DHS 110.44 DHS 110.44Special events. A licensed ambulance service provider or non-transporting EMT service shall obtain department approval before providing emergency medical services for special events outside its primary service area or that will require the provider to exceed its normal staffing and equipment levels within its primary service area. Events that occur on a regular basis may be included in the service operational plan and an update submitted in lieu of a complete plan. To obtain department approval, the ambulance service provider shall submit all of the following to the department not less than 14 business days before the event:
DHS 110.44(1) (1)Name of the ambulance service provider or non-transporting EMT service requesting approval.
DHS 110.44(2) (2)Contact information for the event manager, including how to contact the ambulance service provider during the event.
DHS 110.44(3) (3)Locations, dates, and times of the event.
DHS 110.44(4) (4)Name, address, phone numbers, and e-mail addresses for each service medical director who will oversee the medical services at the event.
DHS 110.44(5) (5)Name and contact information for the medical control facility.
DHS 110.44(6) (6)The types of EMS services that will be provided.
DHS 110.44(7) (7)The level of EMS service that will be provided.
DHS 110.44(8) (8)The ambulance staffing configurations and types.
DHS 110.44(9) (9)Whether the service will be “dedicated services" or “as available" based on resources.
DHS 110.44(10) (10)Description of on-site communications between the event manager, event staff, dispatch, and 9-1-1 dispatch.
DHS 110.44(11) (11)Explanation of how medical control will be contacted for on-site medical direction at the patient location.
DHS 110.44(12) (12)Any special patient care protocols for use at the event.
DHS 110.44(13) (13)Explanation of how EMS personnel will be notified and requested during the event.
DHS 110.44(14) (14)Explanation of how the ambulance service provider will integrate with the 9-1-1 system.
DHS 110.44(15) (15)Explanation of how a 9-1-1 request that is generated within the event by a participant or spectator will be handled.
DHS 110.44(16) (16)Identification of the service provider that will respond to a 9-1-1 call initiated from within the event.
DHS 110.44(17) (17)Documentation that the ambulance service provider for the primary service area in which the event is located has approved the ambulance service provider who is outside its service area to provide event coverage within its primary service area.
DHS 110.44(18) (18)Written assurance that adequate resources will be available.
DHS 110.44(19) (19)Written acknowledgement that the ambulance service provider requesting special event approval assumes all liability for ambulance coverage and response during the event.
DHS 110.44(20) (20)Copies of any agreement or contract for providing emergency medical services for the event.
DHS 110.44 Note Note: When submitting copies of the contracts or agreements the service may redact any compensation information.
DHS 110.44(21) (21)Other information as determined by the department
DHS 110.44 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.45 DHS 110.45Department decisions on applications.
DHS 110.45(1)(1)Except as provided in sub. (2), 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 110.45(2) (2)The department shall either approve the application and issue a license or deny the application within 90 business days after receiving a complete application for an emergency medical service provider license that requires department review of algorithm protocols, including an application for a change or update of any algorithm protocol. If the application for a license or algorithm protocol approval is denied, the department shall give the applicant reasons, in writing, for the denial and shall inform the applicant of the right to appeal that decision.
DHS 110.45(3) (3)The department's failure to deny an application within the time period established under sub. (1) or (2) does not constitute department approval of the license application. An applicant may not provide emergency medical services until the department has issued the applicant a license.
DHS 110.45 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.46 DHS 110.46License duration. A license issued by the department to an emergency medical service provider is valid as long as the provider remains in continuous compliance with EMS-related federal and state statutes, this chapter, and the operational plan approved by the department, or until the provider notifies the department in writing that it intends to cease providing emergency medical services or the department suspends or revokes the license.
DHS 110.46 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.47 DHS 110.47Required personnel and responsibilities. An emergency medical service provider shall have all of the following personnel:
DHS 110.47(1) (1)A service director qualified under s. DHS 110.48.
DHS 110.47(2) (2)A service medical director qualified under s. DHS 110.49.
DHS 110.47(3) (3)An infection control designee who is responsible for maintaining the infection control program and meeting Occupational Safety and Health Administration standards for blood borne pathogens and safety.
DHS 110.47(4) (4)A quality assurance designee who is responsible for managing patient-based quality improvement processes in collaboration with the service medical director.
DHS 110.47(5) (5)A training designee who is responsible for assisting the service medical director in assuring continued competency and facilitating the continuing education of the provider's EMS personnel.
