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146.40(4r)(e) (e) The nurse's assistant or home health aide may provide the department with a brief statement disputing the department's findings under par. (b) or the hearing officer's findings under par. (d) and, if so provided, the department shall enter the statement under sub. (4g) (a) 4.
146.40(4r)(em) (em) If the department of health and family services receives a report under par. (a) or (am) and determines that a person who is the subject of the report holds a credential that is related to the person's employment at, or contract with, the entity, the department of health and family services shall refer the report to the department of regulation and licensing.
146.40(4r)(er) (er) The department may contract with private field investigators to conduct investigations of reports received by the department under par. (a) or (am).
146.40(4r)(f) (f) Section 46.90 does not apply to this subsection.
146.40(5) (5)
146.40(5)(a)(a) The department, in consultation with the technical college system board, shall promulgate rules specifying standards for certification in this state of instructional and competency evaluation programs for nurse's assistants, home health aides and hospice aides. The standards shall include specialized training in providing care to individuals with special needs.
146.40(5)(b) (b) The department shall promulgate rules specifying criteria for acceptance by this state of an instructional and competency evaluation program or a competency evaluation program that is certified in another state, including whether the other state grants nurse's assistant privileges, home health aide privileges or hospice aide privileges to persons who have completed instruction in an instructional and competency evaluation program that is certified under sub. (3) and whether one of the following is true:
146.40(5)(b)1. 1. If the other state certifies instructional and competency evaluation programs for nurse's assistants, home health aides or hospice aides, the state's requirements are substantially similar, as determined by the department, to certification requirements in this state.
146.40(5)(b)2. 2. If the other state certifies nurse's assistants, home health aides or hospice aides, that state's requirements are such that one of the following applies:
146.40(5)(b)2.a. a. The instructional and competency evaluation programs required for attendance by persons receiving certificates are substantially similar, as determined by the department, to instructional and competency evaluation programs certified under sub. (3).
146.40(5)(b)2.b. b. The competency evaluation programs required for successful completion by persons receiving certificates are substantially similar, as determined by the department, to competency evaluation programs approved under sub. (3m).
146.40(6) (6) Any person who violates sub. (2) shall forfeit not more than $1,000.
146.40(7) (7) This section does not apply to a hospice that receives no federal or state moneys for any purpose.
146.40 Cross-reference Cross Reference: See also chs. HFS 13 and 129, Wis. adm. code.
146.40 Annotation Sub. (4r) provides for a hearing examiner to make a determination of abuse. That determination is the final agency determination. Kennedy v. DHSS, 199 Wis. 2d 442, 544 N.W.2d 917 (Ct. App. 1996), 95-1072.
146.50 146.50 Emergency medical services personnel; licensure; certification; training.
146.50(1) (1)Definitions. In this section:
146.50(1)(ag) (ag) "Act of terrorism" means a felony under ch. 939 to 951 that is committed with intent to terrorize and is committed under any of the following circumstances:
146.50(1)(ag)1. 1. The person committing the felony causes bodily harm, great bodily harm, or death to another.
146.50(1)(ag)2. 2. The person committing the felony causes damage to the property of another and the total property damaged is reduced in value by $25,000 or more. For purposes of this subdivision, property is reduced in value by the amount that it would cost either to repair or replace it, whichever is less.
146.50(1)(ag)3. 3. The person committing the felony uses force or violence or the threat of force or violence.
146.50(1)(am) (am) "Ambulance" means an emergency vehicle, including any motor vehicle, boat or aircraft, whether privately or publicly owned, which is designed, constructed or equipped to transport sick, disabled or injured individuals.
146.50(1)(c) (c) "Ambulance service provider" means a person engaged in the business of transporting sick, disabled or injured individuals by ambulance to or from facilities or institutions providing health services.
146.50(1)(cr) (cr) "Automated external defibrillator" means a defibrillator device to which all of the following apply:
146.50(1)(cr)1. 1. It is approved for commercial distribution by the federal food and drug administration.
