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.
DHS 110.51(1)(1)The service medical director shall designate those individuals who may serve as preceptors based on the director's determination that the individuals are qualified to act as preceptors for supervised field training. Only individuals who are designated by the service medical director may serve as preceptors for supervised field training. The service medical director shall withdraw an individual's designation if the director determines that the individual is no longer qualified or at the request of the department, the training center, or the individual.
DHS 110.51(2) (2)In order to serve as a preceptor for field training, an individual shall have all of the following qualifications:
DHS 110.51(2)(a) (a) The individual shall be licensed as an EMT at or above the skill level of the training provided and shall have the knowledge and experience in using the skills, equipment and medications that are required by the scope of practice for the certification or licensure for which training is provided. A physician, registered nurse or physician assistant with training and experience in the pre-hospital emergency care of patients is deemed trained to the paramedic level.
DHS 110.51(2)(b) (b) A preceptor shall have a minimum of two years pre-hospital patient care experience as a licensed, practicing EMT at or above the level of the training provided, or as a physician, registered nurse or physician assistant.
DHS 110.51(2)(c) (c) A preceptor shall oversee and mentor students during supervised field training and shall complete the records required to document the field training.
DHS 110.51(2)(d) (d) The ambulance service provider shall keep résumés and other documentation of the qualifications of those individuals designated as preceptors on file and shall make this documentation immediately available for review by the certified training center or the department.
DHS 110.51 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.
DHS 110.52 DHS 110.52EMS personnel credentialing.
DHS 110.52(1)(1)In order to provide emergency medical care above the first aid scope of practice level, a first responder or EMT must first be credentialed with an emergency medical service provider with which the first responder or EMT will provide emergency medical care.
DHS 110.52(2) (2)An individual is credentialed when the medical director of an emergency medical services provider authorizes the individual to perform specified emergency medical care while in the service of the provider. Authorization is made through a local credentialing agreement form which is submitted by the individual in the manner specified by the department.
DHS 110.52(3) (3)The service medical director shall authorize any skills, equipment, or medications that the individual may use in the service of the provider, other than those that are within the first aid scope of practice. The service medical director may only authorize EMS personnel to perform skills, use equipment and administer medications that are within the scope of practice of the individual's certificate or license and within the scope of practice of the emergency medical service provider's license.
DHS 110.52(4) (4)A certified first responder or licensed EMT may be credentialed by more than one emergency medical service provider.
DHS 110.52(5) (5)An individual's credential remains in effect until the individual's service with the emergency medical services provider ceases, the service medical director withdraws the credential, or the department suspends or revokes the individual's license.
DHS 110.52(6) (6)The service medical director may withdraw an individual's credential if the individual has engaged in conduct that is dangerous or is detrimental to the health or safety of a patient or members of the general public, while acting under the authority of his or her certificate or license, or if the service medical director determines that individual needs remedial training to properly treat patients. If an individual's credential is withdrawn for remedial training, the service medical director and service director shall develop a course of remedial training for the individual with a timeline for completion and return to full service.
DHS 110.52(7) (7)An emergency medical service provider shall notify the department promptly if its service medical director withdraws an individual's credential.
DHS 110.52(8) (8)The termination or withdrawal of an individual's credential does not by itself affect the individual's certificate or license.
DHS 110.52 Note Note: Local credentialing agreement forms may be obtained electronically through the department's E-Licensing system available at www.dhs.wisconsin.gov/ems. For further information or to request an assessment exam contact the Emergency Medical Services Section, 1 W. Wilson St., P.O. Box 2659, Madison, WI 53701-2659.
DHS 110.52 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.