Interview with a Real-Life Ambulance Paramedic

Kari Hautamäki is a Swedish Finn who has a long career as an ambulance paramedic in Sweden – including in and around Stockholm, the, shall we say, “busiest” area for the police and medical emergency services in the country.

After listening to his excellent books a few weeks ago, I invited him for an interview with ForenSeek. Luckily for us, he said yes. Enjoy!

Thank you, Mr. Hautamäki, for your time!

Tell us a bit about who you are, in your own words.

My name is Kari Hautamäki. I was born and raised in Sweden, and then I studied in Finland to become a paramedic and a teacher, and now I live in Sweden where I work as a nurse.

Are your parents Swedish Finns? (Finnish “ruotsinsuomalaisia”)

Yes, Swedish Finns. My father left Finland right after the army and went to work in Sweden. At that time, basically half of Finland went to work there.

And what was it like growing up in Sweden? What was the country like when you were there?

Well, at that time, Sweden was doing well, even enviably well, because it was such a model of a well-maintained society, an example for the whole world. Everyone had jobs and money and life was easy. Of course, there was a bit of a “big brother” attitude towards Finns at that time, even racism, and quite brutal racism at times. I wrote in the first book about the fact that there were still schools in Sweden in the nineties which forbade Finnish children from speaking Finnish, so even on school trips it was forbidden to speak Finnish, my mother tongue.

Just last week when I was at work, I met one other Swedish Finn who had these same memories. The guy, a patient in his 90s, had lived in Sweden all his life, and he talked for a long while about how he too remembered those days when Finnish was a “forbidden” language. Nowadays people are more sensitive about these types of issues, but back then, you could say there was some hardcore racism towards Finns. I mean, how can you forbid people from speaking their own language in their free time?! But that was the policy back then.

Kari Hautamäki posing with a copy of his book.

How would you say Sweden has changed from the time of your childhood compared to 2023?

Sweden has, of course, changed in a million different ways, like the whole world, but what I think is the most visible change in terms of the Sweden of my childhood versus Sweden in 2023 is that there has essentially been a collapse of Swedish society as the “People’s Home” (Swedish “folkhemmet”), a safe haven. And that haven is never coming back again.  

What kinds of things do you think have contributed to that collapse?

The out-of-control immigration policy. In 2015, during the refugee crisis, Finland took in about thirty thousand refugees – and at the same time Sweden took ten times that number, or thereabout. And already before that, when the resources of social welfare and the police and health care and everything were already limited in Sweden, they were already taking in massive amounts of immigrants and refugees. The amounts were so huge that the processes became uncontrollable, and in no way did Sweden have the opportunity to manage this and actually help the people who came and stayed in the country.

The sheer number of refugees and immigrants had also led to a situation where a lot of people have simply disappeared off the radar: according to some estimates, there are around one hundred thousand undocumented immigrants in Sweden, and Swedish society knows nothing about them.

My Finnish relative also lived in Sweden for decades; he worked at a sawmill over there. I remember the trips to the country, with its peace and nature and tranquility. It’s insane to now see these endless news items about gang executions and other violence over there these days.

Indeed. According to statistics, Sweden is now the most dangerous country in Europe in terms of gang violence. Last week I was paired up with a colleague who came to Sweden as a refugee from Eritrea. He literally told me that these days, Sweden is a worse place than Eritrea! Of course, he was maybe adding a little “spice” to his description, but the basic idea is correct: even a lot of refugees feel like they’re not living in the same country they came to years ago.

How does this increase in violence and crime show itself in the life of a regular Swede, the proverbial “Gunnar Svensson”, so to speak?

Regular Swedes will avoid certain suburbs around Stockholm, which only adds to the segregation between born Swedes and immigrants, and creates these enclaves within the urban areas.

Swedish police working the crime scene of a gang-related bombing in Stockholm, Sweden. Photo: Anders Wiklund / AP.

Is this topic taboo in Sweden?

It absolutely is. Swedes will do almost anything to avoid a conflict, which adds to the atmosphere of silence around difficult, “taboo” societal topics. The situation is changing a little bit these days, and this topic is entering into the public arena of discussion little by little, but even now, if someone brings up the problematic aspects of immigration, somebody will yell “racist!” or “fascist!”  

A right wing party called “Sweden Democrats” were a big winner in the elections, but part of the culture of silence around taboo topics is that if you ask someone in the workplace coffee room “Who did you vote for?”, nobody will say “Sweden Democrats”, even though people have clearly voted for them – that’s why they won the elections!

