DHS 110.32(3) (3)A person licensed as a non-transporting EMT service provider may provide emergency medical services before hospitalization and the arrival of an ambulance at the EMT-basic, EMT-intermediate technician, EMT-intermediate, or EMT-paramedic level of care, but may not transport patients.
DHS 110.32(4) (4)A person may be licensed as an ambulance service provider to provide 9-1-1 emergency response, interfacility transport or both, and at one of the following levels of care: EMT basic, EMT-intermediate technician, EMT-intermediate, or EMT-paramedic. An ambulance service provider licensed to provide both a 9-1-1 emergency response and interfacility transports shall be licensed at the same level of care for both services.
DHS 110.32 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.33 DHS 110.33Authorized services.
DHS 110.33(1)(1)An emergency medical services provider may advertise and provide only those services for which it has been licensed by the department.
DHS 110.33(2) (2)An emergency medical services provider may advertise and provide only those services that are within the Wisconsin scope of practice for the level at which the provider is licensed.
DHS 110.33(3) (3)An emergency medical services provider may advertise and provide only those services that are described in its department-approved operational plan. The provider shall keep the operational plan and any addendums current. Any changes to the operational plan, including addendums, shall be submitted to the department for approval not less than 60 days before the intended implementation date and may not be implemented until the service receives department approval.
DHS 110.33 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.34 DHS 110.34Responsibilities. An emergency medical service provider shall do all of the following:
DHS 110.34(1) (1)Comply with the requirements of this chapter and ch. 256, Stats.
DHS 110.34(2) (2)Advertise and provide only those services it is authorized to provide under this subchapter.
DHS 110.34(3) (3)Designate a hospital that will provide day-to-day medical control.
DHS 110.34(4) (4)Designate the primary service area in which it will operate.
DHS 110.34(5) (5)Assure response to 9-1-1 emergency response requests 24 hours-a-day, 7 days-a-week, unless it is not licensed to do so. First responder services are exempt from this requirement but should assure every effort is made to respond to 9-1-1 requests.
DHS 110.34(6) (6)Meet the staffing requirements identified in s. 256.15 (4), Stats., and s. DHS 110.50.
DHS 110.34(7) (7)If the emergency medical services provider is an ambulance service provider, submit a written report to the receiving hospital upon delivering a patient and a complete patient care report within 24 hours of patient delivery. A written report may be a complete patient care report or other documentation approved by the department and accepted by the receiving hospital. A non-transporting EMT service provider or first responder service provider shall hand a written report to the ambulance service provider at the time of the patient care transfer.
DHS 110.34(8) (8)If the emergency medical service provider is an ambulance service provider or non-transporting EMT service provider, submit patient care report data electronically to the department through WARDS using direct web-based input to WARDS or uploading patient care report data to WARDS within 7 days of the patient transport. If the emergency medical service provider is a first responder service provider, submit a patient care report to WARDS only if advanced skills are used in caring for the patient.
DHS 110.34 Note Note: An abbreviated first responder report is available in WARDS to eliminate duplicate entry and facilitate quick entry of this information. The WARDS system can be accessed via the internet at www.emswards.org.
DHS 110.34(9) (9)Comply with the data system guidelines published by the department.
DHS 110.34(10) (10)Maintain written mutual aid and coverage agreements with ambulance service providers operating within or adjacent to its primary service area.
DHS 110.34(11) (11)Designate and maintain affiliation with a regional trauma advisory council.
DHS 110.34(12) (12)Maintain a communication system that allows communication between medical control and EMS personnel and complies with the Wisconsin Emergency Medical Services Communications Plan.
DHS 110.34(13) (13)Designate and maintain affiliation with a training center to provide required training.
DHS 110.34(14) (14)Maintain a quality assurance program that provides continuing education and assures continuing competency of EMS personnel.
DHS 110.34(15) (15)If the emergency medical services provider is an ambulance service provider, maintain at least one ambulance vehicle in good operating condition as required under ch. Trans 309.
DHS 110.34(16) (16)Refuse to respond to an interfacility transport request by a hospital for an emergency transfer that is dispatched through a 9-1-1 center, if not licensed to provide interfacility transports.
DHS 110.34 Note Note: Data system guidelines can be found on the department's website at www.dhs.wisconsin.gov/ems.
DHS 110.34 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.35 DHS 110.35License and application requirements. To apply for a license as an ambulance service provider, a non-transporting EMT service provider, or a first responder service provider, a person shall do all of the following:
DHS 110.35(1) (1)Feasibility study. Complete a feasibility study and submit it to the department for approval. First responder service providers are not required to do a feasibility study.
DHS 110.35(2) (2)Application and operational plan. Upon the department's approval of the feasibility study required under sub. (1), complete and submit an application and an operational plan to the department in the manner specified by the department. The operational plan and its addendums shall include all of the following:
DHS 110.35(2)(a) (a) Signed patient care protocols approved by the service medical director.
