(1) Definitions. In this section:
(ag) “Act of terrorism” means a felony under ch. 939 to 951 that is committed with intent to terrorize and is committed under any of the following circumstances:
1. The person committing the felony causes bodily harm, great bodily harm, or death to another.
2. The person committing the felony causes damage to the property of another and the total property damaged is reduced in value by $25,000 or more. For purposes of this subdivision, property is reduced in value by the amount that it would cost either to repair or replace it, whichever is less.
3. The person committing the felony uses force or violence or the threat of force or violence.
(cr) “Automated external defibrillator” means a defibrillator device to which all of the following apply:
1. It is approved for commercial distribution by the federal food and drug administration.
2. It is capable of recognizing the presence or absence of ventricular fibrillation or rapid ventricular tachycardia and of determining without intervention by the user of the device whether defibrillation should be performed.
3. After having determined that defibrillation should be performed, it is capable, either at the command of an operator or without intervention by an operator, of delivering an electrical shock to an individual.
(d) “Basic life support” means emergency medical care that is rendered to a sick, disabled, or injured individual, based on signs, symptoms, or complaints, prior to the individual’s hospitalization or while transporting the individual between health care facilities and that is limited to use of the knowledge, skills, and techniques received from training required for licensure as an emergency medical technician, or for certification as an emergency medical responder.
(dm) “Defibrillation” means administering an electrical impulse to an individual’s heart in order to stop ventricular fibrillation or rapid ventricular tachycardia.
(hr) “Governmental unit” means the United States; the state; any county, city, village, or town; or any political subdivision, department, division, board, or agency of the United States, the state, or any county, city, village, or town.
(i) “Indian tribe” means a federally recognized American Indian tribe or band in this state.
(ig) “Intent to terrorize” means intent to influence the policy of a governmental unit by intimidation or coercion, to punish a governmental unit for a prior policy decision, to affect the conduct of a governmental unit by homicide or kidnapping, or to intimidate or coerce a civilian population.
(ij) “Interfacility transport” means any transfer of a patient between health care facilities or any nonemergent transfer of a patient.
(im) “Manual defibrillator” means a heart monitor and defibrillator that:
1. Is operated only after an operator has first analyzed and recognized an individual’s cardiac rhythm;
2. Charges and delivers, only at the command of the operator, an electrical impulse to an individual’s heart; and
3. In the case of a defibrillator that may be operated as a manual defibrillator or as an automated external defibrillator, is set to operate as a manual defibrillator.
(iw) “Mutual aid” means emergency medical care provided in another service area when the primary ambulance service provider in that area requires additional resources because it has already committed all its resources to other emergency responses.
(L) “Person” includes an individual, firm, partnership, association, corporation, trust, foundation, company, public agency or a group of individuals, however named, concerned with the operation of an ambulance.
(n) “Public agency” means this state, a county, city, village or town; an agency of this state or of a county, city, village or town; or an Indian tribe.
(p) “Ventricular fibrillation” means a disturbance in the normal rhythm of the heart that is characterized by rapid, irregular and ineffective twitching of the ventricles of the heart.
(2) License or certificate required; exceptions.
(a) Except when acting under s. 257.03 and except as provided in pars. (b) and (c), no person may act as or advertise for the provision of services as an ambulance service provider unless the person holds an ambulance service provider license issued under this section. Except when acting under s. 257.03 and except as provided in pars. (b) and (c), no individual may act as or advertise for the provision of services as an emergency medical services practitioner unless he or she holds an emergency medical services practitioner license or training permit issued under sub. (5). Except when acting under s. 257.03 and except as provided in pars. (b) and (c), no individual may act as or advertise for the provision of services as an emergency medical responder unless he or she holds an emergency medical responder certificate issued under sub. (8).
(b) An ambulance service provider licensed in another state that makes 10 or fewer patient transports per year that originate and terminate within this state is not required to hold an ambulance service provider license under this section. An emergency medical services practitioner licensed in or holding a training permit in another state who is involved in 10 or fewer patient transports per year that originate and terminate within this state is not required to hold an emergency medical services practitioner license or training permit under this section. An emergency medical responder certified in another state who provides emergency medical care to 10 or fewer patients per year within this state is not required to hold an emergency medical responder certificate under this section.
