How States Join the EMS Compact

Interstate Compacts are legislative and contractual agreements that are established between states, districts (like the District of Columbia), and U.S. territories. Compacts serve as formal legal mechanisms for states to cooperate and collaborate on various issues, with the goal of addressing shared concerns and achieving common goals. (For example, one of the most common interstate compacts is the Driver's License Compact.) To become a party to an Interstate Compact, states are required to pass specific legislation.

Joining the EMS Compact

States seeking to join the EMS Compact must take the following steps:

  1. Introduction and Enactment of REPLICA Legislation: The state's legislature must introduce and enact the "Recognition of EMS Personnel Licensure Interstate Compact" (REPLICA) bill. This legislation authorizes the state's participation in the EMS Compact.

  2. The REPLICA legislation must match the Uniform Model Legislation: Because interstate compacts also function as contractual agreements between participating states, it is essential that each state seeking to join the compact passes the same  model legislation. This uniformity ensures consistency in the legal framework and obligations between all member states.

By adhering to these steps, states ensure that their participation in the EMS Compact is based on a standardized legal foundation, promoting uniformity and cooperation among all members.

Three key terms central to understanding the EMS Compact are:

  • Member State - a state that has passed and enacted the EMS Compact legislation.
  • Home State - a member state where an individual EMS provider is licensed to practice emergency medical services as an EMT, Paramedic, or at a state designated level between an EMT and Paramedic (example:Advanced-EMT, EMT-Intermediate).
  • Remote State - an EMS Compact member state in which an individual is not licensed

EMS Compact Member State Requirements

  • Utilize the National Registry (NREMT) examination at the EMT and Paramedic levels for initial state licensure
  • Utilize a FBI compliant background check with biometric data (e.g. fingerprints) within 5 years of Compact activation. (States must require FBI background checks for EMS personnel implemented prior to March 15, 2025.)
  • Have a process to receive, investigate, and resolve complaints; and share information with other Compact states via the National EMS Coordinated Database (NEMSCD).
  • Enact the model REPLICA legislation.

Member State Benefits

  • A Member State gains authority over EMS personnel from other compact states when they are practicing in the Member State.
  • A Member State joins other compact states in the governmental “Commission” to promulgate universal rules governing the cross-border, interstate practice of EMS personnel.
  • Member States gain access to the National EMS Coordinated Database (NEMSCD) the enables
    immediate notification of significant investigatory information and adverse action against EMS personnel licensed in the Member State and for EMS personnel practicing in other states.
  • Member States maintain exclusive authority over the license issued by their State EMS Office/Authority, including the ability to take disciplinary action against any licenses issued by that state in accordance with their state law and regulations.
  • Member States gain the authority and legal framework to investigate complaints against EMS personnel from other compact states when they are practicing in the Member State, combined with the authority to suspend an EMS Provider's Privilege to Practice.