EMS Agencies and Employers: Understanding the EMS Compact and Privilege to Practice

The EMS Compact simplifies the process of EMS Clinicians working across state lines. As an EMS Agency or Employer, it is essential to understand the Compact’s provisions, including the Privilege to Practice (PTP), and your responsibilities when utilizing EMS Clinicians under the Compact.

The EMS Compact is a State Law

The EMS Compact is legally enacted as state law in every member state. Each state law explicitly states:
"Member states shall recognize the privilege to practice of an individual licensed in another member state..."

EMS Clinicians working under the Compact are legally recognized and authorized to fully function in all Compact member states. The Compact allows EMS Clinicians to provide care across state lines without needing an additional state license, streamlining workforce mobility while ensuring that all personnel meet standardized qualifications. No extra paperwork or authorizations are required (but remember, all EMS Clinicians must be appropriately affiliated with an EMS Agency and a Physician Medical Director.

Key Information for EMS Agencies and Employers

The Privilege to Practice (PTP) The PTP allows EMS Clinicians to practice in remote states under a valid Home State EMS License issued by a Compact Member State without needing an additional state license. 

• No Paper License: The EMS Compact does not issue paper licenses or authorizations. All PTPs are verified online.
• How to Verify a Clinician's PTP: Employers can confirm a clinician’s PTP status via the Verify My Status link. If a clinician’s PTP is not showing or valid, contact the state EMS office that issued their home state license. State contact info is available here. 

Physician Medical Direction and EMS Agency Affiliation EMS Clinicians practicing under the PTP must have Physician Medical Direction and be affiliated with an EMS Agency. EMS Agencies are responsible for ensuring compliance with all local jurisdiction laws, including medical oversight. For state-specific EMS Agency requirements, contact your local State EMS Office.

State-Specific Regulations The EMS Compact resolves individual licensing requirements for EMS Clinicians but does not change state laws regarding EMS Agency or vehicle licensure. Agencies must remain compliant with local laws regarding their licensure when operating across state lines. If state law conflicts with Compact law, Compact law takes precedence, as it is also state law. An individual with a Compact PTP meets the legal requirements for practicing EMS in that state.

Information for EMS Clinicians

EMS Clinicians are encouraged to review the EMS Clinician Privilege to Practice page for specific information and for Frequently Asked Questions.

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Frequently Asked Questions (FAQ)

Does the Compact exempt EMS agencies or their ambulances from having to be licensed in a remote state?

No. The Compact only resolves the issue of EMS clinician/personnel licensing. EMS Agencies and their vehicles must still be appropriately licensed in all states where they operate or cross state lines. Section 15 of the legislation—as passed in every Compact member state—clearly states, "Nothing in this compact supersedes state law or rules related to licensure of EMS agencies." Each state retains the authority to hold ambulance services accountable for their licensing process.

Additionally, EMS personnel frequently cross state lines without an ambulance, working independently as individuals. This occurs in wildland fire response, search and rescue efforts, surge staffing, large events, secondary employment, disasters, or temporary duty assignments. The Compact ensures these clinicians can provide care across jurisdictions under appropriate authority. However, EMS Clinicians must properly affiliate with an EMS Agency before practicing in a remote state.

Do employees of an EMS agency have to be state-licensed if they have a Compact Privilege to Practice?

EMS Clinicians with a PTP are legally authorized to practice EMS in all EMS Compact Member States. This right is established in state law. However, the Compact does not supersede state laws related to EMS Agency licensure. Section 15 of the REPLICA legislation clarifies that EMS Agencies must still comply with local and state requirements.

Some states have imposed EMS Agency limitations on the duration that an EMS Agency can utilize EMS Compact PTP personnel. While the individual clinician is legally authorized to practice, in these unique circumstances, the EMS Agency, not the clinician, may be subject to state discipline if they violate such limitations. Sometimes, a clinician with a valid PTP may be permitted, but the agency could still violate state agency licensure rules.

Does the EMS Compact threaten EMS jobs and wages?

No. Instead, all licensure compacts, including the EMS Compact, have been proven to be robust legislative tools promoting workforce recruitment, retention, and diversity. Compacts remove licensure barriers and provide EMS personnel the freedom of mobility daily in all professional occupations.

Interstate compacts, such as those used in nursing, medicine, physical therapy, and psychology, have a long history of supporting workforce growth without reducing wages. The EMS Compact helps address workforce shortages by streamlining mobility and reducing administrative burdens, ensuring EMS clinicians can serve where they are most needed.

Does the EMS Compact allow EMS personnel to self-deploy to disaster events?

No. Section 5 of the Compact explicitly states, "An individual may practice in a remote state under a privilege to practice only in the performance of the individual’s EMS duties as assigned by an appropriate authority." EMS personnel must operate within their assigned duties and under proper authority to be covered by Compact protections.

Why does the EMS Compact (REPLICA) not address worker safety or radio interoperability?

These issues are outside the scope of the Compact and are best addressed through other federal, state, and local legislation. The Compact aims to ensure a streamlined, safe workforce but does not regulate these specific areas.

Will the EMS Compact allow private entities or rival organizations to position resources near state borders to access multiple communities?

No. The EMS Compact does not change EMS Agency licensure, agency accountability requirements, or operational jurisdictions. EMS Agencies remain licensed and accountable to the State EMS Office in each state where they operate.

States retain full authority to regulate EMS agencies. Therefore, the EMS Compact does not enable private entities or rival organizations to bypass state regulations or position resources near state borders to access multiple communities unlawfully. All EMS Agencies must continue to comply with state laws, ensuring that operational jurisdictions and accountability measures remain intact.