(c) Notwithstanding par. (a), a person may act as an ambulance service provider, emergency medical services practitioner, or emergency medical responder without a license, training permit, or certificate described under par. (a) if all of the following apply:
1. The person holds a valid license, training permit, certificate, or other credential allowing the person to act as an ambulance service provider, emergency medical services practitioner, or emergency medical responder in another state.
2. The person is acting in response to a request for mutual aid and responding from the state in which that person holds a license, training permit, certificate, or other credential allowing the person to act as an ambulance service provider, emergency medical services practitioner, or emergency medical responder.
(3) Exception to treatment. This section and the rules promulgated under this section may not be construed to authorize the provision of services or treatment to any individual who objects for reasons of religion to the treatment or services, but may be construed to authorize the transportation of such an individual to a facility of the individual’s choice within the jurisdiction of the emergency medical service.
(4) Ambulance staffing; limitations; rules.
(a) If a sick, disabled or injured individual is transported by ambulance, any of the following combinations of other individuals shall be present in the ambulance:
1. Any 2 emergency medical services practitioners, licensed registered nurses, licensed physician assistants or physicians, or any combination thereof.
2. One emergency medical services practitioner plus one individual with a training permit issued under sub. (5) (b) or plus one emergency medical responder, subject to par. (e).
3. If the ambulance is an aircraft and the sick, disabled, or injured individual is a pediatric patient who is being transferred from one hospital to another hospital, one individual specified in subd. 1. plus one respiratory care practitioner who is certified under subch. II of ch. 448 or who holds a compact privilege under subch. XV of ch. 448.
4. If the ambulance is engaged in a nonemergent interfacility transport, one emergency medical technician who is in the patient compartment during transport of the patient and one individual who has a certification in cardiopulmonary resuscitation, through a course approved by the department.
(b) An ambulance driver who is not an emergency medical services practitioner may assist with the handling and movement of a sick, injured, or disabled individual if an emergency medical services practitioner, registered nurse, physician assistant, or physician directly supervises the driver. No ambulance driver may administer care procedures that an emergency medical services practitioner is authorized to administer unless he or she is an emergency medical services practitioner.
(c) Notwithstanding par. (a) 1. and 2. and subject to pars. (d) and (e), the department may promulgate rules that establish standards for staffing of ambulances in which the primary services provided are those which an advanced emergency medical technician or emergency medical technician — intermediate is authorized to provide or those which a paramedic is authorized to provide.
(d) If an ambulance service provider that was initially licensed at the paramedic level in 1993 and is located in a municipality in Dodge and Jefferson counties has dispatched an ambulance containing 2 paramedics, the department shall allow that ambulance service provider to staff an ambulance at the paramedic level for a subsequent call with one paramedic and one emergency medical services practitioner of any level while the first ambulance containing 2 paramedics is occupied providing service.
(e)
1. The department shall allow an ambulance service provider providing services at the emergency medical technician level to staff an ambulance with at least one emergency medical technician and one individual who is an emergency medical technician, an individual with an emergency medical technician training permit, or an emergency medical responder. An ambulance service provider providing services at the emergency medical technician level shall require an emergency medical technician to be in the patient compartment of the ambulance during transport.
2. The department shall allow an ambulance service provider providing services at the emergency medical technician — intermediate or advanced emergency medical technician level to staff an ambulance with one emergency medical services practitioner at the level of the ambulance service and one individual who holds a credential at the emergency medical responder level or higher. An ambulance service provider providing services at the emergency medical technician — intermediate or advanced emergency medical technician level shall require the individual who holds the same level credential as the ambulance service to remain with the patient at all times during care and transport of the patient, if the patient requires that level of care.
3. This paragraph applies to ambulance service providers for which the population of the largest single municipality, as defined in s. 5.02 (11), in the ambulance service provider’s service area is less than 10,000 and to ambulance service providers with a staffing waiver under par. (f). This paragraph does not apply to ambulance service providers for which the population of the largest single municipality, as defined in s. 5.02 (11), in the ambulance service provider’s service area is more than 20,000.
(f)
1. An ambulance service provider for which the population of the largest single municipality, as defined in s. 5.02 (11), in the ambulance service provider’s service area is 10,000 or more but not more than 20,000 may apply to the department for a waiver of any existing staffing plan in order to staff an ambulance with the personnel described in par. (e).
