Chapter DHS 118

DHS 118.02 History History: CR 04-055: cr. Register December 2004 No. 588, eff. 1-1-05; corrections in (3), (4) and (5) made under s. 13.92 (4) (b) 7., Stats., Register January 2009 No. 637; correction in (4) made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; CR 23-046: am. (2) (a), r. (2) (b), (c), am. (2) (e) Register April 2024 No. 820, eff. 5-1-24.

DHS 118.03 DHS 118.03 Definitions. In this chapter:

DHS 118.03(1) (1) “Ambulance service provider” has the meaning specified in s. 256.01 (3), Stats., namely, a person engaged in the business of transporting sick, disabled or injured individuals by ambulance to or from facilities or institutions providing health services.

DHS 118.03(2) (2) “ACS” means the American college of surgeons.

DHS 118.03(2m) (2m) “APP” means advanced practice provider.

DHS 118.03(3) (3) “Assessment and classification criteria” means the required trauma care services and capabilities for a hospital to be classified as a Level III or IV trauma care facility.

DHS 118.03(3m) (3m) “ATLS” means advanced trauma life support.

DHS 118.03(4) (4) “Audit” means a close examination of a situation or event in a multidisciplinary peer review.

DHS 118.03(5) (5) “Bypass” means to forego delivery of a patient to the nearest hospital for a hospital whose resources are more appropriate for the patient’s injury pursuant to direction given to a pre-hospital emergency medical service by on-line medical direction or predetermined triage criteria.

DHS 118.03(6) (6) “Classification” means the process whereby a hospital identifies its service level as a trauma care facility and the department reviews and approves the hospital as a provider of a level of trauma care services to meet the needs of the severely injured patient.

DHS 118.03(6m) (6m) “CT” means computed tomography.

DHS 118.03(7) (7) “Coordinating facility” means an ACS verified level I or II hospital that has a collaborative relationship with the regional trauma advisory council and the department as specified under s. DHS 118.06 (3) (c).

DHS 118.03(8) (8) “Definitive care” means comprehensive care for the full spectrum of injuries beyond the initial assessment and resuscitation phase.

DHS 118.03(9) (9) “Department” means the department of health services.

DHS 118.03(10) (10) “Dispatch” means identifying and coordinating the emergency resources needed to respond to a specific traumatic injury or illness.

DHS 118.03(10d) (10d) “Emergency medical responder” ” has the meaning given in s. 256.01 (4p), Stats.

DHS 118.03(10j) (10j) “Emergency medical responder service” means a group of persons licensed by the department under s. 256.15 (8), Stats., who are employed or organized to provide emergency care to sick, disabled, or injured individuals as a response for aid requested through a public service access point in conjunction with the dispatch of an ambulance, but who do not provide ambulance transportation of a patient.

DHS 118.03(10m) (10m) “EMS” means emergency medical services.

DHS 118.03(11) (11) “Emergency medical services practitioner” has the meaning given in s. 256.01 (5), Stats.

DHS 118.03(12) (12) “Executive council” means the RTAC leadership body, which is composed of professionals from each region who reflect trauma care expertise, leadership and diversity within each trauma care region.

DHS 118.03(15) (15) “Fiscal agent” means the person or organization responsible for transactions of RTAC funds.

DHS 118.03(16) (16) “Health care provider” means a medical professional who or organization that is involved in either the detection, prevention, or care of an injured person and includes all of the following:

DHS 118.03(16)(a) (a) A nurse licensed under ch. 441, Stats.

DHS 118.03(16)(b) (b) A dentist licensed under ch. 447, Stats.

DHS 118.03(16)(c) (c) A physician or physician assistant licensed under subch. II of ch. 448, Stats.

DHS 118.03(16)(d) (d) A rural medical center, as defined in s. 50.50 (11), Stats.

DHS 118.03(16)(e) (e) A hospital.

DHS 118.03(16)(f) (f) An ambulance service provider.

DHS 118.03(16)(g) (g) An emergency medical services practitioner.

DHS 118.03(16)(h) (h) An emergency medical responder.

DHS 118.03(16)(i) (i) A doctor of podiatric medicine and surgery licensed under subch. IV of ch. 448, Stats.

DHS 118.03(17) (17) “Hospital” means entities approved under subch. II of ch. 50, Stats., and ch. DHS 124, including critical access hospitals, that routinely provide trauma care, excluding hospitals whose principal purpose is to treat persons with a mental illness.

DHS 118.03(17m) (17m) “ICU” means intensive care unit.

DHS 118.03(18) (18) “Indicator review” means the RTAC’s assessment of trauma system performance based on desired trauma system measurements and used by the RTAC in the performance improvement process.

