Section 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.Wis. Admin. Code Department of Health Services DHS 110.50
CR 10-085: cr. Register December 2010 No. 660, eff. 1-1-11.Amended by, CR 20-028: am. (1) (intro.), (a) to (c), renum. (1) (d) 1. to (1) (d) 1. (intro.) and am., cr. (1) (d) 1. a. to c., am. (1) (d) 2., renum. (1) (d) 3. to (1) (d) 3. (intro.) and am., cr. (1) (d) 3. a. to c., am. (1) (d) 4., (e) to (g), (2), cr. (2m), am. (3) (intro.), r. (3) (b), cr. (4) Register September 2021 No. 789, eff. 10-1-21; correction in (3) (intro.) made under s. 35.17, Stats., Register September 2021 No. 789, eff. 10/1/2021