EMS Compact

How States Join the EMS Compact

Interstate Compacts and the EMS Compact

Interstate compacts are legislative and contractual agreements between states, districts (such as the District of Columbia), and U.S. territories. These compacts serve as formal legal mechanisms for states to cooperate on shared issues and achieve common goals. One of the most familiar examples is the Driver’s License Compact. To participate in any interstate compact, a state must pass specific enabling legislation.

Joining the EMS Compact

States seeking to join the United States EMS Compact must complete the following steps:

  1. Introduce and Enact REPLICA Legislation: The state legislature must introduce and enact the “Recognition of EMS Personnel Licensure Interstate Compact” (REPLICA) bill, authorizing the state’s participation in the EMS Compact.

  2. Ensure Legislative Uniformity: Because interstate compacts are both legislative and contractual agreements among states, each state must enact the uniform model legislation without substantive changes. This ensures legal consistency and shared obligations across all Member States.

By following these steps, states ensure that participation in the EMS Compact is based on a standardized legal foundation that promotes cooperation, reciprocity, and public safety.

Key Terms

  • Member State – A state that has enacted the EMS Compact legislation and is officially part of the United States EMS Compact.
  • Home State – A Member State where an EMS Clinician is licensed to practice emergency medical services as an EMT, AEMT, Paramedic, or other state-designated level between EMT and Paramedic.
  • Remote State – A Member State where an EMS Clinician is not licensed but is authorized to practice under the Compact’s Privilege to Practice provisions.

EMS Compact Member State Requirements

  • Use the National Registry of EMTs (NREMT) examination for initial EMT and Paramedic licensure.
  • Implement an FBI-compliant background check with biometric data (such as fingerprints) within five years of Compact activation. (Member States are required to conduct FBI criminal history checks for EMS personnel by March 15, 2025.)
  • Maintain a process to receive, investigate, and resolve complaints, and share relevant information with other Member States via the National EMS Coordinated Database (NEMSCD).
  • Enact the model REPLICA legislation in its standardized form.

Member State Benefits

  • Authority: A Member State gains regulatory authority over EMS Clinicians from other Member States while they are practicing within its jurisdiction.
  • Representation: Each Member State appoints a Commissioner to the Interstate Commission for EMS Personnel Practice, the governmental body that adopts and enforces rules governing cross-border EMS practice.
  • Information Sharing: Member States gain access to the National EMS Coordinated Database (NEMSCD), which provides immediate notification of significant investigatory information and adverse actions involving EMS Clinicians licensed or practicing under Compact authority.
  • Licensure Control: Each Member State retains exclusive authority over licenses it issues, including the power to take disciplinary action in accordance with its own laws and regulations.
  • Investigation and Public Protection Authority: Member States gain significant new powers under the EMS Compact to protect the public. States may investigate complaints involving EMS Clinicians licensed in other Member States while those clinicians are practicing within their borders. Under Section 9 of the REPLICA legislation, each state’s EMS authority is explicitly empowered to:
    • Issue subpoenas for witnesses or evidence during investigations and hearings, enforceable across state lines.
    • Issue cease-and-desist orders or restrict, suspend, or revoke a clinician’s Privilege to Practice when necessary to protect public health and safety.
    • Share significant investigatory information and adverse actions with other Member States through the National EMS Coordinated Database (NEMSCD).
    These authorities ensure that every Member State can act immediately to protect its citizens while maintaining accountability for all EMS Clinicians practicing under Compact privileges.

Last updated: October 2025 by the Interstate Commission for EMS Personnel Practice.