Capitol Update
by Senator Howard Marklein
December 6, 2019


My First Response to My EMS Summits

Legislation drafted to support local, rural volunteer emergency medical providers


As you may know, I have been working on ways to support and promote rural, volunteer Emergency Medical Service (EMS) providers in Wisconsin. I held four summits with local volunteers this fall and have been working through all of the ideas and input I gathered along the way.
I recently circulated three bills to address several of the largest obstacles we identified throughout the 17th Senate District.  I also met with Morna Foy, the President of the Wisconsin Technical College System to discuss ways we can improve EMS training programs at all of our technical colleges.  This conversation was extremely productive and I will continue to connect with Morna and her team to insure that training for emergency responders is consistent and relevant on every campus. In addition, I cleared up several misunderstandings of regulatory policy for individual departments. We are making progress!
The first bill I authored is an omnibus bill that covers a lot of different topics including the burden of collecting signatures for the Funding Assistance Program (FAP), ambulance staffing for low-risk, non-emergency transports (ie: hospital to nursing home), flexible staffing requirements and prohibiting exclusive arrangements.  It is important to note that all of the regulatory changes in this legislation create options for our departments. I do not seek to lower standards or force change. I want to give departments options to meet the unique needs of their own communities.
Each year ambulance service providers have to fill out paperwork to receive state money through the FAP. Part of the application process requires collecting in-person, paper signatures from every local clerk within that department’s service area. This takes time and effort for volunteers who would rather be helping assist on calls. For example – Boscobel needs the signatures of 13 different clerks!  This bill will allow clerks to submit electronic signatures directly to DHS and only require an update to the population data every 10 years (after each census) or if the service area of the ambulance service provider changes.
At every summit, I heard that our local, rural volunteer departments are starving for volunteers. Ambulances often make low-risk transports, but they are still required to have the same staffing for the ambulance as if they are on a regular call.  A low-risk transport could be driving a person from a hospital back to a nursing home or to rehab. We heard that easing the transport requirements for low-risk transports may help rural service providers who are already struggling to meet requirements for routine calls.
We also heard that the Department of Health Services (DHS) has been misinterpreting a law passed by the legislature during the last legislative session. 2017 Act 97 permits a rural ambulance service provider to upgrade its service level to the highest level of any emergency medical services practitioner staffing an ambulance for the provider if the service provider’s medical director approves For example, if a paramedic-certified volunteer is serving on a EMT-level ambulance, they should be allowed to use all of their skills. No one should not be limited from saving a life, if they are trained and capable. 
Unfortunately, DHS has interpreted this law to require ambulances to be stocked for any level of service that may be performed by a volunteer. This was not the legislative intent of our law and is an unrealistic burden on our small, rural services. My bill clarifies that an ambulance does not have to be stocked at the highest level that someone on board would be able to perform.  Instead the person may perform care up to their level of certification.
Speaking of trained Paramedics, I discovered that there are some highly-trained, qualified people who live in our small, rural communities who are prohibited from volunteering on our local EMS teams by their employers. I was shocked to hear that there are a couple of large, urban EMS departments that prohibit their employees from volunteering their time on volunteer departments. They say that they worry about the person getting hurt. I would wager that a person is more likely to get hurt playing church league softball than dedicating their considerable skill, talent and knowledge to saving the life of their neighbors. This bill would prevent any paid, professional department from prohibiting a person from volunteering during their personal time.
I also authored a bill to make the National Registry Test (NREMT) optional for volunteers who are seeking to serve at the Emergency Medical Responder (EMR) level of service. Each local service would be allowed to determine whether they will require the test for their volunteers. This bill would simply give them the option.  No less than 21 other states do not require the NREMT for EMRs. Many of the volunteers who attended my summits told me about potential volunteers who are not participating because of this test. They either struggle with the test or struggle with test-taking in general. Removing this obstacle may enable some departments to recruit more volunteers.
Finally, I authored a bill to make the FAP financially whole. The program started in 1989 with $2.2 million, but it has been cut to $1.96 million. My bill adds $239,800 in General Purpose Revenue (GPR) to the appropriation to provide better support to departments.
This package of Rural EMS legislation is a small step toward supporting our local, rural volunteer EMS providers. It removes some obstacles, improves state-level regulation and makes the funding whole. We still have work to do, but I am proud of these initiatives to support the local men and women who respond when we need them.
For more information and to connect with me, visit my website http://legis.wisconsin.gov/senate/17/marklein and subscribe to my weekly E-Update by sending an email to Sen.Marklein@legis.wisconsin.gov. Do not hesitate to call 800-978-8008 if you have input, ideas or need assistance with any state-related matters.

Marklein represents the 17th Senate District, which includes all or parts Grant, Green, Iowa, Juneau, Lafayette, Monroe, Richland, Sauk and Vernon counties. Marklein serves on the legislature’s budget-writing Joint Finance Committee and is Chair of the Senate Committee on Agriculture, Revenue & Financial Institutions.