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;
CR 20-028: am. (1), (2), (5), (7)
Register September 2021 No. 789, eff. 10-1-21.
DHS 110.48
DHS 110.48 Service 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 professionals are properly licensed and credentialed.
DHS 110.48(4)
(4) Provide day-to-day supervision of the ambulance service provider's operations.
DHS 110.49
DHS 110.49 Service 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)(b)
(b) Current certification in CPR for health care professionals and, if the medical director provides medical direction for an EMT-intermediate, Advanced Emergency Medical Technician or paramedic emergency medical services provider, current certification in ACLS and PALS unless the physician is certified by the American Board of Emergency Medicine or the American Osteopathic Board of 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 or equivalent as determined by the department for any service medical director who is not board certified as specified in par.
(b).
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 professionals treat.
DHS 110.49(2)(b)
(b) Develop, review and approve in writing all patient care protocols that will be used by EMS professionals 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)(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 professionals 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;
CR 20-028: am. (1) (b), (f), (2) (a), (b), (f), (j)
Register September 2021 No. 789, eff. 10-1-21.
DHS 110.495
DHS 110.495 Community emergency medical services medical director. A CEMS provider shall have a minimum of one medical director who meets all of the qualifications under sub.
(1) and has all the responsibilities under sub.
(2).
DHS 110.495(1)
(1) Qualifications. Except as provided by sub.
(3), a community emergency medical services medical director shall have all of the following:
DHS 110.495(1)(b)
(b) Familiarity or experience with emergency medical services and practitioners.
DHS 110.495(2)
(2) Responsibilities. The CEMS medical director or medical direction team shall:
DHS 110.495(2)(a)
(a) Develop, review and approve in writing all patient care protocols that will be used by community emergency medical services practitioners delivering patient care under the operational plan.
DHS 110.495(2)(b)
(b) Ensure that physicians providing online medical consultation do so in a manner consistent with department-approved patient care protocols and guidelines.
DHS 110.495(2)(c)
(c) Establish, participate in, and ensure a continual quality improvement program as part of a patient care improvement process specific to the community emergency medical services.
DHS 110.495(2)(e)
(e) Maintain liaison with the medical community, including hospitals, emergency departments, urgent care clinics, physicians, nurses, and other healthcare providers.
DHS 110.495(2)(f)
(f) Work with regional, state and local authorities to ensure that standards, needs and requirements are met.
DHS 110.495(2)(g)
(g) Maintain current knowledge and skills appropriate for a community emergency medical services medical director/team through continuing education.
DHS 110.495(2)(h)
(h) Approve, direct, and assist in providing training activities that assure community emergency medical services practitioners are competent to provide safe and efficient patient care, based on the department approved patient care protocols/guidelines.
DHS 110.495(3)
(3) Medical direction teams. A medical direction team may be used in lieu of a medical director so long as one member of the team meets the qualifications and responsibilities described under sub.
(1) and
(2). If the CEMS provider using a medical direction team is also licensed to provide other EMS education or patient services, a CEMS medical direction team shall include the EMS service medical director.
DHS 110.495 History
History: CR 20-028: cr.
Register September 2021 No. 789, eff. 10-1-21.
DHS 110.50
DHS 110.50 EMS 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. All individuals constituting the minimum staffing shall be credentialed with the emergency medical service provider under s.
DHS 110.53. 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 ambulance. An EMT ambulance shall be staffed with at least two individuals, credentialed with that emergency medical service provider under s.
DHS 110.53, who are licensed at the EMT level or one licensed EMT and one with an EMT training permit. When staffed with a person that holds an EMT training permit the licensed EMT must be in the patient compartment during transport.
DHS 110.50(1)(b)
(b)
AEMT ambulance. An AEMT ambulance shall be staffed with at least two individuals credentialed with that emergency medical service provider under s.
DHS 110.53. One individual shall be licensed at the AEMT level and one individual licensed at or above the EMT level. If a patient requires AEMT skills, medications or equipment, the AEMT 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 credentialed with that emergency medical service provider under s.
DHS 110.53. One individual shall be licensed at the EMT-intermediate level and one individual licensed at or above the EMT 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)1.1. For an ambulance service provider licensed before January 1, 2000, the ambulance shall be staffed with two paramedics credentialed with that emergency medical service provider under s.
DHS 110.53 except if any of the following apply:
DHS 110.50(1)(d)1.a.
a. The ambulance is responding in a municipality with a population of less than 10,000.
DHS 110.50(1)(d)1.c.
c. All regularly staffed two-paramedic ambulances are committed to emergency events. In that case, additional ambulances may be staffed with one paramedic and individual licensed at or above the EMT level.
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 two individuals credentialed with that emergency medical service provider under s.
