain that pressure."
They rushed O'Rourke to Jacobi Hospital.
"That was the best level of care he was going to get and it was the closest hospital," Harrow said.
Doctors at Jacobi immediately began to reattach his shoulder and arm and treat another injury.
"I had no bone. No nerve. No vascular damage," O'Rourke said.
He was later transferred to New York Presbyterian Hospital for further treatment. A month later, he left to begin grueling physical therapy.
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"I was determined to not give in and not let this injury not let me back," O'Rourke said.
Support from his wife Maggie was so important.
"She constantly, the whole way, was pushing me forward and being like you can really do this. You've got this. This is really what you want," O'Rourke said.
Returning to work after 15 long months, O'Rourke now thanks his EMTs, a host of doctors, staff and physical therapists, along with family and friends for their support as he pushed himself to reach his goal of returning to the job he loves.
"I have a lot to be thankful for this year," he said.
I asked if he would say an extra prayer on Thanksgiving. "Yeah," he said with a broad smile. "A couple probably."