A paramedic in the city and in the countryside – what is it really like?

What does it actually involve to work as a paramedic? Håvard Hasund has several years behind him in the Oslo ambulance service, and now works in a rural district and at an out-of-hours clinic. That makes him one of few who can genuinely compare the two.

It is not called an ambulance driver

That is one of the first things he corrects. “Ambulance driver” is the phrase most people use, but it does not describe the job.

Three routes into the ambulance service

1. Vocational certificateThe trade route, as an ambulance worker.
2. Bachelor's degree in paramedicineThree years at university college. This is the one Håvard took.
3. NursingNurses can also work in the ambulance service.

How he got there

No plan, really. Håvard describes himself as the outdoors person in the class, not the one heading into healthcare. At upper secondary the plan was to coast through and do as little as possible.

Four steps he did not plan

1. The Red CrossActive towards the end of upper secondary. This is where the interest in first aid and emergency medicine was sparked – before that he had only done CPR on a dummy at school.
2. An exchange year in CanadaTo French-speaking Canada. He learned French, but repeated the school year at home – he had not learned much academically. What he did get was friends he still has.
3. The NavyRecruit school, then the Coast Guard as a smoke diver. Regular first-aid training on board, some of it with a doctor. This is where the thought first surfaced.
4. The paramedic degreeApplied in 2019, and describes himself as lucky to have applied precisely then.

The degree

Three years, in outline

Stage	Content
First autumn	anatomy and physiology, 20 credits – with a fair amount of chemistry and some physics
First spring	pathology and pharmacology
Second year	simulation and skills training, and 16 weeks of ambulance placement
Final semester	the dissertation

How he learned anatomy

This is perhaps the most reusable piece of advice in the episode, and it applies well beyond medicine.

I did not try to memorise. I tried to understand how things work in the body.

The method: he found he learned best from video, and used a lot of free lectures on YouTube where somebody explains and draws as they go – alongside reading the book and writing notes.
The point: once you understand how the systems connect, the exam becomes considerably easier than if you have memorised isolated facts.
The effort: he had lectures around three days a week, but treated the degree as a nine-to-five job five days a week, with reading in the evenings on top.

When he considered quitting

In the spring of the second year came 16 weeks of placement. He describes the first period honestly as awful.

The explanation is interesting. At college students are drilled in acute conditions, which builds an expectation that the job is to arrive, find something acute, fix it and drive to hospital. The first call-out was a young woman with a fever. Håvard examined her, found nothing to act on, and was left with one question: what do I do now? His supervisor calmly said they were driving to the GP.

Other call-outs went the other way – patients far sicker than he had the knowledge to handle.

A first placement is not about being world class. It is about functioning, staying humble and not being professionally lost.

It was the supervisor who said it, and Håvard is clear that a poor supervisor could easily have ended it differently – he thought many times that he was not suited to this.
In the second period came another realisation: the more you learn, the less certain you become. And for him, performance and confidence are closely linked.
Then it clicked: "Eventually it loosens up a bit, and you just start doing things. You stop overthinking."

As a student you do not drive. You are in the back with the patient, both ways. This was also during the strictest infection-control period: full kit, a sealed suit, 30 degrees and air conditioning that did not always work.

What a peripheral cannula is

One of the terms that recurs, explained the way he explains it in the episode.

Step by step

1. It is a needle with a tube around itA thin tube surrounding a needle.
2. The needle goes into a veinThe vessel carrying blood back to the heart.
3. Blood means you are inThat is the confirmation you hit it.
4. The needle comes out, the tube goes inNow you have access for medication and fluids.

Debriefing after difficult call-outs

This is one of the most important subjects in the episode. Håvard says there used to be no debriefing system in the emergency services, and that the suicide rate among people working in them was high compared with the rest of the population.

How the scheme worked where he worked

1. You get a callAfter a difficult incident.
2. A couple of days laterDeliberately not immediately, so it is not completely raw.
3. A conversation if neededIf the incident is heavy, or you feel the need, you are called in – preferably with everyone who was involved.
4. Confidential, and paidEverything said is confidential, and attendance is paid as overtime.