DHS 110.53. One individual shall be licensed at the paramedic level and one individual licensed at or above the EMT 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 paramedics, the ambulance shall be staffed with two paramedics except if any of the following apply:
DHS 110.50(1)(d)3.a.
a. The ambulance is responding in a municipality with a population of less than 10,000.
DHS 110.50(1)(d)3.c.
c. All regularly staffed two-paramedic ambulances are committed to emergency events. In that case, additional ambulances may be staffed with one paramedic and individual licensed at or above the EMT level.
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 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 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 2 paramedics respond, after the patient has been assessed and stabilized, one paramedic may be released by patient care protocol or verbal order from a medical control physician. An ambulance service provider that responds with paramedics from two different locations, or that releases one 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 two individuals credentialed with that emergency medical service provider under s.
DHS 110.53. One individual shall be licensed and credentialed at the critical care paramedic level and one individual shall be licensed and credentialed as an emergency medical services practitioner at any 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 emergency medical service provider. A non-transporting emergency medical service provider shall respond to a request for service with at least one licensed emergency medical services practitioner at the level for which the service provider is licensed.
DHS 110.50(1)(g)
(g)
Emergency medical responder service provider. When an emergency medical responder service provider responds to a request for service at least one certified emergency medical 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 emergency medical responder or emergency medical services practitioner at any service level provided he or she is trained and competent in all skills, medications and equipment used by that level of emergency medical responder or emergency medical services practitioner 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 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(2m)
(2m) Subject to the population requirements identified in s.
256.15 (4) (e) and
(f), an ambulance service provider licensed at the EMT, AEMT, or EMT-intermediate level may staff an ambulance with one emergency medical service practitioner licensed at the level of the ambulance service provider and one certified emergency medical responder. The licensed emergency medical services practitioner shall remain with the patient at all times during care and transport of the patient.
DHS 110.50(3)
(3) Except as provided under subs.
(2) and
(2m), 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 the following condition applies:
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(4)
(4) An ambulance service provider may supplement its 9-1-1 response resources with ambulances staffed at a lower service level in addition to the ambulances staffed at its normal level of licensure under all of the following conditions:
DHS 110.50(4)(a)
(a) The ambulance service provider does not reduce the number of ambulances staffed at the level of its licensure available for 9-1-1 responses, except as permitted under s.
DHS 110.37 (2).
DHS 110.50(4)(b)
(b) The ambulance service provider maintains a minimum of one 9-1-1 response ambulance staffed at the level of its licensure 24 hours-a-day, 7 days-a-week.
DHS 110.50(4)(c)
(c) The ambulance service provider provides documentation to the department that the ambulance service provider is dispatched by a public safety answering point or dispatch center using an emergency medical dispatch system. Ambulances staffed at a lower level of service shall only be dispatched if one of the following applies:
DHS 110.50(4)(c)1.
1. The emergency response meets the standards identified within the public safety answering point's or dispatch center's emergency medical dispatch system for the lower service level.
DHS 110.50(4)(c)2.
2. All 9-1-1 ambulances staffed at the highest level of licensure are already committed to other 9-1-1 responses.
DHS 110.50(4)(d)
(d) The ambulance service provider has protocols approved by the service medical director and the department for when a patient's condition requires a response must be upgraded to a higher level of care.
DHS 110.50(4)(e)
(e) If an ambulance service provider is licensed as both a 9-1-1 provider and an inter-facility provider, the provider shall maintain a minimum of one ambulance available at the level of its licensure in its primary service area for 9-1-1 response while providing interfacility transports.
DHS 110.50(4)(f)
(f) The ambulance service provider obtains approval from the department. The ambulance service provider shall request approval through submission of an operational plan.
DHS 110.50 History
History: CR 10-085: cr.
Register December 2010 No. 660, eff. 1-1-11;
CR 20-028: am. (1) (intro.), (a) to (c), renum. (1) (d) 1. to (1) (d) 1. (intro.) and am., cr. (1) (d) 1. a. to c., am. (1) (d) 2., renum. (1) (d) 3. to (1) (d) 3. (intro.) and am., cr. (1) (d) 3. a. to c., am. (1) (d) 4., (e) to (g), (2), cr. (2m), am. (3) (intro.), r. (3) (b), cr. (4)
Register September 2021 No. 789, eff. 10-1-21; correction in (3) (intro.) made under s.
35.17, Stats.,
Register September 2021 No. 789.
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 emergency medical services practitioner 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 emergency medical services practitioner 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;
CR 20-028: am. (2) (a), (b)
Register September 2021 No. 789, eff. 10-1-21.
DHS 110.52
DHS 110.52 EMS professional credentialing.
