STATE OF WISCONSIN
DEPARTMENT OF TRANSPORTATION
OFFICE OF THE SECRETARY
PROPOSED ORDER AMENDING PERMANENT RULE
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The Wisconsin Department of Transportation proposes an order to:
Repeal s. Trans 309.02(6); Amend ss. Trans 309.02 (12), (13), (14), 309.03 (title), (3) (a), (3) (b) 1.(intro.), (3) (b) 1. a., (4), (7), 309.04 (1), 309.06, 309.07 (5), 309.08 (1), 309.10, 309.11, 309.12 (3), (5), 309.14, 309.15 (1), (2) (c), 309.16 (2), 309.18 (1), 309.19 (2) (b); Repeal and Recreate ss. 309.02(4), (5), 309.08(2), 309.09(1)(b) and Subchapter III of ch. Trans 309; and Create ss. Trans 309.02 (1k), (6k), (6r), (9k), (9r), (15), (16), 309.03 (5) (j) to (t), (8), (9), 309.06 (2), 309.08 (3), (4), 309.12 (6), (7), (8), 309.14 (2), 309.15 (2) (g), (4), 309.19 (2) (c), 309.205, 309.207, 309.209.
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The Statement of Scope for this Permanent Rule, SS 110-13, was approved by the Governor on August 12, 2013, published in Wisconsin Administrative Register No. 693 on September 14, 2013, and approved by the Secretary of the State of Wisconsin Department of Transportation Mark Gottlieb, P.E., on September 13, 2013, as required by s. 227.135 (2), Stats. The State of Wisconsin Department of Transportation (Department) proposes an order to amend permanent rule ch. Trans 309 relating to Ambulance Inspection and affecting small businesses. The analysis below was prepared by the Department.
Statutes Interpreted: Section 341.085, Stats. Explanation of Agency Authority: Section 341.085, Stats., provides the statutory authority of the Department regarding ambulance inspection and s. 341.085 (2), Stats. authorizes the Department to adopt rules to prescribe ambulance service equipment and standards.
Related Statute or Rule: None.
Plain Language Analysis: Chapter Trans 309 has not been revised by the Department of Transportation since 1999. Since this time, there have been many changes and advances throughout the industry. The revision of ch. Trans 309 is necessary to update the rules and regulations with industry standards and for the Department to continue to lead in ambulance safety as well as protecting the consumer, general public and those travelling throughout the State.
Comparison with Rules in Adjacent States:
Illinois. Per Illinois Title 77, Chapter I, Subchapter f, part 515, Section 515.830, requires a Federal Department of Transportation vehicle inspection every six months and passing vehicles receive a Safety Sticker. New ambulances and all other ambulances are inspected once per year by one of the 3 inspectors or the supervisor from the Illinois Department of Health for Basic lifesaving equipment and the U.S. General Services Administration’s Specification for ambulances (KKK-A-1822F) with exemptions. Equipment carried in ambulances above the Basic lifesaving level is inspected by the ambulance services designated hospital. Inspection also includes audits of licensing requirements of ambulance services and the emergency medical technicians. Currently reviewing the three ambulance build standards, CAAS, NFPA and GSA. Iowa. Per Iowa Public Health 641 Chapter 132 and joint rule 147A4 requires all ambulances in Iowa to be inspected by one of four Department of Public Heath ambulance inspectors at least every three years. The inspections include a limited mechanical inspection as well as an inspection of medical equipment. Medical equipment carried by the services depends on the scope of practice as set by policies and medical direction. Iowa ambulance inspectors can inspect and/or audit equipment and records of any service program every three years or as necessary to ensure compliance with Iowa codes and rules. Inspection also includes audits of licensing requirements of ambulance services and the emergency medical technicians. Currently in the process of reviewing their rules and may adopt in part or whole the CAAS Ground Vehicle Standard for Ambulances in the future. Michigan. Per Michigan Public Health Code Act 368 Section 333.20923 requires any new ambulance, any replaced ambulance or any upgraded ambulance to be inspected by one of the five regional coordinators/inspectors of the Department of Health & Human Services in Michigan before it is licensed to be in service. Spot checks are also done on 25% of ambulances throughout the year in Michigan. Inspections by a certified mechanic are required on ambulances that are purchased that are over two years old. Medical equipment carried varies in Michigan based on the level of service provided. The equipment list provided by Michigan is very similar to the equipment required in Wisconsin. One major difference is all drugs are provided in sealed kits by pharmacists at service designated hospitals. Inspection also includes audits of licensing requirements of ambulance services and the emergency medical technicians. Starting the process to revise rules to state ‘certification of a ground ambulance as it relates to structural and mechanical specifications, excluding the paint scheme, must comply with the standards in place at the time of manufacture for federal KKK standards, or; a. CAAS GVS, in its entirety or b. NFPA 1917, in its entirety.”.
Minnesota. Per Minnesota Statute 144E.18 Rule 4690.3300 requires the ambulances to be inspected once every two years by one of the five Minnesota ambulance inspectors as set by Minnesota State Emergency Medical Services Regulatory Board. These inspections are of limited mechanical/lighting inspections and a more in-depth medical equipment inspection. Minnesota ambulances that comply with Federal Specification KKK-A-1822 with exceptions are deemed to comply with State Standards. Minnesota requires a list of basic lifesaving equipment similar to Wisconsin and then requires services with advanced life support licenses to carry equipment that is approved by the licensee’s medical director. Inspection also includes audits of licensing requirements of ambulance services and the emergency medical technicians. Minnesota is not currently enforcing the federal build standards. Currently they have a workgroup reviewing the GVS-CAAS v1 standard and the NFPA-1917 standards.
