Chapter DHS 110

DHS 110.28(2) (2) Application. To apply for EMS instructor II certification, the applicant shall submit to the department, in the manner specified by the department, all of the following:

DHS 110.28(2)(a) (a) Documentation of current certification with the NREMT at the EMT level or higher and at or above the level for which the applicant seeks department certification. Certification with the NREMT at the paramedic level is required for critical care paramedic EMS instructor II certification. If the applicant was licensed as a paramedic under this chapter before January 1, 2013, certification with the NREMT is not required for instructor II certification for any level of training.

DHS 110.28(2)(b) (b) Proof of licensure by the department at or above the practice level for which the EMS instructor II approval is sought.

DHS 110.28(2)(c) (c) Proof of equivalency of 2 years experience as a licensed, practicing emergency medical services practitioner at or above the level of EMS instructor II certification sought, or equivalent critical care experience as determined by the department.

DHS 110.28(2)(d) (d) Proof of prior supervised teaching experience sufficient for the training center to consider the instructor competent and to authorize the EMS instructor II to lead a training course.

DHS 110.28(2)(e) (e) Proof of successful completion of an EMS instructor II orientation workshop conducted by the department and the WTCS board, or an equivalent determined by the department.

DHS 110.28(2)(f) (f) If previously certified at any level as an EMS instructor, demonstration of competent instruction as evidenced by a minimum 70% pass rate on the state approved examination for the last course taught.

DHS 110.28(2)(g) (g) Any other information requested by the department.

DHS 110.28(3) (3) WTCS approval. If employed by the WTCS board, the applicant shall be jointly approved by the department and the WTCS board.

DHS 110.28(4) (4) EMS instructor ii renewal certification.

DHS 110.28(4)(a) (a) Certification for EMS instructor II shall expire on June 30 of the third year of the triennial period unless renewed. If an individual does not timely renew his or her EMS instructor II certification, the certification expires and the individual may not act as an EMS instructor II until the certification is renewed.

DHS 110.28(4)(b) (b) To renew EMS instructor II certification, the individual shall submit in the manner specified by the department the application and documentation required under sub. (2) and documentation of continued affiliation with the training center on or before June 30 of the 3rd year of the triennial licensing period.

DHS 110.28 Note Note: Instructor application is submitted by the applicant to the department electronically through the department’s E-Licensing system available at www.dhs.wisconsin.gov/ems. Completed applications are processed electronically through this system. For further information contact the Emergency Medical Services Section, 1 W. Wilson St., P.O. Box 2659, Madison, WI 53701-2659.

DHS 110.28 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (1), (2) (a), (c), (4) Register September 2021 No. 789, eff. 10-1-21; correction in (4) (b) made under s. 35.17, Stats., Register September 2021 No. 789.

DHS 110.29 DHS 110.29 Training center oversight.

DHS 110.29(1) (1) Quality assurance.

DHS 110.29(1)(a) (a) The department is responsible for quality assurance of training centers and instructors. If a training center or instructor is part of the WTCS, quality assurance is a joint responsibility of the department and the WTCS.

DHS 110.29(1)(b) (b) The department may review the performance of training centers and instructors and conduct quality assurance assessments and audits to assure quality education and compliance with educational standards and curriculum. Failure to meet educational, professional, or ethical standards may result in department action under subch. V against a training center or instructor.

DHS 110.29(2) (2) Wisconsin Technical College System. The WTCS office and the department will work to assure that the training centers and instructors under their authority are jointly regulated. The responsibilities of the department and the WTCS will be outlined in a memorandum of understanding, which will be reviewed at least once every 5 years and updated as appropriate.

DHS 110.29 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.

DHS 110.30 DHS 110.30 Department decision on applications.

DHS 110.30(1) (1) 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 certificate of approval. If the department denies the application, the department will notify the applicant of the reason for the denial and any appeal rights.

DHS 110.30(2) (2) 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 110.30 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.

DHS 110.31 DHS 110.31 Expiration dates; approvals and certifications.

DHS 110.31(1) (1) Medical director and program director approval. Department approval of the training center medical director and the training center program director shall remain in effect as long as all requirements continue to be met or until the approval is revoked, suspended, or voluntarily surrendered.

DHS 110.31(2) (2) EMS instructor II certification. Certification for EMS instructor II shall expire on June 30 of the 3rd year of the triennial period unless renewed. If an individual does not timely renew his or her EMS instructor II certification, under s. DHS 110.28 (2), the certification expires and the individual may not act as an EMS instructor II until the certification is renewed.

