On July 1, 2015, Wisconsin Governor Scott Walker signed an exemption from licensing requirements for out-of-state ambulance services.

Act 26 signed by the Governor states, "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 technician 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 technician license or training permit under this section. A first 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 a first responder certificate under this section."

The issue drew attention when Wisconsin EMS Office staff made comments earlier in the year, which the Office later tried to clarify by issuing two memos on licensing requirements.  The Office maintained the position Wisconsin licensure was required in order to provide ambulance or EMT service in Wisconsin as a statute requirement. 

Residents of Gratiot and South Wayne, both located in Lafayette County, Wisconsin, which borders Illinois, became very concerned when their primary ambulance service, located just a few miles away in Warren, Illinois, was informed by the Wisconsin EMS Office they could no longer respond into Wisconsin without licensure approval.  "Without a solution it might take up to 30 minutes for a Wisconsin ambulance to arrive to their homes (in that part of Lafayette County)", according to Assembly Rep. and bill sponsor Todd Novak.

In the opinion of many closely tied to EMS and fire department administration and industry associations in Wisconsin, the new Act 26 is not perfect by any means and leaves in question several items, to include operations mutual aid, documentation requirements, and self reporting of patient calls into Wisconsin. 

Areas with frequent mutual aid requests, like those between Beloit, Wisconsin and South Beloit, Illinois, will easily reach and even exceed 10 patient transports within the first month, not giving them sufficient time to file operation plans and submit qualifying personnel rosters to the Wisconsin EMS Office for licensure approval.  What complicates things further is Illinois does not follow National Registry EMT credentialing and administers their own state EMT test. 

Since Act 26 was a "quick fix" it really missed the mark.  A better, more long-term solution with clarifying legislative language is in the works with EMS and fire industry and association involvement.  For now, ambulance service is restored for those in border state areas, unless they exceed ten runs per year and don't have licensure approval.

>> Click to review Act 26 giving rights to certain out-of-state ambulance service providers.

EMS Section Chief

Mr. James Newlun was named the new Wisconsin EMS Section Chief with a start date of July 13.  The position has been vacant since April 2014 and was posted three separate times during the past twelve months.

Since 2002, Mr. Newlun has been an Emergency Medical Technician (EMT) with Camp Douglas Rescue. As EMT President, he was responsible for all operations, coordination of meetings, and employee/employer relations.  Since 2008, Mr. Newlun has been employed as a full-time firefighter at the Volk Field Fire Department in Camp Douglas. While acting in the capacity of Captain he was responsible for completion of daily assignments, and responses to emergencies.

From 2000 – 2011, Mr. Newlun was a member of the Camp Douglas Fire Department and Chief of the Department from 2008 – 2011.  He was responsible for managing and directing scenes as an Incident Commander, developing and maintaining the annual budget, and making all fire department purchases.  In addition, he managed up to 25 fire department personnel. 

From 2001 – 2010, Mr. Newlun was a Hazmat Technician and Safety Officer with the Juneau County Hazmat team, where he directed and coordinated functions of a comprehensive health and safety program.

In addition, Mr. Newlun has experience working with diverse community partners and grant writing. He has also served on the SCRTAC Executive Council for the past two years as the Rural Representative.

EMS/Trauma Medical Director

Ms. Ullsvik also named Dr. Suzanne Martens as the new Wisconsin EMS/Trauma Medical Director beginning July 1, 2015.  She replaces Dr. Charles Cady who served as state EMS Medical Director since 2008.  Dr. Cady's contract expires June 30, 2015.

Dr. Martens received her Doctor of Medicine degree from the Medical College of Wisconsin, where she also completed Residency.  A Fellowship in Emergency Medical Services was completed at Carolinas Medical Center in North Carolina.  Dr. Martens also has a Master of Public Health degree, and has been a licensed EMT for over 27 years.

Dr. Martens is currently the EMS and Trauma Program Medical Director at a Level III trauma facility.  For 15 years, Dr. Martens has served as the medical director for several local agencies and has the opportunity to work with all levels of EMS providers, career and volunteer, fire-based and private agencies. 

EMS education is important to Dr. Martens.  She is actively involved in the education of current and new EMTs. She visits new classes at the local technical college, serves as an adjunct instructor, and regularly sponsors education evenings for the EMS personnel in her area.

Dr. Martens has been a member of the EMS Physician Advisory Committee (PAC) since 2001 and the committee’s chair since 2008.  She has been involved in the trauma system since 2003, is an active member of the Southeast Regional Trauma Advisory Council (SERTAC), and served as its chair from 2008-2010.  

Fred Hornby leaving State's EMS Section in July

Chippewa Valley Technical College in Eau Claire will host a Community Paramedicine Forum on Monday, July 20.  The event is sponsored by the Wisconsin Office of Rural Health.

The day will include news and updates on community paramedicine in Wisconsin, a health care model designed to improve access to and quality of care in rural and urban communities.

Presentations include:

EMS, hospitals, providers, and local and state elected officials are among those who should find the Forum helpful.

The Forum will be in Room 103A of the Chippewa Valley Technical College Business Education Center, 620 W. Clairemont Ave, Eau Claire.  The $25 registration fee includes continental breakfast and lunch.

The license renewal time period was from November 1, 2013, to June 30, 2014.

The survey is open through Friday, June 26, 2015. Participant responses are completely anonymous.

This webcast discusses chain of custody, drug diversion, and best practices

>> Click to listen now to this webcast interview

Where is your ambulance service most at risk with drug diversion (theft of a controlled narcotics)?

What is your procedure if drugs go missing or the inventory count is off?

Are you routinely checking to make sure box packaging and drug containers haven't been tampered with?

What is the most common weakest link in any drug control program?  (hint:  unwitnessed wasting)

What is best for inventory management and security - a snap lock or zip tie lock?  (Hint:  one lock failed and the other didn't in deterring drug diversion.)

Did you know a DEA registration number is required for each physical location where controlled narcotics are stored?  A two station system requires two different DEA numbers.

While an ambulance service should trust its employees, sometimes the temptation for an employee to steal is too great!  Employee theft is one thing, but diverting controlled narcotics is another that raises the severity of the crime.  According to the DEA, theft of controlled narcotics most often happens when an employee suffers an injury and is taken off the prescribed pain medicine when under the care of a physician. Unfortunately, when it comes to drug diversion, it's not a matter of if something will happen, but when.  Thinking about this is the kind of stuff that gives an ambulance director sleepless nights.

We answered all the questions that led into this post and many others too during our live broadcast of Wisconsin EMS Live regarding EMS controlled narcotics, system management and drug diversion on Tuesday, June 9.  The program was recorded.

Our guests included Drug Enforcement Agency Wisconsin Supervisor Kathy Federico, Wisconsin Ambulance Inspector Paul Schilling, and Baraboo District Ambulance Chief Dana Sechler and Deputy Chief John Rago.

Listen as Dana and John share their recent event catching an employee diverting drugs, and what they did and learned from this experience.

Recommendations from the live show:

>> Click to review Wisconsin EMS Controlled Substance Management  Procedure.

>> Click for a source recommended by Baraboo District Ambulance to purchase biometric safe locks.

Most importantly, test your controlled narcotics procedures and system.  With all good intentions, and what maybe surprising results, throw inventory counts off, visibly tamper and reseal box packaging, open inventory tags - even ask employees to sign as a "witness" to an unwitnessed wasting of narcs.  It's all for the better of your system and minimizing risk.  Find ways to test your system and manage the weakest link - where are you most vulnerable?

Show co-hosts included Joe Covelli, Patrick Ryan and Dan Williams.  The full episode is 60 minutes. >> Click to listen now to this webcast interview.

Don’t miss a beat of the action – listen to Wisconsin EMS Live.  Also, check the archive for all past show episodes.

Ryan Brothers Ambulance in Madison announced it signed a distance learning agreement with Hennepin Technical College in Minneapolis.  The effort shows great collaboration between the two organizations to bring Community Paramedicine to Wisconsin. 

The online classes will be held Thursday evenings beginning August 13, 2015.  The class will be distance learning, with one Skills Day to be held in Madison, Wisconsin in October.  The class is open to those interested.

>> Click for Ryan Brothers class information and course fee.

>> Click for Hennepin Technical College CP brochure.