2. The department may approve a waiver under subd. 1. for an ambulance service provider that demonstrates all of the following:
a. The ambulance service provider has undertaken efforts to recruit and train emergency medical services practitioners capable of being licensed under this section.
b. Despite efforts under subd. 2. a., licensed emergency medical services practitioners are not available in sufficient numbers for staffing for the ambulance services provider.
c. Without a waiver under subd. 1., the municipality that the ambulance service provider serves is unable to meet staffing requirements for ambulances that require 2 emergency medical services practitioners on every service call.
3. The department shall provide a written staffing waiver to any ambulance service provider it approves under subd. 2.
4. A waiver under subd. 1. is valid for 48 months after the date of issuance, and an ambulance service provider may apply to renew the waiver.
5. An ambulance service provider with a waiver under subd. 1. shall attempt to staff an ambulance with 2 licensed emergency medical services practitioners whenever possible.
(4m) Upgrade to ambulance service level.
(a) In this subsection, “rural ambulance service provider” means an ambulance service provider for which the population of the largest single municipality, as defined in s. 5.02 (11), in the ambulance service provider’s service area is less than 10,000.
(b) An ambulance operated by a rural ambulance service provider that is licensed under sub. (5) at any level may upgrade its service level to the highest level of license of any emergency medical services practitioner staffing that ambulance if the medical director approves a proposal submitted to him or her by the rural ambulance service provider.
(c) A rural ambulance service provider that upgrades its service under par. (b) may advertise only the level of service that the rural ambulance service provider is able to provide 24 hours per day.
(d) A rural ambulance service provider that is intending to upgrade its service under par. (b) shall submit to the department an update to its operational plan including a description of its intention to upgrade. The department may not require a rural ambulance service provider to stock an ambulance with equipment to perform all functions that the emergency medical services practitioner with the highest level of license may perform in order to upgrade the ambulance service level under par. (b).
(5) Licensing of ambulance service providers and emergency medical services practitioners; training permits.
(a) Except as provided in ss. 256.17 and 256.18, the department shall license qualified applicants as ambulance service providers or emergency medical services practitioners. The department shall, from the information on the certification form specified under sub. (6) (c) 2., establish in each ambulance service provider’s license the primary service or contract area of the ambulance service provider.
(b) The department shall promulgate rules establishing a system and qualifications for issuance of training permits, except as provided in ss. 256.17 and 256.18, and specifying the period for which an individual may hold a training permit. The department shall consider any relevant education, training, instruction, or other experience that an applicant for a training permit has obtained in connection with any military service, as defined in s. 111.32 (12g) to count toward satisfying the education or training qualifications for issuance of training permits, if the applicant demonstrates to the satisfaction of the department that the education, training, instruction, or other experience obtained by the applicant is substantially equivalent to the education or training qualifications required for the training permit.
(c) A training permit application shall be signed by an ambulance service provider.
(d) An individual who holds a training permit issued under par. (b) may do the following:
1. If issued an emergency medical technician training permit, he or she may perform the actions authorized under rules promulgated by the department for an emergency medical technician, but only if an emergency medical services practitioner directly supervises him or her.
2. If issued an emergency medical technician — intermediate training permit, he or she may perform the actions authorized under rules promulgated by the department for an emergency medical technician — intermediate, but only if a medical director or training instructor is present and giving direction.
2m. If issued an advanced emergency medical technician training permit, he or she may perform the actions authorized under rules promulgated by the department for an advanced emergency medical technician, but only if a medical director or training instructor is present and giving direction.
3. If issued a paramedic training permit, he or she may perform the actions authorized under rules promulgated by the department for a paramedic, but only if a medical director or training instructor is present and giving direction.
(e) A license or training permit issued under this subsection is nontransferable and is valid for the balance of the license or training permit period or until surrendered for cancellation or suspended or revoked for violation of this section or of any other statutes or rules relating to ambulance service providers or emergency medical services practitioners.
(f) The department may charge a reasonable fee for a license or training permit issued under this subsection, except that no fee may be charged to an individual who is an employee of a public agency and who works for volunteer or paid-on-call ambulance service providers and who is an applicant for a license as an emergency medical technician or for a training permit, and no fee may be charged to an individual who is eligible for the veterans fee waiver program under s. 45.44.
