An approved operational plan is the legal description under which an EMS provider operates. EMT-Intermediate and EMT-Paramedic ambulance service providers have long been required to develop and submit an operational plan for license approval. Changes to Chapter DHS 110, Wisconsin Administrative Code mandate that all ambulance service and first responder providers in Wisconsin are required to develop and submit an operational plan to the Department of Health Services (DHS). The requirements for the operational plan can be found in Chapters DHS 110 Wisconsin Administrative Code.
Before operating an EMS service, a county, city, town, village, prospective or licensed EMS service provider, hospital or any combination of these must first submit an operational plan for DHS review and approval. The approval of this plan is a prerequisite to initiation of EMS service in Wisconsin. Any changes to the plan must also be submitted to the EMS Section and approved in writing and existing plans must be reviewed at least once every two years.
To assist the ambulance providers in Wisconsin to meet the plan requirements, an operational plan template has been developed. The template includes all plan components required by administrative code. The plan (effective 2/2006) consists of two parts. The first part, form F-47463, is a multi-page document that provides a sort of inventory of the ambulance service. The form includes instructions for completion and submission to the Wisconsin EMS Section.
The second part is a listing of required plan components. While some operational plan components are standard, some vary with the level of service being provided. Specific operational plan components for each level are listed as parts A, B, C, D and E of the application form. Complete the operational plan form and continue with your plan by identifying the level of care your service will offer and responding to the plan components identified for that level. Both the form F-47463 and your responses to the operational plan component outline for your level of service are required as part of the EMS Service Operational Plan.
Get the forms:
- EMS Provider Operational Plan F- 47463 (Word-fillable, 76 KB) PLUS
- Part A for Medical First Responder service Operational Plan Components F-47463a (PDF, 19 KB)
- Part B for EMT-Basic level service Operational Plan Components F-47463b (PDF, 27 KB)
- Part C for EMT-Intermediate Technician level service Operational Plan Components F-47463c (PDF, 27 KB)
- Part D for EMT-Intermediate level service Operational Plan Components F-47463d (PDF, 27 KB)
- Part E for EMT-Paramedic level service Operational Plan Components F-47463e (PDF, 27 KB)
- Additional Resources
- EMS Mass Casualty Incident Response Plan Guide (PDF, 578 KB)
- RN, PA and MD Verification Form F-00614 (PDF, 60 KB)
- Wisconsin EMS Controlled Substance Management Guidance (PDF, 66 KB)
- EMS Provider Forms for adding the following Advanced Skills by each license level
- First Responder (EMR) F-00987c (Word-fillable, 35 KB)
- EMT-Basic F-00987 (Word-fillable, 35 KB)
- Intermediate Technician (AEMT) F-00987b (Word-fillable, 35 KB)
- Intermediate F-00987a (Word-fillable, 35 KB)
- Paramedic F-00987d (Word-fillable, 35 KB)
- Critical Care Paramedic F-00987e (Word-fillable, 35 KB)
Contact your appropriate program coordinator at the Office of Preparedness and Emergency Health Care (OPEHC) for further information.