DHS 110.31 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (2) Register September 2021 No. 789, eff. 10-1-21; correction in (2) made under s. 35.17, Stats., Register September 2021 No. 789.

subch. IV of ch. DHS 110 Subchapter IV — Emergency Medical Service Provider Licensing and Operation

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

DHS 110.32(1) (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:

DHS 110.32(1)(a) (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).

DHS 110.32(1)(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.

DHS 110.32(1)(c) (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.

DHS 110.32(1)(d) (d) The entity is a rural ambulance service provider that meets all of the requirements of s. 256.15 (4m).

DHS 110.32(2) (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.

DHS 110.32(3) (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.

DHS 110.32(3m) (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.

DHS 110.32(4) (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.

DHS 110.32(5) (5) The department shall issue an emergency medical service provider a separate license for each type of service it is licensed to provide.

DHS 110.32 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: renum. (1) to (1) (intro.), cr. (1) (a) to (d), am. (2), (3), cr. (3m), am. (4), cr. (5) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.33 DHS 110.33 Authorized services.

DHS 110.33(1) (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.

DHS 110.33(2) (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.

DHS 110.33(3) (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 110.33 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (1) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.34 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:

DHS 110.34(1) (1) Comply with the requirements of this chapter and ch. 256, Stats.

DHS 110.34(2) (2) Advertise and provide only those services it is authorized to provide under this subchapter and ch. 256, Stats.

DHS 110.34(3) (3) Identify on-line medical direction that will provide day-to-day medical consultation.

DHS 110.34(4) (4) Designate the primary service area in which it will operate.

DHS 110.34(5) (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.

DHS 110.34(6) (6) Meet the staffing requirements identified in s. 256.15 (4), Stats., and s. DHS 110.50.

DHS 110.34(7) (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.

DHS 110.34(8) (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.

DHS 110.34 Note 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.

DHS 110.34(9) (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.

DHS 110.34(9m) (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:

DHS 110.34(9m)(a) (a) The emergency medical provider responds from this state.

DHS 110.34(9m)(b) (b) The patient is picked up from a location in this state.

DHS 110.34(9m)(c) (c) The patient is transported to a hospital or health care facility within this state.

DHS 110.34(10) (10) Maintain written mutual aid and coverage agreements with ambulance service providers operating within or adjacent to its primary service area.

DHS 110.34(11) (11) Designate and maintain affiliation with a regional trauma advisory council.

DHS 110.34(12) (12) Maintain a communication system that allows communication between medical control and EMS professionals and complies with the Wisconsin Emergency Medical Services Plan.

DHS 110.34(13) (13) Designate and maintain affiliation with a training center to provide required training.

DHS 110.34(14) (14) Maintain a quality assurance program that provides continuing education and assures continuing competency of EMS professionals.

DHS 110.34(15) (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.

DHS 110.34(16) (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 110.34 Note Note: Data system guidelines can be found on the department’s website at www.dhs.wisconsin.gov/ems.

DHS 110.34 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (intro.), (2), (3), (5), (7) to (9), cr. (9m), am. (12), (14) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.35 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:

DHS 110.35(1) (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.

DHS 110.35(2) (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:

DHS 110.35(2)(a) (a) Signed patient care protocols approved by the service medical director.

DHS 110.35(2)(b) (b) A formulary list of medications the emergency medical service provider will use.

DHS 110.35(2)(c) (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.

DHS 110.35(2)(d) (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.

DHS 110.35(2)(e) (e) Operational policies for all of the following:

DHS 110.35(2)(e)1. 1. Response cancellation, describing how the emergency medical service provider will handle a cancellation of a response while en route to the scene.

DHS 110.35(2)(e)2. 2. Use of lights and sirens in responding to a call.

DHS 110.35(2)(e)3. 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.

DHS 110.35(2)(e)4. 4. Refusal of care, describing the procedure for accepting a refusal of care from a patient.

DHS 110.35(2)(e)5. 5. Destination determination, describing how the transport destination of the patient is determined if the provider is an ambulance service provider.

DHS 110.35(2)(e)6. 6. Emergency vehicle operation and driver safety training.

DHS 110.35(2)(e)7. 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.

DHS 110.35(2)(e)8. 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.

DHS 110.35(2)(e)9. 9. Multiple patient incidents describing how the service will handle the response to the incident including triage, care, transportation and patient tracking.

DHS 110.35(2)(f) (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.

DHS 110.35(2)(g) (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: