EMS Provider Operational Plan

An operational plan is a requirement under Wis. Admin. Code ch. DHS 110 to operate an EMS Service in the State of Wisconsin. Initial plans and amendments to current plans can be submitted to the appropriate EMS regional coordinator (regional map) for review and approval.

The following forms and components are required:

Each service is required to submit and maintain the EMS Application and Operational Plan Form and Components

Additionally, the following components are required by service license level:

 

For questions on assistance on how to complete an operational plan, please contact your EMS Regional Coordinator

Wisconsin Admin. Code ch. DHS 110 Relating to EMS Service Requirements

DHS 110.32 Emergency medical service provider license required; license levels.

(1) No entity may act as or advertise for the provision of services as an emergency medical responder service, a non-transporting emergency medical service provider, or an ambulance service provider unless the entity is licensed by the department to do so, except under the following conditions:

(a) The entity is a certified emergency medical responder provider in another state that provides emergency medical care to 10 or fewer patients per year in this state under s. 256.15 (2) (b).
(b) The entity is a licensed ambulance service provider in another state that makes 10 or fewer patient transports per year that originate and terminate in this state under s. 256.15 (2) (b), Stats.
(c) The entity is an ambulance service provider or emergency medical responder provider that holds a valid certificate or license in another state and is acting in response from that state to a request for mutual aid under s. 256.15 (2) (c), Stats.
(d) The entity is a rural ambulance service provider that meets all of the requirements of s. 256.15 (4m).

(2) An entity licensed as an emergency medical responder service provider may provide emergency medical services at the emergency medical responder level of care before hospitalization and the arrival of an ambulance but may not transport patients.

(3) An entity licensed as a non-transporting emergency medical service provider may provide emergency medical services before hospitalization and the arrival of an ambulance at the EMT, AEMT, EMT-intermediate, paramedic level of care, but may not transport patients.

(3m) An entity may be licensed as a non-transporting emergency medical services service provider to provide 9-1-1 emergency response, intercept, tactical emergency medical services, community emergency medical services, or any combination thereof. A non-transporting emergency medical services provider licensed for multiple types of services shall be licensed at the same level for all services for which it is licensed.

(4) An entity may be licensed as an ambulance service provider to provide 9-1-1 emergency response, interfacility transport, intercept, tactical emergency medical services, community emergency medical services or any combination thereof, and at one of the following levels of care: EMT, AEMT, EMT-intermediate, or paramedic. An ambulance service provider licensed to provide multiple types of services shall be licensed at the same level of care for all services for which it is licensed.

(5) The department shall issue an emergency medical service provider a separate license for each type of service it is licensed to provide.

DHS 110.33 Authorized Services.

(1) An emergency medical services provider may advertise and provide only those services for which it has been licensed by the department, except a rural ambulance service provider that upgrades its ambulance service level may provide and advertise services consistent with s. 256.15 (4m) (b) to (d), Stats.

(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.

(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 110.34 Responsibilities

An emergency medical service provider shall do all of the following and document these activities through their operational plan submitted to the department:

(1) Comply with the requirements of this chapter and ch. 256, Stats.

(2) Advertise and provide only those services it is authorized to provide under this subchapter and ch. 256, Stats.

(3) Identify on-line medical direction that will provide day-to-day medical consultation.

(4) Designate the primary service area in which it will operate.

(5) Assure response to 9-1-1 emergency response requests 24 hours-a-day, 7 days-a-week, in its primary service area unless it is not licensed to do so. Emergency medical responder services are exempt from this requirement but should assure every effort is made to respond to 9-1-1 requests.

(6) Meet the staffing requirements identified in s. 256.15 (4), Stats., and s. DHS 110.50.

(7) If the emergency medical services provider is an ambulance service provider, submit a written report to the receiving healthcare facility 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 emergency medical service provider or emergency medical responder service provider shall provide a written or electronic report to the ambulance service provider at the time of the patient care transfer.

(8) If the emergency medical service provider is an ambulance service provider or non-transporting emergency medical service provider, submit patient care report data electronically to the department through Wisconsin Ambulance Run Data System (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 an emergency medical responder service provider, submit a patient care report to WARDS only if advanced skills are used in caring for the patient.
Note: An abbreviated emergency medical 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/elite/Organizationwisconsin.

(9) Comply with the data system guidelines published by the department. The emergency medical service provider shall only utilize third party software that is approved by and compliant with NEMSIS for the current standard specified by the department when submitting/uploading a patient care report to WARDS.

(9m) If the emergency medical service provider crosses state boundaries during an emergency response or patient transport, the emergency medical service provider shall submit patient care report data to WARDS if any two of the following apply:

(a) The emergency medical provider responds from this state.
(b) The patient is picked up from a location in this state.
(c) The patient is transported to a hospital or health care facility within this state.

(10) Maintain written mutual aid and coverage agreements with ambulance service providers operating within or adjacent to its primary service area.

(11) Designate and maintain affiliation with a regional trauma advisory council.

(12) Maintain a communication system that allows communication between medical control and EMS professionals and complies with the Wisconsin Emergency Medical Services Plan.

(13) Designate and maintain affiliation with a training center to provide required training.

(14) Maintain a quality assurance program that provides continuing education and assures continuing competency of EMS professionals.

(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.

(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 110.35 License and Application Requirements

To apply for a license as an ambulance service provider, a non-transporting emergency medical service provider, or an emergency medical responder service provider, a person shall do all of the following:

(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.

(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:

(a) Signed patient care protocols approved by the service medical director.
(b) A formulary list of medications the emergency medical service provider will use.
(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.
(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.
(e) Operational policies for all of the following:

1. Response cancellation, describing how the emergency medical service provider will handle a cancellation of a response while en route to the scene.

2. Use of lights and sirens in responding to a call.

3. Dispatch and response, describing how EMS professionals are dispatched and how the emergency medical service provider acknowledges to the dispatcher that it is responding.

4. Refusal of care, describing the procedure for accepting a refusal of care from a patient.

5. Destination determination, describing how the transport destination of the patient is determined if the provider is an ambulance service provider.

6. Emergency vehicle operation and driver safety training.

7. Controlled substances and how the service provider will obtain, store, secure, exchange, and account for any and all controlled substances used to provide patient care.

8. Continuous quality assurance and improvement program describing the components of the program, including how patient care and documentation will be reviewed, by whom, and how the results will be shared with practitioners and incorporated into continuing education.

9. Multiple patient incidents describing how the service will handle the response to the incident including triage, care, transportation and patient tracking.

(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 emergency medical service provider, whether the application is for initial licensure or a service level upgrade.
(g) When a service provider is required to submit an update to its operational plan, the update to the operational plan must be submitted on the form or in the manner approved by the department indicating:

1. The section of the operational plan being updated or revised.
2. Description detailing the change and intended impact on the service.
3. Approval of the update or revision by the service director and when involving patient care or patient care equipment, the service medical director.
4. Other information as determined by the department.

(3) Department decisions on application.

(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.
(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 110.36 Phase-in Period; Service Level Upgrades and Downgrades

(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.

(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:

(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.
(b) An explanation of how quality assurance will be maintained and skill proficiency will be evaluated.

(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.

(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.

(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).

(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 110.37 Service Level Downgrades

(1) An ambulance service provider or non-transporting emergency medical service provider may downgrade the level of its service only after department approval. The ambulance service provider or non-transporting emergency medical 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.

(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 110.38 Interfacility 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:

(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.

(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.

(3) The ambulance service provider shall not use mutual aid agreements to cover its primary service area while providing interfacility transports.

(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 110.39 Critical 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:

(1) The ambulance service provider shall be licensed at the EMT-paramedic level.

(2) The ambulance service provider shall designate the specialty services it offers.

(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.

(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.

(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.

(6) The ambulance service provider shall specifically identify the EMS professionals that are credentialed or part of the interfacility transport program.

(7) The ambulance service provider shall meet other requirements the department specifies.

DHS 110.395 Community EMS.