DHS 110.35(2)(b) (b) A formulary list of medications the emergency medical service provider will use.
DHS 110.35(2)(c) (c) A list of the advanced skills and procedures the applicant intends to use to provide services within the Wisconsin scope of practice of the level of care for which licensure is sought.
DHS 110.35(2)(d) (d) Proof of professional liability or medical malpractice insurance, and, if the emergency medical service provider is an ambulance service provider, proof of vehicle insurance.
DHS 110.35(2)(e) (e) Operational policies for all of the following:
DHS 110.35(2)(e)1. 1. Response cancellation, describing how the emergency medical service provider will handle a cancellation of a response while en route to the scene.
DHS 110.35(2)(e)2. 2. Use of lights and sirens in responding to a call.
DHS 110.35(2)(e)3. 3. Dispatch and response, describing how EMS personnel are dispatched and how the emergency medical service provider acknowledges to the dispatcher that it is responding.
DHS 110.35(2)(e)4. 4. Refusal of care, describing the procedure for accepting a refusal of care from a patient.
DHS 110.35(2)(e)5. 5. Destination determination, describing how the transport destination of the patient is determined if the provider is an ambulance service provider.
DHS 110.35(2)(e)6. 6. Emergency vehicle operation and driver safety training.
DHS 110.35(2)(f) (f) Written letters or other documentation of endorsement from the local hospital and government within the proposed primary service area, if the application is for licensure as a 9-1-1 ambulance service provider or non-transporting EMT service provider, whether the application is for initial licensure or a service level upgrade.
DHS 110.35(3) (3)Department decisions on application.
DHS 110.35(3)(a)(a) Complete application. The department shall review and make a determination on an application that has been completed in accordance with all of the department's instructions for completion within 60 business days of receiving the application. If the department approves the application, the department will notify the applicant and issue a license. If the department denies the application, the department will notify the applicant of the reason for the denial and any appeal rights.
DHS 110.35(3)(b) (b) Incomplete application. When an incomplete application is received, the department will notify the applicant of any deficiencies within 60 business days. If the applicant fails to respond to the notice and fails to complete the application within 6 months from the date of initial submission to the department, the application is void. The department will not take any further action on the incomplete application. To be considered further by the department, the applicant shall meet the eligibility requirements and submit a new application as required under this subchapter.
DHS 110.35 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.36 DHS 110.36Phase-in period; service level upgrades and downgrades.
DHS 110.36(1)(1)A licensed ambulance service provider applying for licensure at a higher service level that can demonstrate hardship in attaining the higher level may request department approval of a phase-in period not to exceed 12 months. During a phase-in period, an ambulance service provider that is upgrading to a higher service level may provide emergency medical care at both the higher service level and its current service level without assuring a consistent level of care at the higher level 24 hours a day.
DHS 110.36(2) (2)An applicant for department approval of a phase-in period to upgrade its service level shall submit a license application, operational plan and addendums for the higher service level as specified under s. DHS 110.35 and all of the following:
DHS 110.36(2)(a) (a) A detailed explanation of why the phase-in period is necessary, how the phase-in will be accomplished and the specific date, not to exceed 12 months from department approval, that full-time 24 hours-per day, 7 days-per-week service at the higher service level will be achieved.
DHS 110.36(2)(b) (b) An explanation of how quality assurance will be maintained and skill proficiency will be evaluated.
DHS 110.36(3) (3)If the department approves a request to provide emergency medical care at a higher service level during a phase-in period, the department shall issue a provisional license for the duration of the phase-in period.
DHS 110.36(4) (4)During the phase-in period, the applicant shall meet all of the requirements under s. 256.15, Stats., this chapter, and the approved operational plan, except the requirement to provide 24-hour-per-day, 7-day-per-week staffing coverage at the higher service level.
DHS 110.36(5) (5)An emergency medical service provider that does not achieve full-time 24 hours-per-day, 7 days-per-week service within the approved 12 month phase-in period shall notify the department, cease providing service at the upgraded level, and revert back to its previous service level, unless the department approves an extension under sub. (6).
DHS 110.36(6) (6)An emergency medical service provider that does not achieve full-time 24 hours per day, 7 days-per-week service within the 12 month phase-in may request one extension for an additional 12 months if the request is made in writing to the department no less than 60 business days before the expiration of the phase-in period. A phase-in period shall not exceed a total of 24 months.
DHS 110.36 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.37 DHS 110.37Service level downgrades.
DHS 110.37(1)(1)An ambulance service provider or non-transporting EMT service provider may downgrade the level of its service only after department approval. The ambulance service provider or non-transporting EMT service provider shall submit a complete operational plan under s. DHS 110.35 (2), provide documentation from each community it serves that a public meeting was held at which the downgrade was an agenda item, and submit to the department a letter of support or understanding from each community it serves.