146.50(1)(cr)2. 2. It is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and of determining without intervention by the user of the device whether defibrillation should be performed.
146.50(1)(cr)3. 3. After having determined that defibrillation should be performed, it is capable, either at the command of an operator or without intervention by an operator, of delivering an electrical shock to an individual.
146.50(1)(d) (d) "Basic life support" means emergency medical care that is rendered to a sick, disabled or injured individual, based on signs, symptoms or complaints, prior to the individual's hospitalization or while transporting the individual between health care facilities and that is limited to use of the knowledge, skills and techniques received from training required for licensure as an emergency medical technician - basic, or for certification as a first responder.
146.50(1)(dm) (dm) "Defibrillation" means administering an electrical impulse to an individual's heart in order to stop ventricular fibrillation or rapid ventricular tachycardia.
146.50(1)(e) (e) "Emergency medical technician" means an emergency medical technician – basic, an emergency medical technician – intermediate or an emergency medical technician – paramedic.
146.50(1)(f) (f) "Emergency medical technician – basic" means an individual who is licensed by the department to administer basic life support and to properly handle and transport sick, disabled or injured individuals.
146.50(1)(g) (g) "Emergency medical technician – intermediate" means an individual who is licensed by the department as an emergency medical technician - intermediate under sub. (5).
146.50(1)(h) (h) "Emergency medical technician – paramedic" means an individual who is specially trained in emergency cardiac, trauma and other lifesaving or emergency procedures in a training program or course of instruction prescribed by the department and who is examined and licensed as an emergency medical technician – paramedic under sub. (5).
146.50(1)(hm) (hm) "First responder" means an individual who is certified by the department as a first responder under sub. (8).
146.50(1)(hr) (hr) "Governmental unit" means the United States; the state; any county, city, village, or town; or any political subdivision, department, division, board, or agency of the United States, the state, or any county, city, village, or town.
146.50(1)(i) (i) "Indian tribe" means a federally recognized American Indian tribe or band in this state.
146.50(1)(ig) (ig) "Intent to terrorize" means intent to influence the policy of a governmental unit by intimidation or coercion, to punish a governmental unit for a prior policy decision, to affect the conduct of a governmental unit by homicide or kidnapping, or to intimidate or coerce a civilian population.
146.50(1)(im) (im) "Manual defibrillator" means a heart monitor and defibrillator that:
146.50(1)(im)1. 1. Is operated only after an operator has first analyzed and recognized an individual's cardiac rhythm;
146.50(1)(im)2. 2. Charges and delivers, only at the command of the operator, an electrical impulse to an individual's heart; and
146.50(1)(im)3. 3. In the case of a defibrillator that may be operated as a manual defibrillator or as an automated external defibrillator, is set to operate as a manual defibrillator.
146.50(1)(j) (j) "Medical director" means a physician who trains, medically coordinates, directs, supervises, establishes standard operating procedures for, and designates physicians for direction and supervision of, emergency medical technicians and who reviews the performance of emergency medical technicians and ambulance service providers.
146.50(1)(k) (k) "Nonprofit corporation" means a nonstock corporation organized under ch. 181 that is a nonprofit corporation, as defined in s. 181.0103 (17).
146.50(1)(L) (L) "Person" includes an individual, firm, partnership, association, corporation, trust, foundation, company, public agency or a group of individuals, however named, concerned with the operation of an ambulance.
146.50(1)(m) (m) "Physician" has the meaning specified in s. 448.01 (5).
146.50(1)(n) (n) "Public agency" means this state, a county, city, village or town; an agency of this state or of a county, city, village or town; or an Indian tribe.
146.50(1)(p) (p) "Ventricular fibrillation" means a disturbance in the normal rhythm of the heart that is characterized by rapid, irregular and ineffective twitching of the ventricles of the heart.
