What is the EMS Compact?

What is the EMS Compact?

The United States Emergency Medical Services Compact facilitates the day-to-day movement of EMS personnel across state boundaries in the performance of their duties. EMS personnel, including EMTs and paramedics, licensed in at least one Compact Member State are granted a Privilege to Practice in the other Compact Member States. The EMS Compact is a legal agreement between states, enacted by state legislation in 24 states. A Member State is a state that has passed the Recognition of Emergency Medical Services Personnel Licensure Interstate Compact (REPLICA) legislation.

The EMS Compact:

  • Increases access to patient care
  • Protects the public
  • Reduces administrative burden for EMS personnel and states
  • Enhances the Emergency Medical Services system in the United States

Components of the EMS Compact


The legislation authorizing the EMS Compact is titled REPLICA, the "Recognition of EMS Personnel Licensure Interstate CompAct." This legislative framework standardizes licensure requirements for EMS personnel, reduces barriers, expands EMS practitioner mobility across state jurisdictions, and enhances public protection.

Interstate Commission for EMS Personnel Practice

The EMS Compact is managed by a multi-state commission, established by the REPLICA legislation. Each member state appoints one Commissioner to the Interstate Commission for EMS Personnel Practice. This Commission is a governmental body that ensures transparent governance, stakeholder engagement, effective coordination, and consistent implementation of the Compact's provisions.

National EMS Coordinated Database (NEMSCD)

The National EMS Coordinated Database, authorized by the REPLICA legislation, tracks EMS license information and Privilege to Practice status for EMS personnel in Compact Member States. This database serves as the primary source for de-duplicated licensing data, providing an authoritative list of licensed EMS practitioners across the country.

EMS Compact States

Member States agree to standardized requirements for EMS personnel licensure, including:

  • Require FBI background checks when applying for an initial state EMS license
  • Require National EMS Certification (NREMT) for an initial state EMS license
  • Collaborate on investigations involving EMS personnel

Overview of the EMS Compact

Background Information

Over a decade ago, the need for standardization and addressing the challenges of EMS personnel operating across state lines led the Department of Homeland Security and the National Association of State EMS Officials (NASEMSO) to collaborate on a solution. The REPLICA Model Legislation was introduced in 2014, with two states enacting it by 2015. By 2017, the EMS Compact had grown to ten member states. The Compact was officially activated on March 10, 2020, and has since been instrumental in expanding day-to-day EMS practitioner mobility and access to Emergency Medical Services. Since its activation, EMS personnel with a Privilege to Practice have supplemented critical staffing in rural areas, addressed urgent staffing needs during the COVID-19 pandemic, and aided in the rapid mobilization of EMS teams for wildland fire incidents. The Compact simplifies the movement of qualified EMS professionals, strengthens the authority of State EMS Offices, and underscores the essential contributions of local EMS agencies.

Key Features

  • Enhanced State Cooperation: The EMS Compact promotes interstate cooperation with unified legislation allowing qualified EMS personnel to operate in multiple states with minimal bureaucracy. The Compact also grants legislative authority for state EMS officials to issue subpoenas and collaborate on multijurisdictional investigations.
  • Privilege to Practice: Through the EMS Compact, over 400,000 EMS personnel have access to a Privilege to Practice valid in 24 states. This privilege is extended to eligible EMS practitioners at no cost.
  • Governance: The EMS Compact is overseen by the Interstate Commission for EMS Personnel Practice, a governmental body instituted by state law. The Commission emphasizes transparency, stakeholder engagement, effective coordination, and consistent implementation, ensuring standardized and accountable EMS practices across member states.
  • National EMS Coordinated Database: Serving as the primary source database, the EMS Compact's National EMS Coordinated Database eradicates duplicate licensing data, providing an authoritative list of licensed EMS practitioners throughout the country.

Facts About the EMS Compact

  • The 24 EMS Compact Member States have legislatively unified EMS personnel licensure standards, background checks, and public protection and investigation standards.
  • Over 400,000 EMS personnel have access to a Privilege to Practice valid in 24 states.
  • The Privilege to Practice is provided at no cost to all eligible EMS practitioners.
  • The EMS Compact is governed by the Interstate Commission for EMS Personnel Practice, a governmental body formed by state law.
  • The National EMS Coordinated Database is the only primary source database that has de-duplicated licensed EMS practitioners in the United States.
  • The EMS Compact was instrumental in expediting EMS practitioner mobility during the COVID-19 pandemic and wildland fires.
  • State EMS Offices gain legislative authority to regulate all EMS practitioners working in their jurisdiction and collaborate on multi-jurisdictional investigations.

Privilege to Practice (PTP) Requirements

  • Have a current unrestricted license as an EMT, AEMT, Paramedic (or a state-recognized and licensed level with a scope of practice and authority between EMT and paramedic) issued by an EMS Compact Member State.
  • Be at least 18 years of age.
  • Practice under the supervision of a physician (MD/DO) medical director.
  • Be affiliated with an EMS agency authorized in the Remote State.
  • There are no time limitations imposed on the Privilege to Practice under the Compact legislation.
  • If an EMS practitioner meets the criteria for the Privilege to Practice, the Compact requires a participating state to recognize the privilege for qualified purposes.

Scope of Practice

  • The scope of practice of an EMS practitioner operating under the Privilege to Practice defaults to the provider's Home State.
  • Remote states may modify the scope of practice of providers operating under a Compact privilege.

EMS Agency / Employer

  • EMS agencies must comply with all rules and regulations established by the jurisdiction where they are operating.
  • The EMS Compact applies to EMS personnel but does not apply to EMS agencies or employers.

Member State Requirements

  • Use the NREMT Exam for all new EMT & Paramedic licenses issued by the State EMS Office.
  • Require an FBI background check for initial licensure.
  • Notify the Commission of adverse actions (license discipline).

EMS Practitioner Discipline

  • All discipline cases are reported to the Coordinated Database no later than two business days after the discipline is imposed.
  • State discipline cases are also reported to the National Practitioner Data Base (NPDB).

Other State Laws & Rules

  • EMS practitioners are required to know and abide by all applicable statutes, rules, and regulations for the jurisdictions where they are operating (many of which may alter the scope of practice for the practitioner).

EMS ID Number

  • EMSID numbers are issued for all EMS practitioners in the United States at no charge.
  • Use the EMS ID number to view/validate Privilege to Practice on www.EMSCompact.gov.

The Seven Legislative Declarations of the EMS Compact

The legislative purpose of the EMS Compact is to enhance the effectiveness and responsiveness of emergency medical services personnel across state lines. This Compact legislation establishes seven key objectives aimed at improving public health and safety, ensuring professional accountability, and facilitating the mobility of EMS personnel. The purposes of the EMS Compact as defined in legislation include:

  1. Increase public access to EMS personnel.
  2. Enhance the states' ability to protect the public's health and safety, especially patient safety.
  3. Encourage the cooperation of member states in the areas of EMS personnel licensure and regulation.
  4. Support licensing of military members who are separating from an active-duty tour and their spouses.
  5. Facilitate the exchange of information between member states regarding EMS personnel licensure, adverse actions, and significant investigatory information.
  6. Promote compliance with the laws governing EMS personnel practice in each member state.
  7. Invest all member states with the authority to hold EMS personnel accountable through the mutual recognition of member state licenses.

By participating in the EMS Compact, states can efficiently address the challenges of professional mobility and ensure that EMS personnel can provide high-quality care across state lines.