Coming back to your life and your personal journey: how did you end up in the medical field?

It was the sum of coincidences. Unlike a lot of men, I have never dreamed of working as a police officer or a firefighter or a paramedic.

I was once in the national team in combined ski jumping and skiing. In the last few years, my motivation started to wane a bit, which then led to the fact that I was taken to the hospital more often. Sometimes, while carrying me to the ambulance or a car, my teammates would joke that “We might as well start doing this for a living!”

Later on, when I was thinking about what to do next with my life, this off-beat joke came to mind. I put in the papers to study nursing, and got accepted. That’s the path I am still on.

Is there a separate, specialized training for ambulance staff, or how did you end up in an ambulance versus a hospital or a health center?

The training is the same for all nurses, regardless of where they work. If you want to work as a paramedic, your studies will continue 6 months longer than that of “regular” nurses, and this 6-month period could be called a kind of period of specialization.

Are there any special psychological tests for ambulance staff?

There are psychological tests, but they’re quite basic ones, and don’t take all that long.

What is an ambulance nurse’s work like? Give us a “tour” of a shift, from beginning to end?

Well, every shift starts with at least a few liters of coffee (laughs). Every shift is different from another, there are literally never two shifts that are alike. And really, it’s never driving with the alarm on from start to finish. If you read my books, you might get the impression that every shift is full of action, but that’s only because you have to condense events into a few hundred pages, so you pick and choose the juiciest bits. The genre of the book kind of dictates this.

But even still, I’d say 90 % of the job consists of hectic, high-adrenaline work. The cases, however, don’t generally fit the mold of a Hollywood action movie: a lot of the calls we get consist of cases like urinary tract infections among the elderly, somebody has fallen over on their bike, somebody has an aching body part that immobilizes them, and so on. 

Do you have a “favorite” shift? What kinds of calls does it involve?

I like shifts where a lot of stuff happens, but in an ideal situation, I would have some time to take a breather after each call, maybe have a cup of coffee, and properly prepare for the next call. Especially in Stockholm, the joy of working has totally disappeared, because you’re just inundated with calls, and you end up driving like mad from one job to the next. A work schedule this hectic begins to take its toll on the nurses and doctors, which is ultimately to the detriment of the patient, who needs attention and careful care. When a nurse is overworked, mistakes begin to happen, and it’s often the patient who pays the price for this.

Do you write reports of some kind after each shift, like the police in Finland do?

We write an individual medical report on each individual patient, but beyond that, there’s no comprehensive, general report written on a shift.

Are there specific themes that emerge in your patient cases? Certain types of cases that take up a lot of your time in Sweden?

One theme that keeps coming up again and again nowadays is this incapability in people to take care of simple things themselves. It’s most likely a global phenomenon. People want things to happen automatically, with minimum effort put in by themselves. I think this is tied to the drop in birth rates as well: adults are the new children, so they don’t want to have children themselves, and take the responsibility of raising a kid.

For example, we got a call from a person who had had an aching finger for three weeks. Then, suddenly, he decided to call us in the middle of the night and demand that we pick him up with an ambulance and drive him to intensive care immediately! Instead of having his finger checked out weeks before!  

There are American YouTubers who collect crazy stories from the medical field, and work them into these “Top 5” types of videos. Do you get really insane calls in Sweden as well?

I’ve read about those types of calls myself from the newspaper and internet articles. And I’ve had some cases like that myself.

For example, we once got an urgent call for an ambulance. When we arrived at the destination, there was a lady laying in bed who asked us to turn off her bedside lamp. That was it. That’s the reason she had alerted an ambulance. 

I gave my followers and readers a chance to ask you questions, and one question that was asked by something like four different individuals was this: who drives an ambulance? Is there like a trained driver sitting behind the wheel?

Usually there’s a kind of rotation that changes between each gig: the one who took care of the patient the previous gig, when that patient has been left in the emergency room, then that nurse takes the wheel on the next call, and so on. Of course, if it’s a gig that requires giving the patient a lot of medication, usually the one with the higher education and more experience takes the patient care. But if both nurses are equally educated and experienced, then it’s a matter of discussing and deciding between the nurses.

So there’s no ex rally car driver behind the wheel, like some myths say?

No. But that also varies: in Russia, for example, every ambulance in the country has a doctor and a nurse, and the driver is just someone who owns a driver’s license. I’m sure there are other countries with the same protocol, but that’s the first country that came to mind.

Is it the same system in Finland as in Russia regarding this?

