For Elected Officials

Welcome. This page is your one-stop resource for understanding the United States EMS Compact and how your state can join. Whether you are a legislator, legislative staffer, or executive-branch official, you will find clear, actionable information below.

🏛️ How Does My State Join the EMS Compact?

1. Pass the Model Legislation

   Your state must enact the EMS Compact model legislation without changes. This legislation functions as state law and a binding contract between your state and all other Member States.

   ➤ View Model Legislation | Download .docx

2. Designate a Compact Commissioner

   Once enacted, the Governor (or designee) appoints your state’s Compact Commissioner, typically the State EMS Director or a designee. The Commissioner serves as your state’s voting member on the Interstate Commission for EMS Personnel Practice.

3. Integrate with the National EMS Coordinated Database (NEMSCD)

   Your state EMS agency partners with the Commission to securely submit and manage licensure data via the NEMSCD.

   Note: The state does not pay a fee to join the Compact; limited technical integration may be required depending on existing systems.

4. Go Live

   After legislation, appointment, and integration are complete, your state becomes a fully operational EMS Compact Member.

• EMS clinicians licensed in your state gain an immediate Privilege to Practice in all other Member States.
• Your state gains access to a qualified workforce of over 400,000 EMS clinicians who can respond during emergencies, disasters, or staffing needs.

Legislative Support by the Numbers

Since 2015, the EMS Compact has received overwhelming bipartisan support in state legislatures. In the 25 Member States, more than 3,300 legislators have voted on Compact legislation, with only 59 “no” votes in Houses and 2 in Senates. The table below highlights the breadth of support.

🔍 Want to See What Interstate Compacts Your State Already Uses?

The Council of State Governments maintains a searchable database of active interstate compacts by state and topic.

➤ Search the Interstate Compacts Database

Tip: Search by state, topic area, or compact name.

🚨 Benefits to States, Agencies, and Clinicians

The EMS Compact equips states with modern tools to support a flexible, mobile, and accountable EMS workforce. It is designed for everyday workforce solutions, not only disaster response.

Five Key Benefits

1. Reliable Workforce for Long- and Short-Term Needs

Agencies gain access to more than 400,000 qualified EMS clinicians who meet common standards for education, testing, and background checks. This supports rural coverage, vacancy backfill, and large events, without unnecessary red tape.

2. Advanced Public Protection and Oversight

Your State EMS Office receives secure access to the NEMSCD and authority to:

• Track and share licensure history
• Receive timely notifications of disciplinary actions or investigations
• Conduct cross-border investigations
• Issue subpoenas across state lines

These tools promote transparency and patient safety in ways no single state can achieve alone.

3. Professional Mobility for a Modern Workforce

EMS aligns with mobility already used by other professions. Clinicians can hold a single state license and practice across state lines, improving flexibility, reducing burnout, and supporting retention.

4. Readiness Without Delay

Beyond long-term workforce support, the Compact enables immediate mutual aid during disasters, mass gatherings, or major incidents. Clinicians can cross state lines and begin work without waiting for emergency declarations or temporary waivers.

5. A State Voice in National EMS Policy

Each Member State appoints a voting Commissioner to the Commission, the governmental body that administers the Compact. Your state’s EMS leadership helps shape national solutions while protecting local interests.

Links & Bookmarks for Legislators

• Model EMS Compact Legislation
• Key EMS Compact Terms & Definitions
• Member States & Commissioners
• Compact History & Origins
• Compact Governance
• Commission Leadership
• EMS Personnel
• EMS Agencies
• Facts & Benefits

Understanding Interstate Compacts

The “Bench Book” developed by the Interstate Commission for Adult Offender Supervision (ICAOS) is a widely used resource on compact law for judges, court personnel, lawyers, and legislators. Selected chapters:

• 1.1 Who Must Comply with an Interstate Compact?
• 1.2 Nature of Interstate Compacts
• 1.2.2 Compacts Are Not Uniform Laws
• 1.3 Delegation of State Authority to an Interstate Commission
• 1.4 Congressional Consent Requirement
• 1.6 State Law Conflicts with an Interstate Compact

National Center for Interstate Compacts

The Council of State Governments operates the National Center for Interstate Compacts. CSG notes that interstate compacts provide an efficient means to enable borderless practice for licensed professionals and military spouses, reducing the burden of holding multiple licenses.