DHS 118.03(19) (19) “Lead agency” means an organization or agency that serves as the focal point for program development on the local, regional and state level. In this chapter, the department serves as the lead agency.

DHS 118.03(20) (20) “Level I” means a class of trauma care facility that is characterized by the hospital’s capability of providing leadership and total care for every aspect of traumatic injury from prevention through rehabilitation, including research.

DHS 118.03(21) (21) “Level II” means a class of trauma care facility that is characterized by the hospital’s ability to provide initial definitive trauma care regardless of the severity of injury, but may not be able to provide the same comprehensive care as a level I trauma center.

DHS 118.03(22) (22) “Level III” means a class of trauma care facility that is characterized by the hospital’s ability to:

DHS 118.03(22)(a) (a) Provide assessment, resuscitation and stabilization.

DHS 118.03(22)(b) (b) Provide emergency surgery and arrange, when necessary, transfer to a level I or II trauma facility for definitive surgical and intensive trauma care.

DHS 118.03(23) (23) “Level IV” means a class of trauma care facility that is characterized by the hospital’s ability to stabilize and provide advanced trauma life support prior to patient transfer.

DHS 118.03(24) (24) “Loop-closure” means the process whereby an RTAC has identified a quality improvement problem, completed an evaluation, developed an action plan and notified appropriate health care providers of the results.

DHS 118.03(24m) (24m) “MRI” means magnetic resonance imaging.

DHS 118.03(25) (25) “Medical director” means the physician who is designated in an operational plan to be responsible for all of the following off-line medical direction activities:

DHS 118.03(25)(a) (a) Controlling, directing and supervising all phases of the emergency medical services program operated under the plan and the emergency medical services practitioners performing under the plan.

DHS 118.03(25)(b) (b) Establishing standard operating protocols for emergency medical services practitioners performing under the plan.

DHS 118.03(25)(c) (c) Coordinating and supervising evaluation activities carried out under the plan.

DHS 118.03(25)(d) (d) Designating on-line medical control physicians, if the physicians are to be used in implementing the emergency medical services program.

DHS 118.03(26) (26) “Needs assessment” means a written report prepared by an RTAC identifying and documenting trauma care and injury prevention resources and deficiencies within a defined area of the trauma system and which serves as the basis for developing a regional trauma plan.

DHS 118.03(27) (27) “Nurse anesthetist” means a professional nurse licensed under ch. 441, Stats., who has obtained, through additional education and successful completion of a national examination, a certification as an anesthesia nursing specialist.

DHS 118.03(28) (28) “Off-line medical direction” means medical direction that does not involve voice communication provided to emergency medical services practitioners and emergency medical responders providing direct patient care.

DHS 118.03(29) (29) “On-line medical direction” means medical direction of the activities of an emergency medical services practitioner that involves voice communication provided to the emergency medical services practitioners by the medical director or by a physician designated by the medical director.

DHS 118.03(30) (30) “On-line medical control physician” means a physician who is designated by the medical director to provide voice communicated medical direction to emergency medical services practitioner and emergency medical responder personnel and to assume responsibility for the care provided by emergency medical technician and first responder personnel in response to that direction.

DHS 118.03(31) (31) “Out-of-hospital” means care provided to sick or injured persons before or during transportation to a medical facility, including any necessary stabilization of the sick or injured person.

DHS 118.03(32) (32) “Pediatric trauma center” means a freestanding or separate administrative unit in a hospital that is dedicated to addressing the trauma needs of a pediatric patient population and meets the resource requirements outlined by the ACS for verification as a pediatric trauma center.

DHS 118.03(33) (33) “Performance improvement” means a method of evaluating and improving processes of trauma patient care that emphasizes a multidisciplinary approach to problem solving.

DHS 118.03(34) (34) “Physician” means a person licensed under ch. 448, Stats., to practice medicine and surgery.

DHS 118.03(34m) (34m) “PIPS” means performance improvement and patient safety.

DHS 118.03(35) (35) “Protocol” means a written statement approved by the department and signed and dated by the medical director that lists and describes the steps any out-of-hospital care provider is to follow in assessing and treating a patient.

DHS 118.03(36) (36) “Regional trauma advisory council” or “RTAC” means an organized group of healthcare entities and other concerned individuals who have an interest in organizing and improving trauma care within a specified geographic region approved by the department.

DHS 118.03(37) (37) “Regional trauma plan” means a written report prepared by an RTAC that meets all of the following criteria:

DHS 118.03(37)(a) (a) Identifies the region’s current trauma care development strengths and weaknesses.

DHS 118.03(37)(b) (b) Describes specific goals for future growth and activities in the region.

DHS 118.03(37)(c) (c) Is based on the RTAC’s needs assessment.

