Employers & EMS Agencies

EMS Agencies, Employers, and the Compact

The EMS Compact is an EMS Personnel Licensure Compact; the Compact does not have authority over EMS agencies or employers.  The Model Legislation, passed by all Compact States, explicitly states, “Nothing in this compact supersedes state law or rules related to licensure of EMS agencies.”  EMS Agencies should be familiar with all applicable laws, rules, and regulations in the state(s) they are operating.

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

Answer:  No. The issue that exists today with EMS crossing state borders is a twofold problem: the personnel must be licensed, and the agency or vehicle must be licensed. The Compact is designed to help resolve one of the two issues; the licensing of personnel.

The Compact expects that EMS agencies and their vehicles will be properly licensed in all states where they operating or crossing state lines.  Specifically, Section 15 of the REPLICA legislation, “Construction and Severability” of the Compact states, “Nothing in this compact supersedes state law or rules related to licensure of EMS agencies.”  That very last sentence in the Compact assures each state’s authority to hold ambulance services accountable to the agency licensure process, state by state, as they do today.

Additionally, it is important to remember that EMS personnel are often requested to cross state lines in circumstances in which they function without an ambulance, for example, wildland fire response teams, search and rescue efforts, or surge staffing for special events.

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

Answer:  It depend on your state's law pertaining to EMS Agencies.  Although EMS Personnel with a valid Privilege to Practice are permitted to practice in a Remote State, Section 15 of the REPLICA legislation states, “Nothing in this compact supersedes state law or rules related to licensure of EMS agencies.”  EMS Agencies are responsible for ensuring they are in compliance with all applicable laws and regulations. It may be possible for the individual EMT or Paramedic to be permitted, but the agency be in violation of a state agency licensure rule or regulation.

Could the EMS Compact be a threat to EMS jobs and wages?

Answer:  There is no evidence that interstate compacts reduce wages despite the long-standing existence of interstate compacts in other professions such as nurses, physicians, physical therapists, and psychologists.

Does the EMS Compact allow for and, or encourage EMS personnel to self-deploy to disaster events?

Answer:  No. Under Section 5. “Conditions of Practice in a Remote State” the Compact expressly 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 need to function within the Compact’s authority in order to be covered by the protections it offers. EMS state offices will now have a way to hold EMS personnel accountable in these situation as well as to know who is practicing within their state and that they meet the member states standards.

Is it possible that REPLICA does not address worker safety or radio interoperability?

Answer:  These issues are outside the scope of REPLICA and are best addressed in a variety of other federal, state, and local pieces of legislation. It is the goal of the Commission to ensure a safe workforce, no matter on where they are providing EMS.

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

Answer:  The EMS Compact provides a mechanism for qualified EMS personnel to cross state borders in authorized circumstances. States retain their existing authority to determine when REPLICA is applicable, and when an individual is required to be licensed within a state.  The REPLICA legislation prohibits the Interstate Commission for EMS Personnel Practice from writing rules or interfering with EMS agency licensure.  Ambulance services are expected to be licensed in states that they transport patients to and, or from EMS agencies are required to follow the licensure requirements for the state(s) in which they operate.

REPLICA states that it will “enhance the states’ ability to protect the public’s health and safety, especially patient safety.  Are there controls over the quality of providers, service or agency, and measures that a providing agency is licensed or regulated in a remote state?

Answer:  Yes, REPLICA brings member states under an umbrella of accountability and quality controls not previously seen in our profession.  These include the sharing of a common standard for testing and an FBI compliant background check at the time of initial licensure, access to a Coordinated Database which includes licensure history on personnel from member states, requiring that personnel have medical direction in their home states and allowing for the utilization of home state protocols

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

Answer: The EMS Compact provides a privilege to practice in authorized circumstances to all EMS personnel in member states. It is not limited to one type of service model or built to benefit one type of EMS provider and their personnel over another. The Compact language was drafted by representatives from air and ground, career and volunteer, private for-profit and non-profit EMS representatives, fire based, state EMS Officials and federal partners. Specifically, the following organizations had seats on the Compact’s Drafting Team and these representatives worked to build the REPLICA legislation.

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

Answer: There is no evidence to support that the EMS Compact would compromise the quality of care for patients.  The EMS Compact brings an umbrella over quality that has not previously existed between some states including:

  • The EMS Compact requires all Emergency Medical Technicians, (EMTs), Advanced EMTs (AEMT) and Paramedics working across state lines to have passed a common, standardized, and educationally sound ‘fitness test’ for EMS licensure (National EMS Certification) and to meet the current educational and performance standards in their home state.
  • The EMS Compact requires all EMS personnel exercising the ‘privilege to practice’ in a remote state to function under a defined scope of practice and under the supervision of a physician medical director.
  • The EMS Compact increases safety for patients and EMS coworkers by ensuring that member states utilize Federal Bureau of Investigation (FBI) compliant background checks with biometric data.
  • The EMS Compact reduces the potential for medical errors by authorizing EMS personnel to work under their home state scope of practice.
  • The EMS Compact member states’ EMS licensing authority will have access to a national, EMS personnel Coordinated Database.  State EMS Officials will have the ability to rapidly share licensure history of personnel for the first time in our profession.

Furthermore, under Section 8. “Adverse Actions”, if an individual’s license in any home state is restricted or suspended, the individual shall not be eligible to practice in a remote state under the privilege to practice until the individual’s home state license is restored. This is based on home state laws and rules understanding that there are differences between states, including in the area of what constitutes a felony and, or a misdemeanor.  Any member state may take adverse action against an individual’s privilege to practice in that state based on the factual findings of another member state, so long as each state follows its own procedures for imposing such adverse action.

* No later than five years after activation of the Compact, Member States are required to conduct a criminal background check of all applicants for initial licensure, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation with the exception of federal employees who have suitability determination in accordance with US CFR §731.202 and submit documentation of such as promulgated in the rules of the Commission; (See Section 3, C., 4. of the Compact.)