As we've previously reported, out of 1,000 community paramedics trained in the United States right now, Minnesota's Hennepin Technical College has trained 600 of them.

The patients typically are confined to their beds and can't be moved in a wheelchair, so they need the service that ambulances and emergency medical technicians can offer.

The Centers for Medicare and Medicaid Services is now seven months into a pilot program designed to weed out fraud in ambulance service for nonemergencies.

The agency -- and some transportation companies -- say tougher compliance is doing the trick and saving taxpayers money. But other operators say it is going overboard and putting patients' lives at risk.

What's all the fuss about?  States with the biggest increase in nonemergency ambulance trips, 2002-2011:

1. California: +554 percent

2. Georgia: +301 percent

3. South Carolina: +218 percent

4. Indiana: +183 percent

5. Pennsylvania: +159 percent

6. New Jersey: +144 percent

U.S.: +94 percent

>> Read more

Rep. Novak explains, "The residents of Gratiot and South Wayne are obviously very concerned over the thought that it might take up to 30 minutes for a Wisconsin ambulance to arrive at their home."

At present, an Illinois ambulance can no longer cross the stateline, because its volunteer staff doesn't possess a certificate that Wisconsin requires.

In his testimony today, Novak explains the National Registry Certificate has nothing to do with the quality of service, it simply makes it easier for agencies to cross state lines. Illinois doesn't require it. Novak's bill looks to make an exemption for out-of-state ambulance services that make 10 or less transports per year in Wisconsin.

Novak says, "Warren, Illinois, will only be dispatched in emergency situations. And I believe between DHS and the sheriff, we'll be able to keep track of when Warren will be dispatched out."

>> Click for video news story.

Community paramedicine is all the buzz in Wisconsin EMS right now.  We are learning a lot from our EMS friends in Minnesota, Texas, and elsewhere.  On May 25, Nevada became the newest state to pass CP legislation. 

Minnesota is years ahead of Wisconsin in developing community CP programs, legislation, curriculum, training, and licensing personnel.  Minnesota has extended to Wisconsin their assistance, so we can shorten the learning curve, get caught up, and use best practices they've already vetted as successful.  As we've previously reported, out of 1,000 community paramedics trained in the United States right now, Minnesota's Hennepin Technical College has trained 600 of them.

This past week we have fielded a lot of questions about CP and ways for those interested to get involved.  Here's my top six suggestions:

1. Sign up for the Rural Health CP list serve.  The link is https://lists.wisc.edu/read/all_forums/subscribe?name=cp.  I believe there are over 150 signed up to get information on CP.

2. PAAW created a webpage dedicated to serve as a central point of communication and information for those interested in CP.  The link is http://paaw.us/cp.

3. We've done several interviews on CP.  The two most recent are at these locations by two people leading CP in Minnesota and nationally.
a. Buck McAlpin from Minnesota (click here for audio interview)
b. Gary Wingrove from Mayo Clinic (click here for audio interview)

4.  The Paramedic Systems of Wisconsin conference in Green Bay on Thursday, Sept. 24 will include Minnesota's Buck McAlpin as a presenter speaking on CP.  PAAW is sponsoring his presentation.  The conference website is http://psow.org/.  The conference schedule will be announced sometime in July or early August.

5. PAAW President Patrick Ryan hosts every other Friday a CP conference call.  The next call is Friday, June 5 starting at 9:00 a.m.  The call in number is 646-929-1081.  The calls are also recorded and posted at the website noted above as item 2.  There have been 35 to 40 participants on a regular basis the past few months.  To be added to the call reminder list, contact Patrick at email president@paaw.us.

6. Wisconsin CP legislation in is draft form largely being discussed and driven by the group noted above as item 5.

Accept this posting as your invitation to join the CP conversation.

Our guests include Drug Enforcement Agency Wisconsin Supervisor Kathy Federico, Wisconsin Ambulance Inspector Paul Schilling, and Baraboo District Ambulance Chief Dana Sechler and Deputy Chief John Rago.

Join co-hosts Chris Anderson, Joe Covelli, Patrick Ryan and Dan Williams for the conversation.

The episode is scheduled to run 60 minutes.  As always your questions and emails will be taken during the live show.  Should you miss it each show is recorded, so just look in the archive.