DHS 110.47(6) (6)A data contact designee who is responsible for assuring that patient care report data is submitted to the department as required in this chapter.
DHS 110.47(7) (7)EMS professionals sufficient to meet the staffing requirements under s. DHS 110.50.
DHS 110.47 Note Note: These personnel do not have to be separate people. One person may hold several of these positions.
DHS 110.47 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.48 DHS 110.48Service director. An emergency medical service provider shall have a service director who shall:
DHS 110.48(1) (1)Serve as the primary contact between the emergency medical service provider and the department.
DHS 110.48(2) (2)Assure that all elements of the operational plan are kept current.
DHS 110.48(3) (3)Assure that EMS personnel are properly licensed and credentialed.
DHS 110.48(4) (4)Provide day-to-day supervision of the ambulance service provider's operations.
DHS 110.48 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.49 DHS 110.49Service medical director. An emergency medical service provider shall have a service medical director who meets all of the qualifications under sub. (1) and has all the responsibilities under sub. (2):
DHS 110.49(1) (1)Qualifications. The service medical director shall meet all the following within 180 days from the date of his or her appointment:
DHS 110.49(1)(a) (a) Licensure as a physician.
DHS 110.49(1)(b) (b) Current certification in CPR for health care professionals and, if the medical director provides medical direction for an EMT-intermediate or EMT-paramedic emergency medical services provider, current certification in ACLS, unless the physician is certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine.
DHS 110.49(1)(c) (c) Education, training and experience in emergency medicine.
DHS 110.49(1)(d) (d) Familiarity with the design and operation of pre-hospital EMS systems.
DHS 110.49(1)(e) (e) Experience or training in the EMS quality improvement process.
DHS 110.49(1)(f) (f) Successful completion of the department's service medical director course.
DHS 110.49(1)(g) (g) Any additional requirements prescribed by the department.
DHS 110.49(2) (2)Responsibilities. The service medical director shall do all of the following:
DHS 110.49(2)(a) (a) Prescribe patient care protocols under which the provider's EMS personnel treat.
DHS 110.49(2)(b) (b) Develop, review and approve in writing all patient care protocols that will be used by EMS personnel delivering patient care under the operational plan.
DHS 110.49(2)(c) (c) Ensure that physicians providing on-line medical control do so in a manner consistent with the department approved patient care protocols.
DHS 110.49(2)(d) (d) Ensure that all aspects of the emergency medical services are under medical supervision and direction at all times.
DHS 110.49(2)(e) (e) Establish, participate in, and ensure the continuing implementation of a quality assurance program as part of a patient care improvement process.
DHS 110.49(2)(f) (f) Approve, limit or withdraw credentials as provided under s. DHS 110.52.
DHS 110.49(2)(g) (g) Maintain liaison with the medical community, including hospitals, emergency departments, urgent care clinics, physicians, nurses, and other healthcare providers.
DHS 110.49(2)(h) (h) Work with regional, state and local EMS authorities to ensure that standards, needs and requirements are met and resource utilization is optimized.
DHS 110.49(2)(i) (i) Maintain, through continuing education, current knowledge and skills appropriate for a service medical director.
DHS 110.49(2)(j) (j) Approve, direct, and assist in providing training activities that assure EMS personnel are competent to provide safe and efficient patient care, based on the department approved patient care protocols.
DHS 110.49 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.50 DHS 110.50EMS provider staffing requirements.
DHS 110.50(1)(1)An emergency medical service provider shall satisfy the staffing requirements appropriate to the level of service for which it is licensed. Except as provided in sub. (2) or (3), an emergency medical service provider shall comply with the following requirements that are applicable to the provider's level of service:
DHS 110.50(1)(a) (a) EMT-basic ambulance. An EMT-basic ambulance shall be staffed with at least two individuals who are licensed at the EMT-basic level or one licensed EMT-basic and one with an EMT-basic training permit. When staffed with a person that holds an EMT-basic training permit the licensed EMT-basic must be in the patient compartment during transport.
DHS 110.50(1)(b) (b) EMT-intermediate technician ambulance. An EMT- intermediate technician ambulance shall be staffed with at least two individuals. One individual shall be licensed at the EMT-intermediate technician level and one individual licensed at or above the EMT-basic level. If a patient requires EMT-intermediate technicians skills, medications or equipment, the EMT-intermediate technicians shall remain with the patient at all times during care and transport of the patient.
