What It Means to Go Beyond the Call

What does it mean to go beyond the call? The Emergency Health Services Federation (EHSF)—a regional EMS council representing eight counties in south-central Pennsylvania—asked the EMS providers in its region. As EMS Week approached, the EHSF created its first annual EMS Week essay contest—an opportunity for those interested to elaborate on this year’s theme. Personnel from across the region submitted essays in attempt to win a prize of $500.

The contest gave providers a chance to reflect while sharing personal stories of hope, compassion, and sacrifice. The essays submitted were powerful and encouraged providers to communicate openly about the stresses of the profession.

On May 22, paramedic William Kanoff was announced as the winner at the EHSF’s EMS Leadership Appreciation Breakfast in Harrisburg. Before audience of more than 100 attendees, Kanoff conveyed what it means to him to go beyond the call. His essay is reprinted here.

The EHSF congratulates Kanoff and all the EMS providers who submitted such thoughtful and touching essays displaying their exemplary dedication to EMS. The EHSF would also like to thank the regional medical director, Michael J. Reihart, DO, FACEP, FAEMS, for originating the EMS essay contest.

—Megan A. Ruby, Director of System Operations, EHSF

Beyond the Call — William Kanoff

Beyond the call. That phrase will mean different things to different people. To some it will mean cleaning up and getting back in service. To others it will mean following up on some of their patients to see how they are doing. Depending on the nature of the call, some might be compelled to cry, while others take to the bottle to cope.

On the surface we can all be tough when the need arises. But underneath we are all still human. If any provider ever tells you they never get emotional or upset about a call, they are either lying or too new to the career and have yet to respond to any calls.

I became an EMT in 1977. Throughout the past 42 years, I have welcomed new lives into this world, and I have seen lives exit—unfortunately, more of the latter than the former. Some of those lost were of natural causes, many were of a more violent nature. I have seen the joy on a new mother’s face as I handed her new baby to her for the first time, and I have seen the anguish of a parent when I told them their child was gone. I’ve experienced the high of getting ROSC and seeing that patient walk out of the hospital, and I have experienced the low of fighting to save a life taken too soon. I have had the pleasure of learning from some of the best in the business.

I have been verbally and physically assaulted. Shot at, spit at, cursed at, peed on, puked on, and even pooped on. I have survived being injured and even survived a helicopter crash. The key was that beyond the call, beyond all of that, I survived, and I kept coming back for more.

You may ask why. Well, I’m still trying to figure that out. If you look around at many EMS organizations, there are very few lifers. Many use EMS as a stepping-stone to other careers in healthcare. Many don’t last past five years. Of those who do, many become complacent and just go through the motions, day in and day out, just trying to survive. Others of us hope we can still make a difference.

An instructor once told me that we—EMS, fire, and police—are “bad day” people. People don’t call us when they’re having a good day. They only call for bad ones. While their crisis might not seem that bad to us, it is bad to them. We respond to help others in need. Over time that stress can wear you down. Who takes care of us beyond the call, when we’re having a bad day?

I have lost several colleagues over the years to suicide. While we will never know the true cause, we must consider that post-traumatic stress disorder (PTSD) played a role. We are experts at diagnosing this in our patients, people we just met. But we are poor at diagnosing it in our coworkers, people with whom we spend many waking hours. And we never want to admit we may be suffering from it ourselves. My wife swears I have PTSD. Of course, like a good paramedic, I swear I don’t.

In my experience there tend to be more bad days in EMS than good ones. Beyond the call, we need to look at our people and recognize they may be hurting. They may deny it, but if we can recognize the signs and symptoms, we may be able to prevent a loss.

I once pulled a teenage girl’s lifeless body out of a car in order to reach her friend who was still alive. I placed her on a backboard on the ground. Before I could cover her body, the next ambulance arrived and went to work on her. I told them to stop, she was gone. The EMT looked at me with tears in his eyes and said, “This is my daughter.” I will never forget that moment. I went home that night and hugged my kids tightly as I cried. Big, tough paramedic, firefighter, and former Green Beret, crying on his children’s shoulders. Beyond the call.

Beyond the call, know it is OK to cry, to experience sorrow, pain, anguish, and anger. These are natural reactions to bad events. Do not be ashamed to show emotion. My wife has seen me cry, seen me upset, angry, and in pain. She has been by my side for the past 31 years and has been my biggest supporter, and I love her dearly for it.

If you remain in EMS long enough, you will learn there are ghosts in your head that will haunt you from time to time, causing nightmares. You will never get rid of them, but you can control them, and it is up to you to do so. There is help if you need it. Don’t be ashamed to seek it out. We don’t need to add any more names to the statistics.

Beyond the call, regardless of the outcome, life goes on. Take care of yourself so you can care for others. Support your partners, talk to your significant others, share your stories. Don’t bottle up your emotions. You are tough, but you are not invincible. As an EMS professional, you are unique, you are special, and you are needed beyond the call. 

William Kanoff is a paramedic and emergency clinical associate at the Wellspan York Hospital emergency department in Pennsylvania.