Chapter DHS 110

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:

DHS 110.35(2)(g)1. 1. The section of the operational plan being updated or revised.

DHS 110.35(2)(g)2. 2. Description detailing the change and intended impact on the service.

DHS 110.35(2)(g)3. 3. Approval of the update or revision by the service director and when involving patient care or patient care equipment, the service medical director.

DHS 110.35(2)(g)4. 4. Other information as determined by the department.

DHS 110.35(3) (3) Department decisions on application.

DHS 110.35(3)(a) (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.

DHS 110.35(3)(b) (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 110.35 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (intro.), (2) (e) 3., cr. (2) (e) 7. to 9., am. (2) (f), cr. (2) (g) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.36 DHS 110.36 Phase-in period; service level upgrades and downgrades.

DHS 110.36(1) (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.

DHS 110.36(2) (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:

DHS 110.36(2)(a) (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.

DHS 110.36(2)(b) (b) An explanation of how quality assurance will be maintained and skill proficiency will be evaluated.

DHS 110.36(3) (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.

DHS 110.36(4) (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.

DHS 110.36(5) (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).

DHS 110.36(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 110.36 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.

DHS 110.37 DHS 110.37 Service level downgrades.

DHS 110.37(1) (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.

DHS 110.37(2) (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 110.37 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 110.38 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:

DHS 110.38(1) (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.

DHS 110.38(2) (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.

DHS 110.38(3) (3) The ambulance service provider shall not use mutual aid agreements to cover its primary service area while providing interfacility transports.

DHS 110.38(4) (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 110.38 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.

DHS 110.39 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:

DHS 110.39(1) (1) The ambulance service provider shall be licensed at the EMT-paramedic level.

DHS 110.39(2) (2) The ambulance service provider shall designate the specialty services it offers.

DHS 110.39(3) (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.

DHS 110.39(4) (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.

DHS 110.39(5) (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.

DHS 110.39(6) (6) The ambulance service provider shall specifically identify the EMS professionals that are credentialed or part of the interfacility transport program.

DHS 110.39(7) (7) The ambulance service provider shall meet other requirements the department specifies.

DHS 110.39 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (6) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.395 DHS 110.395 Community EMS.

DHS 110.395(1) (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:

DHS 110.395(1)(a) (a) Name of the EMS provider or other organization requesting approval.

DHS 110.395(1)(b) (b) Contact information for the service director of the CEMS program, including how to contact the EMS provider or other organization.

DHS 110.395(1)(c) (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.

DHS 110.395(1)(d) (d) The type of CEMS service that will be provided and at what licensure level.

DHS 110.395(1)(e) (e) The staffing configurations for providing CEMS service.

DHS 110.395(1)(f) (f) An explanation of how medical direction or consultation will be contacted at the patient location, if indicated.

DHS 110.395(1)(g) (g) Patient care protocols and guidelines for providing CEMS services.

DHS 110.395(1)(h) (h) An explanation of how the CEMS provider will be notified and requested for CEMS services.

DHS 110.395(1)(i) (i) An explanation of how the CEMS provider will notify and integrate with the 9-1-1 system, should the patient require an ambulance.

DHS 110.395(1)(j) (j) Identification of the ambulance service provider(s) that will respond to a 9-1-1 call initiated by the CEMS provider.

DHS 110.395(1)(k) (k) Copies of each agreement or contract for providing community emergency medical services.

DHS 110.395 Note Note: When submitting copies of agreements or contracts, the submitter may redact any compensation information.

DHS 110.395(1)(L) (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.

DHS 110.395(1)(m) (m) Other information as determined by the department.

DHS 110.395(2) (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.

DHS 110.395(3) (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 110.395 History History: CR 20-028: cr. Register September 2021 No. 789, eff. 10-1-21.

DHS 110.40 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:

DHS 110.40(1) (1) The emergency medical service provider shall be licensed as a 9-1-1 emergency medical service provider.

DHS 110.40(2) (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.

DHS 110.40(4) (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 110.40 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (intro), r. (3) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.41 DHS 110.41 Air medical services.

DHS 110.41(1) (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:

DHS 110.41(1)(a) (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.

DHS 110.41(1)(b) (b) Effective July 1, 2010, only ambulance service providers licensed at the paramedic level may be licensed as air medical services providers.

DHS 110.41(2) (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.

DHS 110.41(3) (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 110.41 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (1) (intro.) Register September 2021 No. 789, eff. 10-1-21.

DHS 110.42 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:

DHS 110.42(1) (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).

DHS 110.42(2) (2) Tactical teams. To obtain department approval, an agency shall do all of the following:

DHS 110.42(2)(a) (a) Apply on a form obtained from the department.

DHS 110.42(2)(b) (b) Submit patient care protocols for the emergency medical care the agency intends to provide.

DHS 110.42(2)(c) (c) Submit an explanation of how the agency will interact with an ambulance service provider and maintain the initial level of patient care.

DHS 110.42(2)(d) (d) Submit proof of medical liability insurance.

DHS 110.42(2)(e) (e) Submit a written quality assurance and training plan for the EMS professionals that operate on the team.

DHS 110.42 Note Note: An application form may be obtained through the department’s website 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 110.42 History History: CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11; CR 20-028: am. (intro.), (2) (e) Register September 2021 No. 789, eff. 10-1-21.