At the 18th annual Pocono EMS Conference last weekend, Paramedic Jeffrey Knopf described the call he and partner Tim Sullivan received at 7:14 a.m. Jan. 26, 2009.

"I heard a police officer calling for help for a child that was unconscious," said Knopf, an Emmaus resident who had been working for Northampton Regional EMS at the time. Two minutes later they were dispatched to the Northampton Area Middle School.

The unconscious child was seventh-grader Dakota Galusha, who would be pronounced dead approximately 40 minutes later at St. Luke's Hospital due to injuries sustained when he was run over by a school bus.

"My job is to take you through my story and try to integrate and help you guys, as providers, deal with situations like this," said Knopf, leading off his presentation for firefighters, EMTs, paramedics and other first responders gathered at Pocono Manor. Except for the occasional cough or sniffle, the audience was silent and attentive.

"We're not really put on earth to see this stuff, but we chose a profession to try to save and make a difference in people's lives and sometimes it goes wrong," said Knopf, who now works for the Borough of Emmaus Ambulance.

Halfway to the school, dispatch told them to "expedite," which means the call is serious.

"It's telling us it's a very critical patient, especially if the police are getting upset about it," Knopf said.

The last leg of the journey was difficult because the school campus was packed with students, school buses and other vehicles. As the ambulance turned the corner in front of the school, Knopf saw a boy lying on the pavement and a woman holding his head.

"This is a very difficult thing for me to talk about so I might have to stop every once in awhile," he said.

Speaking slowly and deliberately, often pausing between phrases, Knopf continued with the story.

He and his partner did not know what had happened and no one nearby could tell them. When they got Dakota into the back of the ambulance and removed his clothes, they saw the boy had tire marks on his back and one side of his chest was higher than the other.

Dakota began to lose his pulse, so Knopf began CPR. At about that time, a school bus backed up to the ambulance and school district police Chief Robert Peloquin told Knopf and Sullivan officials believed Dakota had been run over by the bus.

Knopf asked Peloquin to drive the ambulance so that Sullivan could assist him in the back.

"The police chief said, 'I can't drive. I have to do a police investigation,'" said Knopf.

He paused between each phrase as he continued to speak.

"So here I am in the back of the ambulance ... compressions ... ventilations ... pushing medications ... burping the chest ... compressions ... ventilations ... talking to this kid ... watching his life just ... leave," Knopf said.

"Did I know deep down this isn't going to be a good outcome? Absolutely. But that's not what we train for, is it?" he said. "I know if the hospital was two blocks away it wouldn't have mattered."

Dakota was pronounced dead within five minutes of their arrival at St. Luke's Hospital.

"Everybody in the trauma bay was just a total wreck, including the doctors," said Knopf, who escaped to a back room to cry.

"My job is to save people. But this day it didn't work. And I don't take defeat real well."

Before leaving work, Knopf had to clean out the ambulance and, because the case had been declared a homicide or "death at the hands of another," he had to complete paperwork for the coroner's office.

Still wearing his uniform, he stopped at Turkey Hill in Northampton on the way home. People were talking about Dakota and, Knopf said, when they saw his uniform, they asked questions.

"Were you on that call? Was it bad? The last thing I want to talk about is that call," he said.

Over the next several days, Knopf found himself fixating on the media coverage of the event and YouTube videos made to memorialize Dakota.

"I just kept going through this call. I couldn't get this call out of my mind. I couldn't believe this happened," he said, describing how he cut himself off from family and friends, thinking it was just a temporary phase.

When Sullivan, who now works in Palmerton, was able to convince Knopf finally to eat something, they went to an Italian restaurant in Northampton and ordered manicotti.

"I remember sitting there and I remember going to eat that manicotti," he said. "And the sauce reminded me of the day when I was intubating Dakota and I got sick. And I knew I had a problem. I knew I needed help."

Getting the support he needed was not easy. Knopf said a colleague told him, "If you can't handle this, you need to be in another field."

Members of the audience gasped.

"I wanted to take that guy by the throat and choke him, literally," Knopf said. "I've been doing this for a long time. You know, if you don't care about this, and it doesn't affect you, then you don't belong in this field."

As Knopf continued to struggle, he said, he lost about 80 pounds.

"This was consuming me. This was all I thought about," he said.

It was not until October 2009 that he was finally diagnosed with Post Traumatic Stress Disorder. The symptoms include getting upset when reminded of what happened; difficulty sleeping; nightmares, vivid memories or flashbacks of the event; feeling emotionally cut off from others; feeling numb or losing interest in things; depression; and feeling jittery, irritated or anxious.

"I didn't get along with anybody. You said something to me the wrong way, I bit your head off," Knopf said. "There's nights now that I still have nightmares about this call."

Two days before the first anniversary of Dakota's death, he finally told a friend about his experiences.

"Two months later, I did it in a group setting like this in a class and told the story for the first time, and that kinda helps me a little bit, knowing that I can try to help you if it ever happens to you guys."

Knopf eventually joined the Critical Incident Stress Management team in order to do more to help others deal with difficult calls.

"We are here for you guys. We understand that this happens," said Knopf.

Members of the CISM team will visit with emergency responders at their stations after a call or meet with them one on one somewhere out of the way, said Knopf.

Describing the work as "emotional first aid," he gave the team's hot line number, 610-973-1624, and encouraged the audience to use it when needed.

Though life is better now that his PTSD has been treated, he has been forever changed.

"Every day, to this day, when I wake up, that little boy [is] the first thing I think of," he said.