Summary of the Factual Data and Analytical Methodologies that the Agency Used in Support of the Proposed Rule and How Any Related Findings Support the Regulatory Approach Chosen for the Rule: The proposed rule was written to revise Trans 309 to not only update but also return parts of the inspection process where they logically fit. In 2012 there was a NHTSA National Highway Transportation Safety Administration study in Wisconsin with the Department of Health Services titled The Reassessment of Emergency Medical Services. In this study, there was a recommendation on page 12 that states “Consolidate ambulance inspection and licensing authority within the Department of Health Services with sufficient funding and personnel to support the function”. Also on page 21 it notes, “There is a standardized list of ambulance equipment, including pediatric equipment, listed in the administrative rule Trans 309. The EMS Unit has worked with DOT to develop licensing rules and makes suggestions regarding qualifications for inspection personnel. However, the equipment list has not been updated for over 12 years and the language resides in the DOT administrative rule. Both Dot and the EMS Unit will be reviewing the list for updates but constituents expressed the desire to have this inspection function within the EMS Unit.” By removing section III, Equipment Standards from Trans 309 and moving it under the control of the Department of Health, EMS Unit where the expertise for the type of medical equipment carried and testing needed for this equipment lies is a logical fit. DOT will continue to inspect the Vehicle, maintenance of the vehicle and emergency lighting areas of the ambulances where the Department of Transportation’s expertise lies. However, because of public comments received during review of the draft rule, the removal of medical equipment standards from Trans 309 will be deferred until July 15, 2023, to allow the Department of Health Services to obtain clear authority and capacity to inspect ambulances for medical equipment. This rulemaking therefore revises Subchapter III to create updated ambulance medical equipment standards that will be in effect for Department inspections until their July, 2023 repeal.
Analysis Regarding Rule’s Effect on Small Businesses: There are three types of ambulance services in the State of Wisconsin, private ambulance services, not for profit ambulance services and municipal ambulance services. Several of these ambulance services throughout the state would qualify as a small business under s. 227.114, Stats. This rule making will add minor additional costs to ambulance services by adding some equipment however by removing the Medical Equipment inspection area and turning it over to the Department of Health Services EMS Section and the Services Medical Directors it will lessen the amount of time spent on the inspection and lessen the burden on small business. Another option that may be used for the medical equipment inspections by the services and DHS is having private businesses that test and certify medical equipment that are already operational around the State performing inspections. This rulemaking will add minor additional costs to ambulance services by adding some equipment; however, it will also be offset by removing some equipment that was previously required. Many of the revisions made are already in requirements from the federal ambulance build standards and in the Wisconsin Department of Health Services Emergency Medical Services requirements for ambulances.
This rulemaking is a revision of the existing Transportation Rule 309 and is updating the rule to be more in line with current practices in ambulance operations in the State of Wisconsin.
Effect on small business: Ambulance services may see an increase in costs with this rulemaking by having to add new equipment or from obtaining annual Department of Transportation inspections. However, costs may also decrease or remain similar to current costs for ambulance services because this rulemaking will also provide areas where services can decrease equipment being carried. The benefits and safety advances incurred by this rulemaking should be very beneficial to the ambulance services as well as the consumers.
Anticipated costs incurred by private sector: This rulemaking will require new equipment to be carried on ambulances and new configurations to ambulances however this effect should be minimal financially on ambulance services. Numerous changes have been required on a federal build level for years and ambulances have had these changes and updates incorporated and the rule making is being updated to include these changes. In November of 2016 The Division of State Patrol has asked numerous vehicle service centers around the State for pricing for annual Department of Transportation inspections. The prices for the inspections ranged from $0 to $115. The services that did not charge a fee require any defects to be repaired by their technicians. The average cost for the annual inspection was $86.55.
Osseo Ford Osseo, WI $79.00 (one hour rate) + form and decal
Phillips Service Center Phillips, WI $80.00
Roberts Repair Rhinelander, WI $88.94
Twin Ports Fleet Maintenance, Superior, WI $79.00
La Crosse Truck Center, La Crosse, WI $89.00
Mid State Truck Service Inc., Wausau, Wisconsin Rapids, Plover, Chippewa Falls, Marshfield & Abbotsford, WI $60.00, (Wausau location includes inspection with oil changes, no extra charge)
Quality Truck Care Center, Green Bay, Appleton, Oshkosh & Fond Du Lac, WI $76.08, ($75.00 for the inspection and $1.08 for the DOT paperwork & sticker)
Badger Truck Center, Milwaukee, WI $115.00
Meier Truck Fleet Repair, Madison, WI $110.00
Depending on the ambulance service, many will be able to perform the inspections themselves as they have certified inspectors/technicians on staff.
The agency contact person listed below is also the small business regulatory coordinator for this proposed rule. This proposed rule, fiscal estimate, and other related documents may be viewed at https://docs.legis.wisconsin.gov/code.
Agency Contact Person:
Paul R. Schilling
State of Wisconsin Department of Transportation
Bureau of Traffic Safety, Motor Carrier Investigation Unit
4822 Madison Yards Way
Madison, Wisconsin 53705
Place Where Comments Should Be Submitted and Deadline: Comments may be submitted to the agency contact person listed above or through the Legislature’s Administrative Rules website http://docs.legis.wisconsin.gov/code until the deadline given in the forthcoming notice of public hearing.
TEXT OF PERMANENT RULE
SECTION 1. Trans 309.02 (1k) is created to read: “Advanced emergency medical technician” has the meaning given in s, 256.01 (1k), Stats.
SECTION 2. Trans 309.02 (4) is repealed and recreated to read: “Emergency medical technician" has the meaning given in s. 256.01(6), Stats.