Insights from Oslo

This summer I had the distinct privilege of touring one of the most forward-thinking EMS systems on the globe. The Oslo University Hospital in Norway runs a diverse 600+ person agency, running calls in the air, land and sea as part of the government-run healthcare system. 

The Norwegian health system is grouped into primary care and specialized care. Primary care includes general practitioners, home healthcare, nursing and retirement homes. Specialized care includes hospitals (both somatic and psychiatric), walk-in clinics and EMS. However, this doesn’t preclude EMS from integrating with both entities.

In fact, Oslo EMS (OEMS) not only operates bikes, boats, planes, helicopters and ambulances, but they run the university health system bus to transport people to their healthcare provider appointments. They even schedule taxi and minibus service as needed for patients. The general practitioner for the municipality recommends the form of transportation a patient should take to an upcoming appointment—taxi, ambulance or bus—and that recommendation goes into to the call center, which then schedules the transport. OEMS operates the dispatch center and balances the recommendations of the GP with the availability of vehicles. OEMS not only manages the ground units for their two counties of service, but also coordinates all air ambulances in a 10-county region.

One of the crew-centric policies recently enacted is centered around food breaks. People like uninterrupted meal times, and happy people make better providers, so dispatch actually tones crews out to take their breaks. The call center then makes every effort to avoid sending them calls during that downtime. Obviously, that’s not entirely preventable, but providers appreciate the effort.

Crews are comprised of one “ambulance worker” (equivalent to an AEMT in the U.S.) and one paramedic. Traditionally, becoming a paramedic in Norway required an individual to practice as an ambulance worker for two years and then take a year of classes at the university. However, this year Norway joined a few other countries that offer a bachelor’s degree in paramedicine. Paramedic students now attend year-round for three years to complete their coursework.

In Norway, you don’t go to “high school” at age 16, but rather choose either four years of vocational training (two years of “high school” plus two years of apprenticeship) or a three-year general study “high school.” So up until three years ago, the EMS career path was two years of vocational college plus two years of EMS apprenticeship plus one year of general study college classes to become an ambulance worker. As an ambulance worker, you could then attend the university for one year (60 credit hours) to become a paramedic. 

Three years ago, a new career ladder was developed in which you attend a three-year general study high school (U.S. high school age) and then attend a university year-round for three years (180 credits) to receive a bachelor’s degree in paramedic science.

This May the inaugural paramedic class completed their coursework and graduated 30 students. The class was made up of about 80% military veterans, half of whom had been deployed abroad. Other students had engineering or other healthcare experience in their backgrounds, and there was even a physiotherapist enrolled.

To help integrate old-school and new-school paramedics, current paramedics are actually recruited to teach students in the sim lab. Paramedics would literally come off a night shift into the sim lab and take students through the hands-on experience, sometimes relating the simulation to actual experiences they had the night before. The sim lab becomes a very synergistic and lively meeting point between theory and practice.
According to Carl Christiansen, paramedic instructor at Oslo University, the old-school paramedics get paid for their time in the lab, but they primarily do it because “they think it’s fun, and we make sure of that. It’s a rewarding experience for all.”

Students spend 60 days in the sim lab during the program. They are also in the ED and in operating departments performing mutilation training. They work in walk-in clinics, mental health departments and, of course, are primarily on ambulances conducting clinical placements for 40 weeks.

According to Christiansen, “At the end of the day, we want responsible and autonomous practitioners. We want people who behave professionally and can make sound clinical decisions in the field. We work very hard to create a culture of respect for them, and they back to us, in order to develop a deep sense of mutual trust.”

Interestingly, the new degree program uses almost exclusively American and British textbooks, partly because the U.K. served as a model for the Norwegian program. The pay expectation for ambulance workers is similar to that of a plumber in Oslo, and a paramedic can expect pay similar to a BSN.

My Oslo visit was a wonderful experience and I wish the recent graduates a very fulfilling and rewarding career. I also want to thank Ronald Rolfsen for playing a most hospitable host during my visit. If you have any questions about the program, Rolfsen will be available at EMS World Expo in Las Vegas, Oct 16–20 this year. 

Key Stats

The 600+ staff

• 55 EMT apprentices
• 400 EMTs
• 30 Dispatchers
• 55 Nurses
• 20 Physicians
• 10 Educational staff
• 30 Managers/administrators
• 15 stations + Oslo Airport
• 27 ambulances running 24-7
• 22 ambulances running daytime and weekends
• 2 bicycle paramedic units
• 1 motorcycle paramedic unit
• 1 supervisor vehicle
• 1 intensive care ambulance
• 1 boat (operated by Oslo Fire Department)
• 2 fixed-wing airplanes
• 2 helicopters
• 1 physician vehicle
• 1 bus

2016 Stats

• 149,000 ground calls
• 4,200 air calls
• 730,000 patient transports (including taxi and minibus scheduled transports)
• 40 sea calls
• 2.4 million miles driven
• Calls increasing 3%–5% annually