No, it’s not. In Finland, almost ninety-seven percent of the healthcare system is run in the same way as in Sweden.

Do you make money in your line of work?

Well, in certain countries it is possible to live a tolerable life where you don’t need to count every penny. When I worked in Finland, so my basic salary at that time was 2380 plus a bonus for somewhat dangerous work, which was usually about a thousand euros. In Stockholm, Sweden my basic salary was €5,100, with bonuses added on top of that. Living costs in Sweden are also a little lower than in Finland.

Is the work dangerous?

Well, sometimes. It’s so sad that none of our nurses have the self-desense training that, for example the police or any security guards have, or any self-defense training at all, so yes, the work started to get dangerous in Stockholm. This leads to a constant state of alertness, which leads to increased stress in the job.

Plus there was the added hazard that even if a call comes saying it’s about, for example, chest pain, you can’t trust that that’s what the situation is actually about. I’ve been involved in calls that came to us as health problems, but turned out to be gang-related shootings. They’re called in as something other than shootings because the people making the calls don’t want to be considered “snitches”. So you go in prepared to treat someone for a heart attack, and when you get to the scene, there’s a guy lying on the ground, bleeding from a gunshot wound.

Have you ever had to deal with a physical assault from a patient?

Once, while working in Finland, a woman tried to forcefully, shall we say, “make love” to me. I had to physically restrain her.

Also, in Sweden, I was attacked with a knife. I was wearing these safety shoes with metal at the end of the sole, and I kicked the knife off the attacker’s hand and restrained the guy.

Does your employer provide psychological “aftercare” in cases like these?

We can use the services of a psychologist in cases like this, if we choose to.

What kinds of false assumptions and myths are there regarding your work? Are some of them true?

One persistent myth is that there are only white dressed in these old-style white uniforms working in the field. Of course, it’s not true – I’m living proof that there are a lot of males working as nurses and paramedics, too. Plus every nurse works with their own personality, and have their own little ways of doing things.

Some ambulance staff also feel offended by the assumption, which is spread among some communities of nurses, that all you need in order to work in an ambulance is a driver’s license. But of course, we go through training like everyone else, and have our own special line of work that requires special know-how.

What factors make you stay in such a demanding job?

I like the fact that I see and experience things almost daily that many people never get to experience in their entire lives. This job provides a unique viewpoint into the world. Working in an ambulance also makes you respect life, because you see daily how fragile it can be, and easily and suddenly you can lose it. Even the more stressful and dangerous calls make you appreciate your life more when you’re off-duty. Doing a shift in an ambulance reminds you that, even with all the problems I have in my life, my life is still pretty good.

Do some cases stay with you after a shift? Are there cases that kind of follow you home?

Overall, I try to maintain an almost “psychopathic” mode at work, because I have to be able to think clearly to serve the patient as well as possible. But cases do occasionally get “under my skin”, so to speak, and I’ve cried a few tears during a few calls over the years.

One example of such a case would be that Swedish Finn I mentioned at the beginning of our conversation. We sat down and had a chat about the old days of living in Sweden as a Finnish person, and the racism and restrictions on speaking your own language that went with it. It was an example of an emotional encounter with a patient, one where you really go on a personal, human level of communication, and you’re no longer just in your professional role as a nurse treating a patient. These types of encounters also give me feelings of success. The moments of success in this field don’t just consist of calls where you’re able to revive a patient with CPR or something like that. You also feel successful when you’re able to give the patient a meaningful experience in some way. 

Swedish ambulance paramedics treating a patient.

Do you ever get gifts from patients you’ve treated?

Giving positive feedback is, for some psychological reason, more difficult than giving negative feedback. For example, I once received a bill in the mail from a patient I had revived with CPR. The reason? I had to cut his jacket open in order to begin the procedure of saving his life… The guy sent me a bill for his broken jacket. (laughs)

Let’s hope you didn’t pay it.

I most certainly did not. (laughs) But we do also get thanks from patients, and that feels good.

Give us an example of a disturbing or sad case that has stayed with you for negative reasons!

There was an arson case in Sweden where a 15-year-old boy accidentally burned to death. He was not the target of the arson, but died as a collateral victim. I was one of the people who were present on the crime scene. That was sad and disturbing.

Also, last year, I had an elderly Swedish Finn who cried about not having the chance to visit their home country for the last time before dying. That one stayed with me. It wasn’t a negative memory, but it touched me on some deep level. I think every person living abroad has a soft spot in their heart for their homeland.

Tell us a crime story from your career!