146.50(2) (2)License or certificate required. No person may act as or advertise for the provision of services as an ambulance service provider unless the person holds an ambulance service provider license issued under this section. No individual may act as or advertise for the provision of services as an emergency medical technician unless he or she holds an emergency medical technician license or training permit issued under sub. (5). No individual may act as or advertise for the provision of services as a first responder unless he or she holds a first responder certificate issued under sub. (8).
146.50(3) (3)Exception to treatment. This section and the rules promulgated under this section may not be construed to authorize the provision of services or treatment to any individual who objects for reasons of religion to the treatment or services, but may be construed to authorize the transportation of such an individual to a facility of the individual's choice within the jurisdiction of the emergency medical service.
146.50(4) (4)Ambulance staffing; limitations; rules.
146.50(4)(a)(a) If a sick, disabled or injured individual is transported by ambulance, the following other individuals shall be present in the ambulance:
146.50(4)(a)1. 1. Any 2 emergency medical technicians, licensed registered nurses, licensed physician assistants or physicians, or any combination thereof; or
146.50(4)(a)2. 2. One emergency medical technician plus one individual with a training permit issued under sub. (5) (b).
146.50(4)(b) (b) An ambulance driver who is not an emergency medical technician may assist with the handling and movement of a sick, injured or disabled individual if an emergency medical technician, registered nurse, physician assistant or physician directly supervises the driver. No ambulance driver may administer care procedures that an emergency medical technician is authorized to administer unless he or she is an emergency medical technician.
146.50(4)(c) (c) Notwithstanding par. (a), the department may promulgate rules that establish standards for staffing of ambulances in which the primary services provided are those which an emergency medical technician - intermediate is authorized to provide or those which an emergency medical technician - paramedic is authorized to provide.
146.50(5) (5)Licensing of ambulance service providers and emergency medical technicians; training permits.
146.50(5)(a)(a) Except as provided in ss. 146.51 and 146.52, the department shall license qualified applicants as ambulance service providers or emergency medical technicians. The department shall, from the information on the certification form specified under sub. (6) (c) 2., establish in each ambulance service provider's biennial license the primary service or contract area of the ambulance service provider.
146.50(5)(b) (b) The department shall promulgate rules establishing a system and qualifications for issuance of training permits, except as provided in ss. 146.51 and 146.52, and specifying the period for which an individual may hold a training permit.
146.50(5)(c) (c) A training permit application shall be signed by an ambulance service provider.
146.50(5)(d) (d) An individual who holds a training permit issued under par. (b) may do the following:
146.50(5)(d)1. 1. If issued an emergency medical technician – basic training permit, he or she may perform the actions authorized under rules promulgated by the department for an emergency medical technician - basic, but only if an emergency medical technician directly supervises him or her.
146.50(5)(d)2. 2. If issued an emergency medical technician – intermediate training permit, he or she may perform the actions authorized under rules promulgated by the department for an emergency medical technician - intermediate, but only if a medical director or training instructor is present and giving direction.
146.50(5)(d)3. 3. If issued an emergency medical technician - paramedic training permit, he or she may perform the actions authorized under rules promulgated by the department for an emergency medical technician - paramedic, but only if a medical director or training instructor is present and giving direction.
146.50(5)(e) (e) A license or training permit issued under this subsection is nontransferable and is valid for the balance of the license or training permit period or until surrendered for cancellation or suspended or revoked for violation of this section or of any other statutes or rules relating to ambulance service providers or emergency medical technicians.
146.50(5)(f) (f) The department may charge a reasonable fee for a license or training permit issued under this subsection, except that no fee may be charged to an individual who is an employee of a public agency and who works for volunteer or paid-on-call ambulance service providers and who is an applicant for a license as an emergency medical technician - basic or for a training permit.
146.50(5)(g) (g) Except as provided in ss. 146.51 and 146.52, an emergency medical technician license shall be issued to the individual licensed, and the department may not impose a requirement that an individual be affiliated with an ambulance service provider in order to receive an emergency medical technician license or to have an emergency medical technician license renewed.