DHS 118.03(38) (38) “Resource hospital” means a hospital in Wisconsin or a bordering state that makes a written commitment to assist the level III coordinating facility of an RTAC to meet the needs required for the development, implementation, maintenance and evaluation of the regional trauma system.

DHS 118.03(39) (39) “Rural” means outside a metropolitan statistical area specified under 42 CFR 412.62 (ii) (A) or in a city, village or town with a population of less than 14,000.

DHS 118.03(40) (40) “Statewide trauma advisory council” or “STAC” means the entity established by the department to advise the department on a variety of issues pertaining to the establishment and operation of the statewide trauma care system.

DHS 118.03(40g) (40g) “TMD” means trauma medical director.

DHS 118.03(40r) (40r) “TPM” means trauma program manager.

DHS 118.03(41) (41) “Trauma care system” means a comprehensive and organized approach to facilitating and coordinating a multidisciplinary system response to traumatically injured patients and includes the continuum of care from initial injury detection through definitive care, rehabilitation and injury control.

DHS 118.03(42) (42) “Trauma care facility” or “TCF” means a hospital that the department has approved as having the services and capabilities of a level I, II, III or IV trauma care facility.

DHS 118.03(43) (43) “Traumatic injury” means major or severe injuries to more than one system of a person’s body or major injury to a single system of the body that has the potential of causing death or major disability.

DHS 118.03(44) (44) “Trauma registry” means a system for collecting data from hospitals for which the department manages and analyzes the data and disseminates the results.

DHS 118.03(45) (45) “Triage” means classifying patients according to the severity of their medical conditions at the scene of an injury or onset of illness and subsequently providing care first to those patients with the greatest medical needs and who are likely to benefit from that care.

DHS 118.03(45g) (45g) “Type 1 Criteria” means required criteria identified in Appendix A that may significantly impact a trauma care facility’s ability to provide optimal care for trauma patients.

DHS 118.03(45r) (45r) “Type 2 Criteria” means required criteria identified in Appendix A that may impact a trauma care facility’s ability to provide optimal care for trauma patients.

DHS 118.03(46) (46) “Unclassified hospital” means a hospital that either has chosen not to be a part of Wisconsin’s trauma care system, or a hospital that the department has not approved as a level I, II, III or IV trauma care facility.

DHS 118.03(47) (47) “Urban” means an area within a metropolitan statistical area specified under 42 CFR 412.62 (ii) (A) or in a city, village or town with a population of 14,000 or more.

DHS 118.03(48) (48) “Verification” means the process specified by the ACS whereby a hospital desiring recognition as a level I, II, III or IV trauma care facility is designated as that level by the ACS.

DHS 118.03 History History: CR 04-055: cr. Register December 2004 No. 588, eff. 1-1-05; corrections in (1), (9), (11), (13), (14) and (17) made under s. 13.92 (4) (b) 6. and 7., Stats., Register January 2009 No. 637; correction in (11) made under s. 13.92 (4) (b) 7., Stats., Register July 2011 No. 667; correction in (13) made under s. 13.92 (4) (b) 7., Stats., Register March 2014 No. 699; CR 19-086: cr. (2m), (3m), (6m), (10m), (17m), (24m), am. (32), cr. (34m), (40g), (40r), am. (42), cr. (45g), (45r) Register May 2021 No. 785, eff. 10-1-21; CR 23-046: cr. (10d), (10j), r. and recr. (11), r. (13), (14), am. (16) (g), (h), (25) (intro.), (a), (b), (28) to (30) Register April 2024 No. 820, eff. 5-1-24.

subch. II of ch. DHS 118 Subchapter II — Statewide Organization for Trauma Care

DHS 118.04 DHS 118.04 Lead agency.

DHS 118.04(1) (1) Designation. The department shall be the lead agency for the development, implementation and monitoring of the statewide trauma care system.

DHS 118.04(2) (2) Lead agency duties. The lead agency shall do all of the following:

DHS 118.04(2)(a) (a) General duties. Develop and revise guidelines and administrative rules for the statewide trauma care system.

DHS 118.04(2)(b) (b) Organize and structure RTACs.

DHS 118.04(2)(b)1. 1. Approve the designation of all trauma care geographic regions based on consideration of what represents the best care of the trauma patient.

DHS 118.04 Note Note: Wisconsin is divided into 9 trauma care geographic regions. Each region has an RTAC. A trauma care region is defined by the location of the health care providers that have selected a particular RTAC for primary membership and in which the majority of each provider’s trauma care and prevention occurs.

DHS 118.04(2)(b)2. 2. Review the geographic distribution and organization of regional trauma advisory councils and ensure executive councils that promote the optimal operation of the statewide trauma care system.