Are there controls over the quality of EMS personnel, services, and agencies in remote states?

Yes. The EMS Compact implements robust accountability and quality control measures for EMS personnel, which were not previously in place. These measures include:

• Standardized Testing: All clinicians must pass a national standardized test as part of their initial licensure process.
• FBI-Compliant Criminal History Checks: To ensure the highest safety standards, clinicians undergo an FBI-compliant criminal history check at initial licensure.
• Coordinated Database: State officials have access to a centralized, multi-state Coordinated Database that tracks the licensure history of EMS clinicians across all Compact member states. This enhances oversight, coordination, and transparency.
• Physician Medical Direction: All EMS clinicians must operate under the Physician Medical Direction, which ensures appropriate clinical oversight and adherence to medical protocols.
• Professional Code of Conduct: The Compact has adopted a Professional Code of Conduct for all clinicians utilizing the Privilege to Practice, ensuring consistent ethical standards and accountability across all Compact member states.

In addition to these controls, all Compact member states retain full authority to investigate, sanction, or restrict EMS clinicians operating in their jurisdiction for state law or Compact regulations violations. States also gain the ability to collaborate across borders on complaints and investigations and have new multi-state subpoena authority. These mechanisms greatly enhance public safety, accountability, and the ability to address issues that span multiple states.

Moreover, all Compact member states have aligned minimum licensure standards for initial licensing at the EMT, Advanced EMT, and Paramedic levels and for levels between EMT and Paramedic. These common standards ensure that EMS personnel practicing under the Compact meet a consistent baseline of training and certification across all member states.

However, the EMS Compact does not regulate EMS Agencies. Instead, they remain accountable to their respective State EMS Offices and must comply with all local laws and regulations within each state where they operate.

Does the EMS Compact only benefit large private entities or the federal government?

No. The Compact benefits all EMS personnel in member states, regardless of the type of service or agency they work for. The Compact was drafted with input from air and ground EMS representatives, career and volunteer services, for-profit and non-profit providers, fire-based EMS, state EMS officials, and federal partners.

Could the EMS Compact compromise the quality of patient care and services in member states?

No. The EMS Compact is specifically designed to increase public safety and improve the quality of patient care across all member states. The language in the law, passed by every Compact member state, outlines the Compact's key objectives, which include:

• Increasing public access to EMS personnel.
• Enhancing the state's ability to protect public health and safety, particularly patient safety.
• Promoting cooperation among member states in EMS personnel licensure and regulation.
• Supporting the licensing of military members separating from active duty and their spouses.
• Facilitating the exchange of licensure, adverse actions, and investigatory information between states.
• Promoting compliance with each state’s EMS laws.
• Granting member states the authority to hold EMS personnel accountable through mutual recognition of state licenses.

In practice, the Compact improves the quality of care by:

• National Certification and State Standards: Requiring all clinicians practicing across state lines to meet stringent national certification and state licensure standards, ensuring a high level of competency.
• Defined Scope of Practice and Physician Medical Direction: Clinicians must operate under a clearly defined scope of practice and have oversight from a Physician Medical Director, ensuring proper supervision.
• FBI-Compliant Criminal History Checks: Clinicians must undergo FBI-compliant criminal history checks with biometric data at initial licensure, adding an extra layer of safety and security.
• Reduction in Medical Errors: Allowing EMS personnel to practice under their home state's scope of practice reduces confusion and minimizes the risk of medical errors.
• Coordinated National Database: A centralized national database enables rapid sharing of licensure history, disciplinary actions, and other vital information between states, ensuring transparency and accountability.

By achieving these objectives, the EMS Compact actively enhances public safety, ensures better patient care, and holds EMS personnel to consistent, high standards across all member states.

What happens if an individual’s license is restricted or suspended in their home state?

If a clinician’s home state license is restricted or suspended, they cannot practice under the Compact’s Privilege to Practice (PTP) in any other Compact member state until their home state license is fully restored. Additionally, remote states have the legal authority to investigate, suspend, or restrict any individual’s PTP within their jurisdiction if violations occur.

This is a powerful tool: if any Compact member state takes disciplinary action against an EMS clinician’s Privilege to Practice, the individual’s Compact privileges are suspended across all Compact states until the issue is resolved. Furthermore, all complaints and investigations are forwarded to the clinician’s home state, where the state of licensure is fully authorized to conduct a comprehensive investigation and impose disciplinary action on the home state license for actions that occurred in any Compact state.

Additionally, under the Compact, all disciplinary actions are reported to the National EMS Coordinated Database. This new tool provides unprecedented levels of transparency and accountability, enabling state licensing officials to access real-time information regarding licensure status, investigations, and disciplinary actions. Thus, it ensures a coordinated and transparent approach to regulation across all member states.

This multistate collaboration ensures robust accountability and enhances public safety by allowing all member states to coordinate and take appropriate action when necessary.

Does the Compact require background checks for EMS personnel?

Yes. The EMS Compact requires all member states to implement FBI-compliant biometric criminal history checks for all applicants seeking initial licensure. This includes submitting fingerprints to the FBI. States must have this system in place by the end of March 2025.

It's important to clarify that while the phrase "FBI background check" is commonly used in EMS licensure, it differs from the background checks typically associated with national security clearances, which involve individual investigators and more in-depth scrutiny. In the context of EMS licensure, "FBI background check" refers to the biometric criminal history check required by the Compact, which ensures applicants' criminal history is thoroughly reviewed using FBI databases.

Additionally, federal employees with an active national security clearance are exempt from this requirement. The Compact legislation provides a mechanism for their security clearance to be recognized instead of an additional fingerprint biometric criminal history check.