DHS 110.50(1)(c) (c) EMT-intermediate ambulance. An EMT- intermediate ambulance shall be staffed with at least two individuals. One individual shall be licensed at the EMT-intermediate level and one individual licensed at or above the EMT-basic level. If a patient requires EMT-intermediate skills, medications or equipment, the EMT-intermediate shall remain with the patient at all times during care and transport of the patient.
DHS 110.50(1)(d) (d) Paramedic ambulance.
DHS 110.50(1)(d)1.1. For an ambulance service provider licensed before January 1, 2000, the ambulance shall be staffed with two EMT-paramedics.
DHS 110.50(1)(d)2. 2. Except as provided in subd. 3., for an ambulance service provider licensed after January 1, 2000, the ambulance shall be staffed with at least one EMT-paramedic and one EMT at any level. If a patient requires patient care at the paramedic level, the paramedic shall remain with the patient at all times during care and transport of the patient.
DHS 110.50(1)(d)3. 3. For an ambulance service provider licensed at the paramedic level in the same primary service area in which paramedic service was or is provided by two EMT-paramedics, the ambulance shall be staffed with two EMT-paramedics.
DHS 110.50(1)(d)4. 4. A provider that uses a two paramedic system, in which paramedics respond separately from different locations, shall dispatch both EMT-paramedics immediately and simultaneously for all emergency response requests. A single paramedic performing in this staffing configuration may perform all the skills allowed in the scope of practice of the EMT-paramedic prior to the arrival of a second paramedic, as long as the arrival of the second paramedic is expected within a reasonable and prudent time based on the patient's condition. If only one EMT-paramedic responds, care shall be provided within the next lower level scope of practice, and transport of the patient requires one EMT-paramedic and one additional EMT at any level. If 2 EMT-paramedics respond, after the patient has been assessed and stabilized, one EMT-paramedic may be released by patient care protocol or verbal order from a medical control physician. An ambulance service provider that responds with EMT-paramedics from two different locations, or that releases one EMT paramedic after assessment, shall identify in its operational plan what time frame is considered to be a timely response based on its resources and primary service area logistics.
DHS 110.50(1)(e) (e) Critical care ambulance. A critical care level interfacility transport shall be staffed with at least one individual licensed and credentialed at the critical care paramedic level and one individual licensed and credentialed at any EMT level. If a patient requires critical care paramedic skills or medications, the critical care paramedic shall remain with the patient at all times during care and transport of the patient.
DHS 110.50(1)(f) (f) Non-transporting EMT. A non-transporting EMT service provider shall staff the same as an ambulance service provider with the exception of the requirements relating to transporting of the patient.
DHS 110.50(1)(g) (g) First responder. When a first responder service provider responds to a request for service at least one certified first responder shall respond.
DHS 110.50(1)(h) (h) Interfacility transfers. Staffing for interfacility transfers shall be based on the needs of the patient as identified by the sending physician. A service may staff to any of the configurations in this subsection but may not exceed the level at which the service is licensed.
DHS 110.50(2) (2)A physician, physician assistant or a registered nurse may take the place of any EMT at any service level provided he or she is trained and competent in all skills, medications and equipment used by that level of EMT in the pre-hospital setting and provided he or she is approved by the service medical director. A physician assistant or registered nurse may not practice at a higher level of care than the level at which the service is licensed.
DHS 110.50 Note Note: To assist the service medical director in assuring competency, there are registered nurse to EMT-basic and registered nurse to paramedic transition courses available through the certified training centers. A physician, physician assistant, or registered who is not licensed as an EMS professional is operating under his or her physician, nurse or physician assistant license. Any conduct subject to enforcement action under subch. V while operating as an EMS professional will be reported to the appropriate governing board and may affect the individual's physician, nurse or physician assistant license.
DHS 110.50(3) (3)An ambulance service provider may only deviate from the ambulance staffing requirements under sub. (1) if all 9-1-1 response ambulances are busy and the service has an approved reserve ambulance vehicle and one of the following conditions apply:
DHS 110.50(3)(a) (a) An ambulance service provider may staff and operate reserve ambulances at a lower service level appropriate to the licensure level of the available staff if it obtains approval from the department. The reserve or back-up ambulance shall be stocked and equipped appropriately for the level of service provided. The ambulance service provider shall request approval through submission of an operational plan amendment.
DHS 110.50(3)(b) (b) In a two paramedic system, if only one paramedic is available, the ambulance shall operate at the next lower EMT level.
DHS 110.50 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.51 DHS 110.51Preceptors.
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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.