(1) In addition to the responsibilities under s. DHS 110.34, an emergency medical services provider or other organization licensed to provide CEMS shall obtain department approval before using licensed EMS practitioners to provide CEMS. To obtain department approval, the EMS provider or other organization shall submit all of the following to the department:

(a) Name of the EMS provider or other organization requesting approval.
(b) Contact information for the service director of the CEMS program, including how to contact the EMS provider or other organization.
(c) Name, address, phone number and e-mail address for the each medical director or member of the medical advisory committee who will oversee the CEMS program.
(d) The type of CEMS service that will be provided and at what licensure level.
(e) The staffing configurations for providing CEMS service.
(f) An explanation of how medical direction or consultation will be contacted at the patient location, if indicated.
(g) Patient care protocols and guidelines for providing CEMS services.
(h) An explanation of how the CEMS provider will be notified and requested for CEMS services.
(i) An explanation of how the CEMS provider will notify and integrate with the 9-1-1 system, should the patient require an ambulance.
(j) Identification of the ambulance service provider(s) that will respond to a 9-1-1 call initiated by the CEMS provider.
(k) Copies of each agreement or contract for providing community emergency medical services.
Note: When submitting copies of agreements or contracts, the submitter may redact any compensation information.
(L) Written acknowledgement that community emergency medical services will not interfere with the emergency medical services provider's responsibility to provide 9-1-1 emergency response within its primary service area, if the ambulance service provider or non-transporting emergency medical practitioner service provider is also licensed as a 9-1-1 provider.
(m) Other information as determined by the department.

(2) An emergency medical services provider or other organization licensed to provide community emergency medical service shall adhere to all applicable sections of this chapter as determined by the department.

(3) The community emergency medical services program shall submit patient care report data electronically to the department through the WARDS using a department approved direct web-based system within seven days of patient contact.

 

DHS 110.40 Intercept Service

In addition to the responsibilities under s. DHS 110.34, and ambulance service provider or non-transporting emergency medical service that provides intercept services is subject to all of the following requirements:

(1) The emergency medical service provider shall be licensed as a 9-1-1 emergency medical service provider.
(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.
(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 110.41 Air Medical Services

(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 10 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:

(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.

(b) Effective July 1, 2010, only ambulance service providers licensed at the paramedic level may be licensed as air medical services providers.

(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.

(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 110.42 Tactical Emergency Medical Services

An ambulance service provider or other agency shall obtain departmental approval before using licensed EMS professionals to provide tactical emergency medical services as follows:

(1) Ambulance services providers. To obtain department approval to provide tactical emergency medical services, an ambulance service provider shall submit an application and operational plan as provided under s. DHS 110.35 (2).

(2) Tactical teams. To obtain department approval, an agency shall do all of the following:

(a) Apply on a form obtained from the department.
(b) Submit patient care protocols for the emergency medical care the agency intends to provide.
(c) Submit an explanation of how the agency will interact with an ambulance service provider and maintain the initial level of patient care.
(d) Submit proof of medical liability insurance.
(e) Submit a written quality assurance and training plan for the EMS professionals that operate on the team.

DHS 110.43 Special Units

If a licensed ambulance service owns, operates, and maintains special transport vehicles including, but not limited to, boats, ATV's, or snowmobiles, the licensed ambulance service shall identify them in its application and operational plan as required under s. DHS 110.35 (2).

DHS 110.44 Special Events

A licensed ambulance service provider or non-transporting emergency medical service provider 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 or emergency medical service provider shall submit all of the following to the department not less than 10 business days before the event:

(1) Name of the ambulance service provider or non-transporting emergency medical service provider requesting approval.
(2) Contact information for the event manager, including how to contact the ambulance service provider during the event.
(3) Locations, dates, and times of the event.
(4) Name, address, phone numbers, and e-mail addresses for each service medical director who will oversee the medical services at the event.
(5) Name and contact information for the medical control facility.
(6) The types of EMS services that will be provided.
(7) The level of EMS service that will be provided.
(8) The number of ambulances dedicated to the event including ambulance staffing configurations and types.
(9) Whether the service will be “dedicated services" or “as available" based on resources.
(9m) Whether the special event coverage is for participants, spectators, or both.
(10) Description of on-site communications between the event manager, event staff, dispatch, and 9-1-1 dispatch.
(11) Explanation of how medical consultation will be contacted or if on-site medical consultation will be used.
(12) Any special patient care protocols for use at the event.
(13) Explanation of how EMS professionals will be notified and requested during the event.
(14) Explanation of how the ambulance service provider will integrate with the 9-1-1 system.
(15) Explanation of how a 9-1-1 request that is generated within the event by a participant or spectator will be handled.
(16) Identification of the service provider that will respond to a 9-1-1 call initiated from within the event.
(17) If the event occurs outside the primary service area of the ambulance service provider or non-transporting emergency medical service, documentation that the ambulance service provider for the primary service area in which the event is located has been notified at least 10 business days prior to the event or documentation that the ambulance service provider for the primary service area in which the event is located has approved the ambulance service provider or non-transporting emergency medical service requesting special event approval to provide event coverage within its primary service area.
(18) Written assurance that adequate resources will be available.
(19) Written acknowledgement that the ambulance service provider requesting special event approval assumes all liability for ambulance coverage and response during the event.
(20) Copies of any agreement or contract for providing emergency medical services for the event.
Note: When submitting copies of the contracts or agreements the service may redact any compensation information.
(20g) Written acknowledgement that the special event coverage will not interfere with its responsibility to provide 9-1-1 emergency response within its primary service area, if the ambulance service provider or non-transporting emergency medical service provider is also licensed as a 9-1-1 provider.
(20r) If the special event coverage is for spectators and participants or both and more than 5000 people total are anticipated to be in attendance, a mass casualty plan including all of the following:

(a) Name and contact information of the ambulance service provider or public safety agency that shall be the lead agency in the event of a mass casualty incident.
(b) A copy of the triage protocol to be used in the mass casualty incident.
(c) A copy of the destination determination policy to be used in a mass casualty incident.
(d) A list of destination hospitals including contact information.
(e) Copies of any mutual aid agreements specific to the event.
(f) A list of any specialty resources prepositioned for the event.
(g) Patient tracking method to be used.
(h) Written acknowledgement that the ambulance service has identified potential staging areas and landing zones near the event.
(i) Written acknowledgement that the ambulance service provider or non-transporting emergency medical service provider has notified area hospitals of the date of the event.

(21) Other information as determined by the department.

DHS 110.45 Department Decisions on Applications

(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.

(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.

(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 110.46 License Duration

(1) A license issued by the department to an emergency medical service provider is valid for the duration of the triennium 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.

(2) Notwithstanding sub. (1), an emergency medical service provider shall renew its license by June 30 of the third year of the triennium by submitting to the department an updated application that includes documentation acceptable to the department showing proof of eligibility. The application and documentation shall be submitted to the department in the manner or method specified by the department.

DHS 110.47 Required Personnel and Responsibilities

An emergency medical service provider shall have all of the following personnel:

(1) A service director qualified under s. DHS 110.49.
(2) A service medical director qualified under s. DHS 110.50.
(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.
(4) A quality assurance designee who is responsible for managing patient-based quality improvement processes in collaboration with the service medical director.
(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 professionals.
(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.
(7) EMS professionals sufficient to meet the staffing requirements under s. DHS 110.51.
Note: These personnel do not have to be separate people. One person may hold several of these positions.

DHS 110.48 Service Director

An emergency medical service provider shall have a service director who shall:

(1) Serve as the primary contact between the emergency medical service provider and the department.
(2) Assure that all elements of the operational plan are kept current.
(3) Assure that EMS professionals are properly licensed and credentialed.
(4) Provide day-to-day supervision of the ambulance service provider's operations.

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):

(1) Qualifications. The service medical director shall meet all the following within 180 days from the date of his or her appointment:

(a) Licensure as a physician.
(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.
(c) Education, training and experience in emergency medicine.
(d) Familiarity with the design and operation of pre-hospital EMS systems.
(e) Experience or training in the EMS quality improvement process.
(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).
(g) Any additional requirements prescribed by the department.

(2) Responsibilities. The service medical director shall do all of the following:

(a) Prescribe patient care protocols under which the provider's professionals treat.
(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.
(c) Ensure that physicians providing on-line medical control do so in a manner consistent with the department approved patient care protocols.
(d) Ensure that all aspects of the emergency medical services are under medical supervision and direction at all times.
(e) Establish, participate in, and ensure the continuing implementation of a quality assurance program as part of a patient care improvement process.
(f) Approve, limit, suspend, or revoke credentials as provided under s. DHS 110.53.
(g) Maintain liaison with the medical community, including hospitals, emergency departments, urgent care clinics, physicians, nurses, and other healthcare providers.
(h) Work with regional, state and local EMS authorities to ensure that standards, needs and requirements are met and resource utilization is optimized.
(i) Maintain, through continuing education, current knowledge and skills appropriate for a service medical director.
(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 110.495 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).