(g) Except as provided in ss. 256.17 and 256.18, an emergency medical services practitioner license shall be issued to the individual licensed, and the department may not impose a requirement that an individual be affiliated with an ambulance service provider in order to receive an emergency medical services practitioner license or to have an emergency medical services practitioner license renewed.
(6) Qualifications for licensure.
(a) Except as provided in ss. 256.17 and 256.18, to be eligible for an initial license as an emergency medical services practitioner, an individual shall:
1. Be 18 years of age or older; be capable of performing the actions authorized in rules promulgated under sub. (13) (c) for an emergency medical technician, an advanced emergency medical technician, an emergency medical technician — intermediate, or a paramedic, for which licensure is sought; and, subject to ss. 111.321, 111.322 and 111.335, not have an arrest or conviction record.
2. Have satisfactorily completed a course of instruction and training, including training for response to acts of terrorism, prescribed by the department or have presented evidence satisfactory to the department of sufficient education and training in the field of emergency care. The department shall consider as satisfactory evidence of education and training in the field of emergency care any relevant education, training, instruction, or other experience that an applicant for an initial license obtained in connection with any military service, as defined in s. 111.32 (12g), if the applicant demonstrates to the satisfaction of the department that the education, training, instruction, or other experience obtained by the applicant is substantially equivalent to the course of instruction and training required under this subdivision.
3. Have passed an examination approved by the department.
4. Have such additional qualifications as may be required by the department.
(b)
1. Except as provided in ss. 256.17 and 256.18, to be eligible for a renewal of a license as an emergency medical services practitioner, the licensee shall, in addition to meeting the requirements of par. (a) 1., complete the training, education, or examination requirements specified in rules promulgated under subd. 2.
2. The department, in conjunction with the technical college system board, shall promulgate rules specifying training, education, or examination requirements, including requirements for training for response to acts of terrorism, for license renewals for emergency medical services practitioners.
(c) Except as provided in ss. 256.17 and 256.18, to be eligible for a license as an ambulance service provider, an individual shall be 18 years of age or older and have such additional qualifications as may be established in rules promulgated by the department, except that no ambulance service provider may be required to take training or an examination or receive education to qualify for licensure or for renewal of licensure. An ambulance service provider shall, as a condition of licensure, provide medical malpractice insurance sufficient to protect all emergency medical services practitioners who perform for compensation as employees of the ambulance service provider. For renewal of a biennial license as an ambulance service provider, an applicant shall also provide all of the following:
1. A financial report, on a form developed and provided by the department, of all expenditures made in the 2 previous fiscal years from all funds provided to the ambulance service provider under s. 256.12 (4).
2. Certification, on a form developed and provided by the department, signed by a representative of the ambulance service provider and the clerk of each county, city, town or village served by the ambulance service provider, of the population and boundaries of the ambulance service provider’s primary service or contract area in that county, city, town or village.
(6g) Certification for performance of defibrillation.
(a) Except as provided in ss. 256.17 and 256.18, the department shall certify qualified applicants for the performance of defibrillation, under certification standards that the department shall promulgate as rules.
(b) A certificate issued under this subsection shall specify whether the holder of the certificate is authorized to perform defibrillation by use of any of the following:
2m. An automated external defibrillator.
3. A manual defibrillator.
(6n) Authorized actions of emergency medical services practitioners. An emergency medical services practitioner may undertake only those actions that are authorized in rules promulgated under sub. (13) (c).
(6p) Delegation from a health care provider. An emergency medical services practitioner who is acting upon a delegation by a health care provider does not violate the actions authorized for emergency services under sub. (6n) for actions taken in accordance with that delegation if all of the following criteria are satisfied:
(a) The health care provider delegates to the emergency medical services practitioner only actions that are within the scope of the health care provider’s credential and competency.
(b) The health care provider ensures that the action is delegated to an emergency medical services practitioner who is adequately knowledgeable and trained to perform the delegated action.
(7) Licensing in other jurisdictions. Except as provided in ss. 256.17 and 256.18, the department may issue a license as an emergency medical services practitioner, without examination, to any individual who holds a current license or certificate as an emergency medical services practitioner from another jurisdiction if the department finds that the standards for licensing or issuing certificates in the other jurisdiction are at least substantially equivalent to those in this state, and that the applicant is otherwise qualified.
