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

The United States EMS Compact simplifies lawful multistate practice for EMS clinicians. As an EMS agency or employer, it is important to understand the Compact’s Privilege to Practice (PTP), what it authorizes for individual clinicians, and what it does not change for EMS agencies, vehicles, or local operational requirements.

The EMS Compact is State Law

The Compact is enacted as state law in every Member State. Each state’s statute requires recognition of an individual’s Privilege to Practice when that individual holds an active, unrestricted EMS license from another Member State and meets Compact criteria. This authorizes qualified clinicians to practice across Member States without obtaining an additional state license.

There is no separate application or fee for PTP. Verification is online, and practice must occur under agency affiliation and physician medical direction.

Key Information for EMS Agencies and Employers

Privilege to Practice for Individuals

• No paper licenses: The Compact does not issue paper licenses or letters. Status is validated online.
• How to verify: Confirm a clinician’s PTP and Home State license via Verify my status. If a PTP record is not visible, check the state’s NEMSCD integration status and contact the issuing State EMS Office: State contacts.

Physician Medical Direction and Agency Affiliation

Clinicians practicing under PTP must have physician medical direction and be affiliated with an EMS agency that is licensed or otherwise authorized in the jurisdiction of practice. Agencies are responsible for ensuring compliance with all local statutes, rules, protocols, and medical oversight requirements. For state-specific agency requirements, consult your State EMS Office.

State-Specific Regulations

The Compact resolves individual clinician licensure across Member States. It does not alter or replace state law for agency licensure, vehicle permitting, service areas, staffing, equipment, communications, or local medical control. Agencies must remain fully compliant with each state’s requirements where they operate. A qualified clinician’s PTP satisfies the individual legal authorization to practice; it does not substitute for any agency obligations.

Information for EMS Clinicians

Clinicians should review the EMS Clinician Privilege to Practice page for eligibility and FAQs.

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Frequently Asked Questions (FAQ)

Does the Compact exempt EMS agencies or ambulances from licensure in a remote state?

No. The Compact applies to individual clinicians. Agencies and vehicles must meet each state’s licensure and operational rules. The model legislation expressly preserves state law governing agency licensure and regulation. States retain full authority over EMS agencies.

Do employees still need a state license if they have PTP?

For individual practice, a qualified clinician’s Compact PTP is sufficient. A remote state may not require an additional individual state license when the clinician meets PTP criteria. However, the Compact does not change agency licensure or operational rules. Some states place conditions on agency use of PTP personnel. In those cases, an agency, not the clinician, may be subject to state discipline for violating agency-level rules.

Does the Compact threaten jobs or wages?

No. Interstate licensure compacts are widely used in health professions to support recruitment, retention, and workforce mobility. Removing redundant licensure barriers helps fill shifts, support rural coverage, and meet surge needs without reducing professional standards. The Compact simplifies lawful mobility while preserving each state’s oversight.

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

No. A clinician may practice in a remote state under PTP only when performing EMS duties assigned by an appropriate authority. Self-deployment is not authorized.

Why does the Compact not address worker safety or radio interoperability?

Those issues are outside the Compact’s scope and are governed by other federal, state, and local laws or programs. The Compact focuses on lawful multistate practice, accountability, and information sharing for individual licensure.

Will the Compact let private entities position resources near borders to access multiple communities?

No. The Compact does not change agency licensure, service area approvals, or jurisdictional control. States retain full authority to regulate EMS agencies and operations.

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

Yes, for personnel. Member States align minimum standards for initial licensure and share data for oversight:

• Standardized testing for initial licensure at EMT and Paramedic levels.
• FBI-compliant biometric criminal history checks for initial licensure, within the timelines set by Compact law.
• Coordinated Database (NEMSCD) access for state officials to view licensure history, significant investigatory information, and adverse actions across Member States.
• Physician medical direction for all practicing clinicians.
• Professional Code of Conduct for clinicians using PTP: view.

States retain full authority to investigate and take action on clinicians. The Compact adds cross-border collaboration, information exchange, and subpoena tools for multi-state matters. Agency regulation, quality programs, and enforcement remain under each state’s laws and rules.

Could the Compact compromise quality of care?

No. The Compact is designed to increase public safety by aligning minimum licensure standards, requiring medical direction, enabling rapid cross-state verification, and facilitating investigations and adverse-action sharing. It improves readiness and accountability while preserving state sovereignty.

What happens if a clinician’s Home State license is restricted or suspended?

A clinician with a restricted or suspended Home State license may not practice under PTP in any Member State until the Home State license is restored. Remote States may also suspend or restrict the clinician’s PTP within their jurisdiction based on local facts and may share findings through the Coordinated Database. When a state suspends PTP, PTP is suspended across all Member States until resolved.

Does the Compact require background checks?

Yes. Member States must implement FBI-compliant biometric criminal history checks for initial licensure, within the timelines set in Compact law. Federal employees with a qualifying suitability determination may present documentation as provided in the Commission’s rules.