(1) Qualifications. Except as provided by sub. (3), a community emergency medical services medical director shall have all of the following:

(a) Current licensure as a physician.
(b) Familiarity or experience with emergency medical services and practitioners.
(c) Any additional requirements as prescribed by the department.

(2) Responsibilities. The CEMS medical director or medical direction team shall:

(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.
(b) Ensure that physicians providing online medical consultation do so in a manner consistent with department-approved patient care protocols and guidelines.
(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.
(d) Approve, limit, suspend or revoke credentials as provided under s. DHS 110.53.
(e) Maintain liaison with the medical community, including hospitals, emergency departments, urgent care clinics, physicians, nurses, and other healthcare providers.
(f) Work with regional, state and local authorities to ensure that standards, needs and requirements are met.
(g) Maintain current knowledge and skills appropriate for a community emergency medical services medical director/team through continuing education.
(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.

(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 110.50 EMS Provider Staffing Requirements

(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:

(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.

(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.

(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.

(d) Paramedic ambulance.

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:

a. The ambulance is responding in a municipality with a population of less than 10,000.
b. The ambulance is performing an interfacility transport.
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.

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.

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:

a. The ambulance is responding in a municipality with a population of less than 10,000.
b. The ambulance is performing an interfacility transport.
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.

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.

(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.

(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.

(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.

(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.

(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.
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.

(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.

(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:
(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.

(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:

(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).
(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.
(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:

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.

2. All 9-1-1 ambulances staffed at the highest level of licensure are already committed to other 9-1-1 responses.

(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.

(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.

(f) The ambulance service provider obtains approval from the department. The ambulance service provider shall request approval through submission of an operational plan.

DHS 110.51 Preceptors

(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.

(2) In order to serve as a preceptor for field training, an individual shall have all of the following qualifications:

(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.

(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.

(c) A preceptor shall oversee and mentor students during supervised field training and shall complete the records required to document the field training.

(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 110.52 EMS Personnel Credentialing

(1) In order to provide emergency medical care, an emergency medical responder or emergency medical services practitioner must first be credentialed with an emergency medical service provider with which the emergency medical responder or emergency medical services practitioner will provide emergency medical care.

(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.

(3) The service medical director shall authorize any skills, equipment, or medications that the individual may use in the service of the provider. The service medical director may only authorize EMS professionals 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.

(4) A certified emergency medical responder or licensed emergency medical services practitioner may be credentialed by more than one emergency medical service provider.

(5) An individual's credential remains in effect until the individual's service with the emergency medical services provider ceases, the service medical director limits, suspends, or revokes the credential, or the department suspends or revokes the individual's license.

(6) The service medical director may limit or suspend 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 limited or suspended 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.

(7) The service medical director may revoke 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. Prior to the revocation, the service medical director shall consult with the department's emergency medical services staff and the state emergency medical services medical director.

(8) The limitation, suspension, or revocation of an individual's credential does not by itself affect the individual's certificate or license.

DHS 110.525 Field Training Requirements

(1) An ambulance service provider may provide supervised field training of EMS professionals through its licensed staff who have been designated as preceptors by the provider's service medical director under s. DHS 110.51 (1).

(2) An ambulance service provider that provides supervised field training of EMS professionals shall have a written agreement with a certified training center that describes who the field training is provided and the responsibilities of the provider and the training center with respect to the field training. This agreement shall be signed by the training center's program director and the ambulance service provider's service director after consultation with both the training center medical director and the service medical director.

DHS 110.526 Opioids training.

(1) An EMS practitioner shall undergo training regarding the safe and proper administration of naloxone or another opioid antagonist to individuals who are undergoing or suspected of undergoing an opioid-related drug overdose consisting of instruction in recognizing opioid-related drug overdose patients, medication preparation and administration, and any other information requested by the department.

(2) An EMS practitioner may fulfill the training requirement under sub. (1) through any of the following:

(a) Initial training in the applicable Wisconsin curriculum that includes administration of naloxone or another opioid antagonist.
(b) Continuing education through a training center that includes administration of naloxone or another opioid antagonist.
(c) Training provided by an emergency medical service provider with which the individual is credentialed that is approved by the service medical director and the department.
(d) Any other training as approved by the department.

Last Revised: October 5, 2021