There was a guy I knew about, who had dreamed all his life about being a nurse. Finally, he graduated, and it was time to start looking for a job. The problem is, the guy was connected to a gang, and this change of life was not okay for his gang. The gang ordered him to come meet them and talk to them about what he was doing. When the guy got to the meeting, the gang members shot him. The guy knew what was coming but went anyway – there was just no choice. 

I was on the ambulance that responded to the call, and when we got there, the guy was bleeding from his foot. The gangbangers had tried to shoot him in the head, but they had caught him in the foot instead.

Did he survive?

He did!

When we go to the scene, I told him “You’re a tough motherfucker for showing up, even though you knew exactly what would happen!” He replied: “I’m not tough – just tired of not being able to lead a normal life. I wanted them to kill me.”

This is one of the darker stories I’ve come across in my career.

As you know, my blog deals with the darker sides of human life and history. In this vein, I must ask you (and you don’t have to answer if you don’t want): what’s the most brutal or gory case you’ve had?   

Generally, the most brutal cases are shootings and stabbings. But if I had to choose one particularly harrowing call, it would probably be that kid from the arson I mentioned earlier.

When we drove to the destination where the call directed us, we found the boy’s body in the back porch. The flames of the fire had melted his body into the wooden floorboards of the porch; it was basically just a mass of human flesh, blood, and wood. I’ll never forget that sight.

Moving from, shall we say, this world to the next, I have a question that was suggested by a reader: have you ever experienced anything “paranormal” at work?

I’ve never had any real paranormal experiences, but I’ve experienced several moments that could be described as eerie or spooky.

For instance, I don’t even believe in god, but when a person dies, there’s an eerie feeling, a kind of atmosphere around that person. It’s almost like something has left the physical body, a spirit or soul of some sort. Plus the deceased person will often have… I don’t know, almost a look of relief and happiness on their face after death, like everything is okay now and the pain is over.

Of course, this effect could just be the result of blood circulation ceasing to operate. When the blood stops circulating, the skin gets cold and pale.

But even still, I feel like these physical reasons don’t entirely account for that eerie post-mortem effect right after the person has died.  

Have you heard of the “21 grams” theory, that a body weighs exactly 21 grams less after the physical death? The idea is that this is the weight of a person’s soul.

Never heard of it, but that’s kind of interesting. Of course, to test this, we would have to lay each patient on a scale. (laughs)

Do you have any (for lack of a better term) “rituals” that you observe if a patient dies in the ambulance? A moment of silence or something?

In principle, ambulances don’t deliver dead bodies anywhere. If someone has died, the police handle the situation from there on out. Of course, the exception is when a patient dies during the ambulance ride. But even in such cases, no, we don’t have any rituals or traditions for moments like that.

Do events from your work ever appear in your dreams? Do you get nightmares?

If I’m going through a particularly stressful period at work, I might have nightmares about being chased or some other classic “stress dream” scenarios. But the patients themselves don’t appear in my dreams, or incidents directly from work.

Moving on to your wonderful books: are there any plans to have them translated into English?

Believe it or not, the English translation was finished today! I’ll keep you updated on when it comes out.

Finnish edition of the book. The title translates to “You’re Not Going to Die (Yet)”).

I’ll be sure to notify my readers and Instagram followers when it’s available in English.

Any plans for more books?

I get constant pressure from readers and from my publisher to write more. We’ll see. I feel like I’ve said essentially everything I have to say about the “juicy bits” of my profession, so my third book might be about the aspects of crime (gang life, violence on the streets of Sweden) that I’ve encountered in my career.

Where can people keep up with you and your projects?

The easiest way is to follow me on my Instagram. I will also attend the Helsinki Book Fair this October.

And, finally, my regular questions. Your top 3 albums, books and movies!

Music: Metallica’s “Black Album” (aka “Metallica”). I also love a hip hop group called Jedi Mind Tricks. And for the third, I’m going to say Abba’s “Greatest Hits”.

Movies: I love Goodfellas (1990) and Papillon (1973). Can I name a TV series? Okay, in that case I’m gonna say Trailer Park Boys, which I’ve watched through about 5 times.

Have you seen the Swedish thriller Snabba Cash (2010) ?

Oh yes! Great film, though not necessarily in my top 3.

As for books, I just recently listened to the Kalevala as an audiobook, and it made a lasting impression on me; Finnish mythology is fascinating. I also love a book titled The Tao of Pooh, by Benjamin Hoff. And the Ramses series by Christian Jacq.

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