(8) Certification of emergency medical responders.
(a) Except as provided in ss. 256.17 and 256.18, the department shall certify qualified applicants as emergency medical responders.
(b) To be eligible for initial certification as an emergency medical responder, except as provided in ss. 256.17 and 256.18, an individual shall meet all of the following requirements:
1. The individual is 18 years of age or older and capable of performing the actions authorized under par. (e), or in rules promulgated under par. (e), for an emergency medical responder.
2. Subject to ss. 111.321, 111.322 and 111.335, the individual does not have an arrest or conviction record.
3. The individual satisfactorily completes an emergency medical responder course that meets or exceeds the guidelines issued by the National Highway Traffic Safety Administration under 23 CFR 1205.3 (a) (5), that includes training for response to acts of terrorism, and that is approved by the department. Any relevant education, training, instruction, or other experience that an applicant for initial certification as an emergency medical responder who is not affiliated with an ambulance service provider or emergency medical services program obtained in connection with any military service, as defined in s. 111.32 (12g), satisfies the completion of an emergency medical responder course, if the applicant demonstrates to the satisfaction of the department that the education, training, instruction, or other experience obtained by the applicant is substantially equivalent to the emergency medical responder course.
(bm) The department may not require an applicant for certification as an emergency medical responder to register with or take the examination of the national registry of emergency medical technicians. An ambulance service provider or another emergency medical services program may require an emergency medical responder to register with or take the examination of the national registry of emergency medical technicians as a condition of being employed by or volunteering with the provider or program.
(c) To be eligible for a renewal of a certificate as an emergency medical responder, except as provided in ss. 256.17 and 256.18, the holder of the certificate shall satisfactorily complete an emergency medical responder refresher course that meets or exceeds the guidelines issued by the National Highway Traffic Safety Administration under 23 CFR 1205.3 (a) (5), that includes training for response to acts of terrorism, and that is approved by the department.
(cm) Every holder of a certificate issued under this subsection shall renew the certificate every 3 years by applying to the department on forms provided by the department. Upon receipt of an application for renewal containing documentation acceptable to the department that the requirements for certification have been met, the department shall renew the certificate unless the department finds that the applicant has acted in a manner or under circumstances constituting grounds for suspension or revocation of the certificate.
(d) The department may not charge a fee for a certificate initially issued or renewed under this subsection.
(e) A certified emergency medical responder is authorized to use an automated external defibrillator, as prescribed for emergency medical responders in rules promulgated by the department. The rules shall set forth authorization for the use of an automated external defibrillator or, for a defibrillator that may be operated in more than one mode, use as an automated external defibrillator only. A certified emergency medical responder is authorized to administer naloxone or another opioid antagonist if the emergency medical responder has received training necessary to safely administer naloxone or the other opioid antagonist, as determined by the department. A certified emergency medical responder is also authorized to employ other techniques, including the administration of nonvisualized advanced airways, and the administration of medications that are specified by the department by rule. In promulgating the rules under this paragraph, the department shall consult with the state medical director for emergency medical services and the emergency medical services board. The rule shall include those techniques that are specified in the most current guidelines issued by the National Highway Traffic Safety Administration under 23 CFR 1205.3 (a) (5).
(f) Except as provided in ss. 256.17 and 256.18, the department may issue a certificate as an emergency medical responder, without requiring satisfactory completion of any instruction or training that may be required under par. (b), to any individual who holds a current license or certificate as an emergency medical responder from another jurisdiction if the department finds that the standards for licensing or issuing certificates in the other jurisdiction are at least substantially equivalent to the standards for issuance of certificates for emergency medical responders in this state, and that the applicant is otherwise qualified.
(fm) Except as provided in ss. 256.17 and 256.18, the department shall issue a certificate as an emergency medical responder, without requiring satisfactory completion of any instruction or training that may be required under par. (b), to any individual who meets the criteria under par. (b) 1. and 2. and has obtained relevant education, training, and experience in connection with military service, as defined in s. 111.32 (12g). The determination of whether an individual has obtained relevant education, training, and experience is solely within the discretion of the ambulance service provider or emergency medical services program with which the individual intends to be employed or to volunteer.