146.50(6) (6)Qualifications for licensure.
146.50(6)(a)(a) Except as provided in ss. 146.51 and 146.52, to be eligible for an initial license as an emergency medical technician, an individual shall:
146.50(6)(a)1. 1. Be 18 years of age or older; be capable of performing the actions authorized in rules promulgated under sub. (13) (c) for an emergency medical technician – basic, an emergency medical technician - intermediate or an emergency medical technician – paramedic, for which licensure is sought; and, subject to ss. 111.321, 111.322 and 111.335, not have an arrest or conviction record.
146.50(6)(a)2. 2. Have satisfactorily completed a course of instruction and training, including training for response to acts of terrorism, prescribed by the department or have presented evidence satisfactory to the department of sufficient education and training in the field of emergency care.
146.50(6)(a)3. 3. Have passed an examination approved by the department.
146.50(6)(a)4. 4. Have such additional qualifications as may be required by the department.
146.50(6)(b)1.1. Except as provided in ss. 146.51 and 146.52, to be eligible for a renewal of a license as an emergency medical technician, the licensee shall, in addition to meeting the requirements of par. (a) 1., complete the training, education or examination requirements specified in rules promulgated under subd. 2.
146.50(6)(b)2. 2. The department, in conjunction with the technical college system board, shall promulgate rules specifying training, education, or examination requirements, including requirements for training for response to acts of terrorism, for license renewals for emergency medical technicians.
146.50(6)(c) (c) Except as provided in ss. 146.51 and 146.52, to be eligible for a license as an ambulance service provider, an individual shall be 18 years of age or older and have such additional qualifications as may be established in rules promulgated by the department, except that no ambulance service provider may be required to take training or an examination or receive education to qualify for licensure or for renewal of licensure. An ambulance service provider shall, as a condition of licensure, provide medical malpractice insurance sufficient to protect all emergency medical technicians who perform for compensation as employees of the ambulance service provider. For renewal of a biennial license as an ambulance service provider, an applicant shall also provide all of the following:
146.50(6)(c)1. 1. A financial report, on a form developed and provided by the department, of all expenditures made in the 2 previous fiscal years from all funds provided to the ambulance service provider under s. 146.55 (4).
146.50(6)(c)2. 2. Certification, on a form developed and provided by the department, signed by a representative of the ambulance service provider and the clerk of each county, city, town or village served by the ambulance service provider, of the population and boundaries of the ambulance service provider's primary service or contract area in that county, city, town or village.
146.50(6g) (6g)Certification for performance of defibrillation.
146.50(6g)(a)(a) Except as provided in ss. 146.51 and 146.52, the department shall certify qualified applicants for the performance of defibrillation, under certification standards that the department shall promulgate as rules.
146.50(6g)(b) (b) A certificate issued under this subsection shall specify whether the holder of the certificate is authorized to perform defibrillation by use of any of the following:
146.50(6g)(b)2m. 2m. An automated external defibrillator.
146.50(6g)(b)3. 3. A manual defibrillator.
146.50(6n) (6n)Authorized actions of emergency medical technicians. An emergency medical technician may undertake only those actions that are authorized in rules promulgated under sub. (13) (c).
146.50(7) (7)Licensing in other jurisdictions. Except as provided in ss. 146.51 and 146.52, the department may issue a license as an emergency medical technician, without examination, to any individual who holds a current license or certificate as an emergency medical technician from another jurisdiction if the department finds that the standards for licensing or issuing certificates in the other jurisdiction are at least substantially equivalent to those in this state, and that the applicant is otherwise qualified.
146.50(8) (8)Certification of first responders.
146.50(8)(a)(a) Except as provided in ss. 146.51 and 146.52, the department shall certify qualified applicants as first responders.
146.50(8)(b) (b) To be eligible for initial certification as a first responder, except as provided in ss. 146.51 and 146.52, an individual shall meet all of the following requirements:
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