Since January 2016, states have enacted more than 250 pieces of licensure-compact legislation. Today, all fifty states and several territories participate in one or more occupational licensure compacts.

CSG Resources

• Overview of Health & Occupational Interstate Compacts
• Multistate Problem Solving with Interstate Compacts
• National Center for Interstate Compacts

Development in Interstate Law

Explore recent judicial, legislative, and administrative developments in compact law, including impacts on transportation, environment, and public safety. Authored by Jeffrey B. Litwak and Marisa Fiat.

Developments in Interstate Compact Law and Practice 2022

Legislative Frequently Asked Questions

How much will the EMS Compact cost my state?

Answer: There are no fees charged by the Commission to states or to EMS clinicians. The Commission has statutory authority, like other compact commissions, to levy assessments, but it has never imposed them. A multi-year grant from the National Registry of EMTs currently supports Commission operations and the NEMSCD, avoiding state assessments.

Can the Commission pass rules without public comment?

Answer: No. REPLICA Section 12, “Rulemaking,” requires a public process that includes notice, written comment, and the ability to request a hearing. Each Member State is represented by a voting Commissioner who participates in deliberations and rulemaking.

Does the EMS Compact compromise quality of care?

Answer: No. The Compact raises baseline protections by requiring common entry standards (education, examination), FBI-compliant background checks for initial licensure, medical direction, and coordinated data sharing. Under Section 8, if a home-state license is restricted or suspended, the Privilege to Practice is not valid in other states until restored. Any Member State may act on a clinician’s Privilege to Practice based on another state’s factual findings, using its own due process.

Are Commissioners accountable to the public?

Answer: Yes. Commissioners are public officials, typically executive-branch leaders responsible for EMS. The Commission is a public body subject to open-meeting requirements, and Commissioners are accountable to their state leadership and the public.

Does the Compact expand immunity for Commissioners?

Answer: No. Commissioners have the same immunity they hold in their state roles; REPLICA extends that existing immunity to their Commission duties, it does not expand it.

Does the Compact make government more bureaucratic?

Answer: Compacts reduce duplication by creating uniform rules for cross-border issues that no single state can resolve alone. They preserve state sovereignty while enabling shared solutions.

Can the Commission impact state rights over time through rulemaking?

Answer: No. The Commission may adopt rules only to administer the Compact’s interstate functions, through a public process. States retain full authority over licenses they issue.

Are there controls over provider and agency quality?

Answer: Yes. The Compact’s entry standards, background checks, medical direction, use of home-state scope, and coordinated data strengthen public protection and accountability.

Can a Member State withdraw from the EMS Compact?

Answer: Yes. A state may withdraw by statute repealing the agreement, as outlined in Section 14 of the Model Legislation. Obligations for reporting before the effective date of withdrawal remain in place.

Endorsements

The EMS Compact reflects a multi-year national collaboration. Many organizations support it:

The Council of State Governments – Resolution of Support

CSG passed a formal resolution supporting REPLICA on August 13, 2014.

International Association of EMS Chiefs – Statement of Support

“The International Association of EMS Chiefs is pleased to support the efforts of REPLICA… This compact directly benefits the boots-on-the-ground provider and the patients they treat.” – October 29, 2017

National Registry of Emergency Medical Technicians – Statement of Support

See the National Registry’s statement of support, August 2016.

National EMS Advisory Council – Final Advisory on REPLICA

“Activation of REPLICA in every State and Territory is in line with the NEMSAC core values…” – September 8, 2016. Read the Final Advisory.

National Volunteer Fire Council

“The adoption of the compact will make it easier for EMS personnel in different states to cooperate in the delivery of services.” – NVFC, September 25, 2014

Supporting National Associations and Organizations

• American Ambulance Association
• Association of Air Medical Services
• Association of Critical Care Transport
• Council of State Governments
• International Association of EMS Chiefs
• International Association of Fire Chiefs
• National Association of EMS Educators
• National Association of EMS Physicians
• National Association of Emergency Medical Technicians
• National Association of State EMS Officials
• National EMS Management Association
• National Registry of Emergency Medical Technicians
• National Volunteer Fire Council