The dissertation: delirium in older patients

Håvard wrote about delirium and a screening tool for catching it early.

Briefly, as explained in the episode: older patients can develop a temporary state of confusion when the body is placed under strain, for instance by an infection. It does not mean the person is cognitively impaired ordinarily. It broadly appears in two forms – agitated, restless and irritable, or quiet, where the patient is drowsy and falls asleep without stimulus or mid-conversation. Older patients with a hip fracture are particularly exposed, because the fracture is a major trauma for the body.

Working in Oslo

He stayed in Oslo for six years, three as a student and three working, employed in the staffing pool – a separate unit that fills gaps where there is absence or a need for extra capacity. A typical day: turn up at a fixed place, change, have a coffee, and wait for the staffing coordinator to ring and say which station you are going to.

In central Oslo there is a lot of overdose work, and at night a lot of drunkenness. Violence and shootings occur. But he stresses something important: fundamentally it is the same job across the country – a great many older people with heart problems and COPD, wherever you are.

The year on dispatch

He also worked a year split fifty-fifty: half as a medical dispatcher, half in the ambulance. The reason was frustration. They went on many call-outs where they arrived and found nothing, and it felt like resources spent for no reason. Rather than walk around irritated at dispatch, he applied to go there and find out how it actually is.

What you have to judge from

In the ambulance

You are there

• You see the patient
• You can examine them
• You take measurements

On the phone

You have a voice

• You hear the caller
• There is a video option, but it is not the same
• You rarely find out how it went

City against district

Today he works half-time in a rural ambulance service and half-time at the out-of-hours clinic, where he also drives the doctor’s car.

Two working days, one underlying job

Oslo

Pace

• Many call-outs
• Overdose, drink, violence
• Little idle time

The district

Gaps

• Far fewer call-outs
• A lot of idle time between them
• Time goes on training, television, hunting and fishing

Who the job suits

His answer is unceremonious but apt. If you are interested in emergency medicine, this is a good place to be. And you should like people – there is a lot of talking, and most call-outs are transport or low-acuity situations rather than drama.

It is a really enjoyable and rewarding job. You feel that you contribute – maybe not to people getting well, but at least to them having a decent trip and feeling they are well looked after.

Emergency medicine is discussed at a general level and is not medical advice. No identifiable patient stories are shared. Entry requirements change – always check current information with the admissions service. In an emergency, call the emergency number.

Main topics

• What the job is actually called, and the three routes in
• His own way there – Red Cross, Canada and the Coast Guard
• The degree, year by year
• How he learned anatomy
• First placement, and when he considered quitting
• What a peripheral cannula is
• Debriefing after difficult call-outs
• The dissertation on delirium
• The staffing pool, and the work in Oslo
• The year on dispatch, and what a phone call cannot give you
• City against district
• Who the job suits

Questions this episode answers

• How do you become a paramedic, and what training is required?
• What is the difference between a paramedic, an ambulance worker and an ambulance driver?
• What is the first year of the paramedic degree like?
• What is it like doing a placement on an ambulance as a student?
• What happens after a difficult callout – how does debriefing work?
• What is it like taking emergency calls as a dispatcher?
• What are the biggest differences between working in Oslo and in a rural district?
• Who is the job right for?

Key points

• It is not called an ambulance driver. Paramedic is a three-year degree, and there are three routes into the ambulance service.
• Entry requires general university admission certification, but the grade threshold has risen sharply – partly because television made the job visible.
• The first year is heavy and theoretical. The practical side does not arrive until the second.
• The most reusable advice: understand how the body fits together rather than memorising isolated facts.
• A first placement is not a test of being the best. It is about functioning and not being professionally lost.
• The more you learn, the less certain you become – until it clicks and you stop overthinking.
• Oslo has its own debriefing system where the conversations are led by people who have worked in the service themselves.
• The difference between city and district is the volume of call-outs. The underlying job is the same everywhere.
• Most call-outs are not drama. Which is why you should like people.