DHS 110.37(2) (2)An ambulance service provider may reduce the number of available ambulances for 9-1-1 emergency responses from the number identified in its operational plan if the ambulance service provider documents a hardship other than financial in an operational plan amendment and receives department approval.
DHS 110.37 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.38 DHS 110.38Interfacility transports. In addition to the responsibilities under s. DHS 110.34, an ambulance service provider licensed to provide interfacility transports shall satisfy all of the following requirements:
DHS 110.38(1) (1)The ambulance service provider shall ensure that interfacility transports do not interfere with its responsibility to provide 9-1-1 emergency response in its primary service area, if it is also licensed as a 9-1-1 provider.
DHS 110.38(2) (2)The ambulance service provider shall assure proper staffing for interfacility transports based on the acuity of the patient, the orders of the sending physician and the staffing requirements in s. DHS 110.50.
DHS 110.38(3) (3)The ambulance service provider shall not use mutual aid agreements to cover its primary service area while providing interfacility transports.
DHS 110.38(4) (4)If the ambulance service provider is licensed as both a 9-1-1 provider and interfacility provider, the provider shall have a minimum of one ambulance for 9-1-1 emergency response and one ambulance for interfacility transports, unless the ambulance service provider has a coverage agreement with a neighboring ambulance service provider that will be able to provide one 9-1-1 ambulance for each primary service area.
DHS 110.38 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.39 DHS 110.39Critical care and specialty care transports. In addition to the responsibilities under s. DHS 110.34, an ambulance service provider that provides critical care and specialty care transport services shall satisfy all of the following requirements:
DHS 110.39(1) (1)The ambulance service provider shall be licensed at the EMT-paramedic level.
DHS 110.39(2) (2)The ambulance service provider shall designate the specialty services it offers.
DHS 110.39(3) (3)The ambulance service provider shall identify a schedule for the availability of specialty care services, if it does not provide 24 hour-a-day, 7 day-a-week coverage.
DHS 110.39(4) (4)The ambulance service provider shall implement and maintain patient care protocols to be used by critical care paramedics, which follow the Wisconsin scope of practice for the critical care paramedic.
DHS 110.39(5) (5)The ambulance service provider shall staff an ambulance appropriately for the acuity of the patient as designated by the sending physician and in conformity to the staffing requirements in s. DHS 110.50.
DHS 110.39(6) (6)The ambulance service provider shall specifically identify the EMS personnel that are credentialed or part of the interfacility transport program.
DHS 110.39(7) (7)The ambulance service provider shall meet other requirements the department specifies.
DHS 110.39 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.40 DHS 110.40Intercept service. In addition to the responsibilities under s. DHS 110.34, an ambulance service provider or non-transporting EMT service that provides intercept services is subject to all of the following requirements:
DHS 110.40(1) (1)The emergency medical service provider shall be licensed as a 9-1-1 emergency medical service provider.
DHS 110.40(2) (2)The emergency medical service provider intercept services shall not interfere with its responsibility to provide 9-1-1 emergency response within its primary service area.
DHS 110.40(3) (3)If providing intercept services in a 2 paramedic system, the ambulance service provider shall use 2 paramedics during transports, and, if 2 paramedics are not available, it shall operate at the next lower level of service.
DHS 110.40(4) (4)The intercept service shall identify a schedule for availability of intercept services, if the service does not provide 24 hour-a-day, 7 day-a-week coverage.
DHS 110.40 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.41 DHS 110.41Air medical services.
DHS 110.41(1)(1)In order to provide air medical service in Wisconsin, an ambulance service provider, including an ambulance service provider licensed in another state that makes more than 4 patient transports a year that originate and terminate in Wisconsin, shall be licensed under s. DHS 110.35, to provide air medical services and shall be nationally accredited for air medical transports by an entity approved by the department as follows:
DHS 110.41(1)(a) (a) An ambulance service provider that was licensed by the department as an air medical service provider before July 1, 2010 shall obtain national accreditation for air medical transports by an entity approved by the department no later than July 1, 2015.
DHS 110.41(1)(b) (b) Effective July 1, 2010, only ambulance service providers licensed at the paramedic level may be licensed as air medical services providers.
DHS 110.41(2) (2)An ambulance service provider licensed at the paramedic level and endorsed to provide air medical services that responds to 9-1-1 emergency response calls in its primary service area, shall provide 24-hour-a-day, 7days-a-week air medical service, except when limited in particular circumstances by safety or mechanical considerations.
DHS 110.41(3) (3)When an ambulance service provider receives a request for air medical services transport, the ambulance service provider shall notify the requesting agency of the estimated time of arrival at the scene of a medical emergency or the medical facility for an interfacility transport, and it shall immediately communicate any changes in estimated time of arrival to the requesting agency.
DHS 110.41 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
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Published under s. 35.93, Stats. Updated on the first day of each month. Entire code is always current. The Register date on each page is the date the chapter was last published.