The Backup Plan

The Backup Plan

By Ann Freestone, BA’89

Alumnus leading the charge to address declining
numbers of EMS volunteers in rural areas

It doesn’t always happen that a backup plan becomes a full-fledged career.

That’s exactly what happened to Eric Ernest, BSEMS’06, MD’10, the only fellowship-trained, board-certified emergency medical services (EMS) physician in Nebraska.

He’s also the assistant medical director for Creighton EMS Education and assistant professor at the University of Nebraska Medical Center (UNMC). Adding to his credentials, he recently became the Nebraska State EMS medical director.   

In 2002, Ernest entered Creighton as a pre-med student from Denver.

“I started undergrad at Creighton with the intention of being a biology major,” says Ernest.

His advisor asked a tough question — “What are you going to do if this doesn’t work out?” — and he didn’t know the answer. That’s when he looked into a backup plan, the emergency medicine services program, and earned a bachelor’s degree in EMS in 2006, prior to his medical degree.  

Ernest remembers the first patient he encountered when he shadowed at the Omaha Fire Department.

“It was a heart attack call and the patient was very, very sick. It grabbed me and led from there,” he says.

Because of his training as a paramedic, Ernest had a strong interest in emergency medicine, so he did an emergency medicine residency at UNMC and followed it up with a fellowship in EMS at Regions Hospital in St. Paul, Minn. He then landed a faculty position at UNMC.

In addition to his other roles, Ernest serves as the medical director for the Bellevue Fire Department, Sarpy County Dispatch, Cass County Emergency Management Agency, Weeping Water Fire Department, Elmwood Fire Department, Nehawka Fire Department and Greenwood Fire Department. He is also the assistant medical director for the Omaha Fire Department.

Since January 2016, Ernest has also served as the Nebraska State EMS medical director, where he is leading collaborative efforts to deal with declining EMS coverage in rural areas.

Ernest says rural communities rely heavily on a volunteer-staffed EMS system because it saves those communities and the state of Nebraska millions of dollars per year.  

There are many reasons for the decline in volunteers: the aging population; people moving to urban areas and/or living in rural areas but commuting to urban areas; and increased training requirements.

“The requirements have increased with the advancement of medicine and technology and what we are able to do in the field before the patient gets to the hospital,” he says. “The training has increased and rightfully so.”    

“Several different agencies and groups are trying to combat the problem,” says Ernest. “There’s no easy solution to it.”

Struggling communities are looking for new and innovative models to consider. For example, Cass County, Neb., staffs a full-time paramedic and emergency medical technician (EMT) who use a pick-up truck to provide what Ernest calls “safety-net care” until the ambulance with the volunteers can get to the patient. The pick-up truck has all the same equipment and medications as an ambulance. This hybrid model includes paid staff and volunteers to address the declining volunteer base.

Other communities are reaching out to high school students who could take an EMS class at age 19.

“A long-term project is looking at how we can keep patients out of the hospital,” says Ernest.

He said he’s working on getting a model of care through the Nebraska legislature that would allow paramedics to act as “community paramedics,” similar to visiting nurses, who could conduct health checks and act as a liaison between patients and their doctors or hospitals.

“We are also looking at alternative dispatch models that can be used to triage the call at the dispatch center and send more select resources to a call, especially for lower acuity calls,” he says.