Unlock Multi-State EMS Practice with the Compact

As an EMS clinician, the EMS Compact empowers you with the flexibility to provide care across all 25 states with just one state EMS license. Once you validate your Compact Privilege to Practice status online, you immediately have the EMS Compact Privilege to Practice in any of the EMS Compact Member States without additional applications or fees. This privilege, granted under state law, works much like driver’s license recognition—streamlining your ability to serve communities wherever needed.

To utilize this legal authorization to practice, you must be affiliated with a legally authorized EMS agency in a remote state and have a physician medical director. These simple requirements allow you to practice quickly and efficiently, ensuring you're always ready to respond, no matter where your skills are needed.

Independent Practice Not Permitted

EMS clinicians do not have independent practice, nor does the EMS Compact permit it. Under the Compact, EMS clinicians are required to maintain a relationship with an EMS agency and a physician medical director. The nature and licensing of EMS agencies vary by state but typically include ambulance services, rescue squads, fire departments, quick response units, and similar entities. In some states, EMS personnel may also be authorized to work in non-traditional settings such as medical facilities, clinics, festivals, sporting events, and concerts.

The EMS clinician must ensure they are affiliated with an EMS agency legally authorized to operate within the state or jurisdiction where they are providing care. The agency is also responsible for providing physician medical direction and ensuring the clinician practices within the proper medical and legal frameworks.
 

Multi-state Privilege to Practice

As an EMS clinician licensed by a Compact Member State,

you are granted the Privilege to Practice across all other Compact states. The core requirements for utilizing this privilege include:

• You must be at least 18 years old.
• Hold a valid, unrestricted license as an EMT, AEMT, Paramedic, or a state-recognized level equivalent.
• Practice under the supervision of a physician medical director.

Note: For the EMS Compact, an "EMS certification" is equivalent to an EMS license.

Scope of Practice in a Remote State

When operating under the Privilege to Practice, EMS clinicians must follow the EMS Protocols established by their EMS agency’s medical director. This may be the medical director of your home state agency or an agency in the remote state where you are working.

Additionally, EMS clinicians must always adhere to the state laws and Administrative Code for the jurisdiction(s) in which they practice. While it’s encouraged to align with your home state’s scope, certain situations—such as extended deployments, special events, or local staffing needs—may require adapting to the protocols of a remote state. Clinicians should be properly oriented to local practices and perform only those procedures or administer medications for which they have been trained.
 

Restricted License or Restricted Privilege to Practice

As Section 8 of the REPLICA legislation outlines, the Privilege to Practice is granted to EMS Providers, and any Compact State can restrict it.

• Only the state that suspended or revoked the Privilege to Practice can edit or remove the restriction. EMS Providers with questions about a suspended or revoked Privilege to Practice should contact the EMS Office that placed the disciplinary action. 
• The suspension of a Privilege to Practice by one state removes the Privilege to Practice in ALL Compact states. 
• Individuals with a suspended EMS Compact Privilege to Practice may seek licensure in any state (Privilege to Practice restrictions do NOT prohibit licensure by other states.)     

---

Frequently Asked Questions

Is there an application or fee for the EMS Compact Privilege to Practice?

No.  The Privilege to Practice is granted automatically to qualified EMS Personnel. No additional applications, fees, paperwork, or administrative processes are required.

Are EMS Agencies required to hire me or utilize me?

No. The EMS Compact does not obligate or require any EMS Agency to hire or utilize EMS personnel. However, it does make the process faster if an EMS Agency chooses to affiliate with you. 

Is the Privilege to Practice the same as reciprocity?

No.  EMS personnel must obtain and maintain a license in their home state of practice.  The EMS Compact extends a privilege to practice under authorized circumstances to EMS personnel based on their home license.  To remain active under the EMS Compact, EMS personnel must follow their home state rules for licensure, license renewals (recertification), and maintain a relationship with an authorized physician medical director.

Does the EMS Compact cover EMS Agencies, Ambulances, and Employers? 

The EMS Compact only applies to qualified EMS Personnel. The EMS Compact DOES NOT apply to EMS Agencies, Ambulances, or Employers.  EMS agencies, ambulances, and employers must meet all applicable state and local laws and regulations. 

Are Emergency Medical Responders (EMRs) covered by the EMS Compact?

No. The EMS Compact does not provide a multistate privilege to practice for Emergency Medical Responders.

Are EMT-Intermediates covered by the EMS Compact?

Yes.  The EMS Compact applies to EMS personnel licensed as an EMT, Paramedic, or a level between EMT and Paramedic (including Advanced-EMT, EMT-Intermediates, or similar levels) in at least one Compact member state. All EMS personnel must practice under the supervision of a physician medical director.  

Is National Registry required for the EMS Compact Privilege to Practice?

No. There is no requirement for individual EMS Personnel to have or maintain National Registry certification. However, states participating in the EMS Compact must use the National Registry certification as a prerequisite for applicants seeking initial (new) state EMS licensure. 
 

I live in a non-compact state. How do I get a compact Privilege to Practice?

Only EMS personnel with a license issued by an EMS Compact state are eligible for the multistate Privilege to Practice. 

What are the requirements for the Privilege to Practice?

EMS Personnel are required to meet the following eligibility requirements:

• Licensed, in good standing, as an EMT, an AEMT (or a level between EMT and Paramedic), or a Paramedic in a Compact state
• Have an EMS Medical Director
• At least 18 years old

What is the difference between a Home State and a Remote State?

• A Home State is a state that has passed and enacted the REPLICA Legislation where an individual is licensed by that State EMS Office or authority to practice emergency medical services. 
• A Remote State is a state that has passed and enacted the REPLICA Legislation in which the individual is NOT licensed by that State EMS Office or authority to practice emergency medical services.  

Can I have more than one Home State license?

Yes. EMS Personnel are permitted to be licensed in multiple states.  For the EMS Compact, a Home State is any EMS Compact Member State that issues you an EMS license. When practicing or working in a Home State, the EMS provider works based on their State EMS license. When working in a Remote State (an EMS Compact Member State where the EMS provider is not licensed), they work under the EMS Compact's Privilege to Practice. 

Can a Remote State investigate or discipline an EMS Provider working under the Privilege to Practice in that state?

Yes. Under the authority granted by the EMS Compact legislation, Remote States can thoroughly investigate EMS Personnel complaints originating in their state, even if the individual under investigation is no longer in their state. Remote States also have the authority to suspend an individual's Privilege to Practice. If the Privilege to Practice is suspended by one state, the Privilege to Practice is immediately suspended in all Compact states.

Can a Remote State suspend or revoke my EMS license?

No, a Remote State can not suspend or revoke a license issued by your Home State. However, Remote States can investigate complaints and suspend an individual's Privilege to Practice.