(g) The department may not impose a requirement that an individual be affiliated with an ambulance service provider in order to receive an emergency medical responder certificate.
(8m) Qualifications for medical directors. The department shall promulgate rules that set forth qualifications for medical directors. Beginning on July 1, 1995, no ambulance service provider that offers services beyond basic life support services may employ, contract with or use the services of a physician to act as a medical director unless the physician is qualified under this subsection.
(9) Training. The department may arrange for or approve courses of or instructional programs in or outside this state to meet the education and training requirements of this section, including training required for license or certificate renewal. If the department determines that an area or community need exists, the courses shall be offered at technical colleges in the area or community. Initial priority shall be given to the training of emergency medical technicians serving the rural areas of the state. If an emergency medical technician completes a course approved by the department on treatment of anaphylactic shock, the emergency medical technician acts within the scope of the license if he or she performs injections or other treatment for anaphylactic shock under the direction of a physician.
(9m) Defibrillation training. The department shall promulgate rules requiring emergency medical services practitioners, emergency medical responders, and individuals who provide instruction to emergency medical services practitioners or emergency medical responders to successfully complete training on the use of an automated external defibrillator. The rules shall specify the content of the training, qualifications for providers of the training, and the frequency with which emergency medical services practitioners, emergency medical responders, and individuals who provide instruction to emergency medical services practitioners or emergency medical responders must complete the training.
(10) License renewal. Every holder of a license issued under sub. (5) or (7) shall renew the license every 3 years by applying to the department on forms provided by the department. Upon receipt of an application for renewal containing documentation acceptable to the department that the requirements of sub. (6) have been met, the department shall renew the license unless the department finds that the applicant has acted in a manner or under circumstances constituting grounds for suspension or revocation of the license.
(10m) Exclusive arrangements prohibited. An ambulance service provider or emergency medical services program may not prohibit an emergency medical responder or emergency medical services practitioner who is employed by or volunteering with the ambulance service provider or emergency medical services program from being employed by or volunteering with another ambulance service provider or emergency medical services program.
(11) Unlicensed or uncertified operation. Notwithstanding the existence or pursuit of any other remedy, the department may, in the manner provided by law, upon the advice of the attorney general, who shall represent the department in all proceedings, institute an action in the name of the state against any person for any of the following:
(a) To restrain or prevent action as an ambulance service provider by a person in violation of sub. (2) (a).
(b) To restrain or prevent action by an ambulance service provider in violation of this section or a rule promulgated under this section.
(c) To restrain or prevent action as an emergency medical services practitioner by an individual in violation of sub. (2) (a).
(d) To restrain or prevent action by an emergency medical services practitioner in violation of this section or a rule promulgated under this section.
(e) To restrain or prevent the establishment, management or operation of an ambulance service in violation of sub. (4).
(f) To restrain or prevent action by an emergency medical responder in violation of this section or a rule promulgated under this section.
(12) Confidentiality of records.
(a) All records made by an ambulance service provider, an emergency medical services practitioner, or an emergency medical responder in administering emergency care procedures to and handling and transporting sick, disabled, or injured individuals shall be maintained as confidential patient health care records subject to s. 252.15 (3m), (6), (8) and (9), if applicable. Nothing in this paragraph or ss. 146.81 to 146.84 permits disclosure to an ambulance service provider, an emergency medical services practitioner, or an emergency medical responder under s. 252.15 (3m), except under s. 252.15 (3m) (e).
(b) Notwithstanding s. 146.82, an ambulance service provider, who is an authority, as defined in s. 19.32 (1), may make available, to any requester, information contained on a record of an ambulance run which identifies the ambulance service provider and emergency medical services practitioners involved; date of the call; dispatch and response times of the ambulance; reason for the dispatch; location to which the ambulance was dispatched; destination, if any, to which the patient was transported by ambulance; and name, age and gender of the patient. No information disclosed under this paragraph may contain details of the medical history, condition, or emergency treatment of any patient.
(13) Rules.
(a) The department may promulgate rules necessary for administration of this section.
(b) The department shall promulgate rules under subs. (8) (b), (c) and (e) and (8m).
(c) The department shall promulgate rules that specify actions that emergency medical services practitioners may undertake after December 31, 1995, including rules that specify the required involvement of physicians in actions undertaken by emergency medical services practitioners.
