The paramedic profession

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

Håvard Hasund has worked as a paramedic both in Oslo and in rural Sunnmøre. A conversation about the training, the placements, the year on dispatch and the large differences between city and countryside.

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What this covers

  1. What the job is actually called, and the three routes in
  2. His own way there – Red Cross, Canada and the Coast Guard
  3. The degree, year by year
  4. How he learned anatomy
  5. First placement, and when he considered quitting
  6. What a peripheral cannula is
  7. Debriefing after difficult call-outs

What this covers (cont.)

  1. The dissertation on delirium
  2. The staffing pool, and the work in Oslo
  3. The year on dispatch, and what a phone call cannot give you
  4. City against district
  5. Who the job suits

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.
The degree is relatively new in Norway – it started in Oslo in 2014, and when Håvard applied in 2019 it existed in three cities. It has since spread further. It is only offered by public institutions, so you cannot buy your way onto it. Entry requires general admission certification, without science prerequisites – but the grade threshold has risen sharply, partly because ambulance programmes on television have made the job far more visible.

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.
He was a smoke diver – so why not the fire service? The answer is disarmingly honest: the heat. On the smoke-diving course he was in rooms with gas flames where it easily reaches several hundred degrees, and in the engine room on board it was 40–60. Cold is fine. Heat is not.

The degree

Three years, in outline

StageContent
First autumnanatomy and physiology, 20 credits – with a fair amount of chemistry and some physics
First springpathology and pharmacology
Second yearsimulation and skills training, and 16 weeks of ambulance placement
Final semesterthe dissertation
He remembers the very first lecture well: the lecturer said outright that the subject would be demanding, that the syllabus is larger than in nursing, and showed articles on how many fail the anatomy exam. The first year resembles nursing closely – the difference lies in how heavily emergency medicine is weighted later.

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.

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."

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.
It can be placed in more than the wrist – often the elbow, because the veins there are large, and in cardiac arrest the neck is used too. At college they practised most things on each other, but not this.

Debriefing after difficult call-outs

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.
What makes the scheme good, he thinks, is who leads the conversations: not psychologists, but people who have worked in the ambulance service for years and have training in this. They have stood in comparable situations themselves. He is careful to say he does not know how it is organised elsewhere. Asked whether you become hardened, the answer is nuanced: somewhat – but a day comes when something reaches you, because it resembles your own life.

The dissertation: delirium in older patients

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

Working in Oslo

The year on dispatch

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
His lesson is that it is very hard to judge anything over the phone. He also saw how much is filtered out before it becomes an ambulance call-out. And yes – the odd calls exist. Paper cuts recur, where the answer is a plaster rather than the emergency number. The strangest was a man out skiing who rang because there was a moose standing in the track. As Håvard dryly notes: how to shoo a moose is not covered on the course.

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
The big difference is the volume of work, not its content. He admits with a smile that he misses some of the pace from Oslo.

Who the job suits

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.

Key points (cont.)

  • 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.

Key points (cont.)

  • Most call-outs are not drama. Which is why you should like people.

Questions this 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?

Questions this answers (cont.)

  • What are the biggest differences between working in Oslo and in a rural district?
  • Who is the job right for?

Spørretimen

Read the whole thing at

www.sporretimen.no/en/episodes/havard-paramedisiner/