For Elected Officials

Welcome. This page is your one-stop resource for understanding the United States EMS Compact and how your state can join. Whether you are a legislator, legislative staffer, or executive branch official, you will find clear, actionable information below.

🏛️ How Does My State Join the EMS Compact?

Joining the Compact is straightforward:

1. Pass the Model Legislation

   Your state must enact the EMS Compact model legislation without changes. This legislation functions as state law and a binding contract between your state and all other EMS Compact member states.

   ➤  Download Model Legislation Text File

2. Designate a Compact Commissioner

   Once enacted, the Governor (or designee) appoints your state’s Compact Commissioner. This individual is typically the State EMS Director or a designee and serves as your state’s voting member on the Interstate Commission for EMS Personnel Practice.

3. Begin Integration into the National EMS Coordinated Database

   Your state EMS agency will partner with the EMS Compact to securely submit and manage licensure data through the National EMS Coordinated Database (NEMSCD).

   Note: The state does not pay a fee, but some technology integration may be required depending on existing systems.

4. Go Live

   Once legislative, appointment, and integration steps are complete, your state becomes a fully operational EMS Compact Member.

• EMS clinicians licensed in your state gain an immediate Privilege to Practice in all other member states.

• Your state gains access to a qualified workforce of over 400,000 EMS clinicians who can respond during emergencies, disasters, or staffing needs.

Legislative Support by the Numbers

Since 2015, the EMS Compact has received overwhelming bipartisan support in state legislatures. In the 25 EMS Compact Member States, more than 3,300 legislators have voted on this Compact legislation, and only 59 House members and 2 State Senators opposed. This table highlights the remarkable bipartisan support at the state level.

🔍 Want  to Know What Interstate Compacts Your State Already Participates In?

The Council of State Governments maintains a searchable database of all active interstate compacts by state and topic. Use it to explore the full range of compacts your state is part of—from EMS and healthcare to transportation, education, and public safety.

➤ Search the Interstate Compacts Database

Hint: You can search by state, topic area, or compact name.

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🚨 Benefits to States, Agencies, and Clinicians

The EMS Compact empowers states with modern tools to support a flexible, mobile, and accountable EMS workforce. It is not limited to disaster response or surge staffing—it is designed for everyday workforce solutions that reflect the realities of EMS operations today.

States that join the Compact gain powerful benefits in five key areas:

1. A Reliable Workforce for Long-Term and Short-Term Needs

EMS agencies gain access to over 400,000 qualified EMS clinicians who meet national standards for education, testing, and background checks. Whether filling ongoing vacancies, supporting rural coverage, or staffing large events, the Compact ensures a consistent and flexible workforce, without burdensome red tape.

2. Advanced Public Protection and Oversight Tools

Your State EMS Office receives secure access to the National EMS Coordinated Database (NEMSCD) and the authority to:

• Track and share licensure history

• Receive real-time notifications of disciplinary actions or investigations

• Conduct cross-border investigations

• Issue subpoenas across state lines

  These tools promote transparency and patient safety in a way that no single state can achieve alone.

3. Professional Mobility that Reflects a Modern Workforce

The EMS Compact aligns EMS with the mobility already enjoyed by nurses, physicians, and physical therapists. It allows EMS clinicians to maintain a single state license while practicing across state lines, offering career flexibility, reducing burnout, and supporting retention.

4. Readiness Without Delay

In addition to long-term workforce support, the Compact enables immediate mutual aid during disasters, mass gatherings, or major incidents. Clinicians can cross state lines and begin work without waiting for emergency declarations or temporary waivers.

5. A State Voice in National EMS Policy

Every member state appoints a voting commissioner to the Interstate Commission for EMS Personnel Practice, the government body responsible for administering the Compact. This ensures your state’s EMS leadership helps shape national solutions while protecting local interests.

Links & Bookmarks for Legislators

• Model EMS Compact Legislation
• Key EMS Compact Terms & Definitions
• List of Member States & Commissioners
• Compact History & Origins
• Compact Governance
• Commission Leadership
• EMS Personnel
• EMS Agencies
• Facts & Benefits

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Understanding Interstate Compacts

While there are many tools and resources available related to Interstate Compacts in the United States, the 'Bench Book' developed by the Interstate Commission for Adult Offender Supervision (ICAOS) in 2005 and revised in 2020 is a established resource for judges, court personnel, lawyers, and legislators for questions on interstate compacts. Links to the ICAOS Bench Book are provided for your reference:

• Bench Book - 1.1 Who Must Comply with an Interstate Compact?
• Bench Book - 1.2 Nature of Interstate Compacts
• Bench Book - 1.2.1 Interstate Compacts are Formal Agreements Between States
• Bench Book - 1.2.2 Compacts Are Not Uniform Laws
• Bench Book - 1.2.3 Compacts Are Not Administrative Agreements
• Bench Book - 1.3 Delegation of State Authority to an Interstate Commission
• Bench Book - 1.4 Congressional Consent Requirement
• Bench Book - 1.4.1 When Consent is Required
• Bench Book - 1.4.2 Withdrawal and Modification of Congressional Consent
• Bench Book - 1.4.3 Implications of Congressional Consent
• Bench Book - 1.5 Interpretation of Interstate Compacts
• Bench Book - 1.6 Application of State Law that Conflicts with an Interstate Compact
• Bench Book - 1.7 Special Considerations for Litigation Involving Interstate Commissions
• Bench Book - 1.7.1 Relief Must Be Consistent with the Compact
• Bench Book - 1.7.2 Eleventh Amendment Issues for Interstate Commissions
• Bench Book - 1.8 Party State, Interstate Commission, and Third-Party Enforcement Compacts
• Bench Book - 1.9 Recommended Sources of Compact Law and Information

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National Center for Interstate Compacts

The Council of State Governments operates the National Center for Interstate Compacts. The Council of State Governments believes interstate compacts provide the most effective means for achieving borderless practice for licensed practitioners and military spouses, relieving the burdens of maintaining multiple state licenses.

Since January 2016, the states have passed 250 separate pieces of licensure compact legislation. To date, 50 states and territories have enacted one or more occupational licensure compacts for nurses, physicians, physical therapists, emergency medical technicians, psychologists, speech therapists/audiologists, occupational therapists, and counselors. 

CSG Resources:

• Overview of Health & Occupational Interstate Compacts
• Multistate Problem Solving with Interstate Compacts
• National Center for Interstate Compacts website

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Development in Interstate Law

Explore the latest insights into interstate compact law with this in-depth review of 2022’s key judicial, legislative, and administrative developments, authored by Jeffrey B. Litwak and Marisa Fiat. This article highlights significant cases and legal interpretations, examines the impact of recent federal initiatives, and discusses evolving compact frameworks that shape critical areas such as transportation, environmental stewardship, and public safety. Whether you’re a policy professional or a legal scholar, this comprehensive overview offers valuable context on the complexities and ongoing advancements in interstate cooperation.

Developments in Interstate Compact Law and Practice 2022

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Legislative Frequently Asked Questions

How much will the EMS Compact cost my state? 

Answer:  Currently, there are no fees associated with the EMS Compact.  The Compact allows for a fee levy when determining a fee.  In December 2017, the National Registry of Emergency Medical Services submitted two proposals to the Commission, one to support the Coordinated Database and one to provide administrative support to the Commission. The support from the National Registry, a not-for-profit organization, has been significant because it has alleviated any immediate need for funding through a levy. In the first year of the Compact, associated costs were related to participation in the Commission. The Commission has conducted much of its business via conference calls or online meetings. The Commission has successfully scheduled those meetings requiring travel with other events to achieve economies of scale for participating states.

The National Association of State EMS Officials (NASEMSO) published a “Funding Assistance Guide” in 2016. This guide lists the various funding resources supporting state EMS office budgets, including in-state revenue streams. According to this guide, EMS personnel licensure fees comprise 5% or less of their annual EMS office budgets.

Can the Commission pass rules and regulations that impact states without providing for public comment unless requested, even though it will use public funds to operate?

Answer:  No. REPLICA Section 12 “Rulemaking” outlines the public process utilized for public comment in writing, reviewing, and adopting rules. This section also outlines how a public hearing can be easily requested. The Commission comprises one voting representative from each member state who will participate in deliberations, decisions, and rulemaking. Like many states’ current rulemaking processes, the Commission Rules Committee will draft and publish any proposed rule language for public comment.

Could the EMS Compact compromise the quality 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 (AEMTs), and Paramedics working across state lines to have passed a common, standardized, and educationally sound ‘fitness test’ for EMS licensure 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 Coordinated Database of EMS personnel. State EMS officials can rapidly share personnel's licensure history 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 states have differences, including 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 procedures for imposing such adverse action.

* No later than five years after activation of the Compact, requires 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 except federal employees who have suitability determination per 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.)

As members of the Interstate Commission for EMS Personnel Practice are not elected officials, does this lessen their accountability to the public?

Answer:  Commissioners are public officials and are generally members of the executive branch of state government.  As the Commission is a public body, Commissioners are accountable to the public.  REPLICA clarifies that “the responsible official of the state EMS authority or his designee shall be the delegate to this compact for each member state.”  Therefore, the Compact delegate is a public official accountable to their home state executive branch leadership, the EMS community, and the general public.

Are members of the Interstate Commission for EMS Personnel Practice granted more immunity through the Compact?

Answer: No.  Members of the Commission have the same level of immunity that applies in their state position.  REPLICA legislation extends this immunity to their role as a Compact delegate, but does not expand the immunity.

The qualified immunity doctrine protects government officials from liability for civil damages “insofar as their conduct does not violate established statutory or constitutional rights of which a reasonable person would have known.”

Does REPLICA, in its current form, make the government bigger and more bureaucratic?

Answer: Interstate Compacts have long been seen as a way to lessen, not increase, the burdens of government regulations while upholding common standards and public protections. Compact member states share the responsibilities of managing cross-border activities instead of each state individually addressing the same issue differently.  Interstate Compacts address matters of concern to the federal government between its member states instead of inviting the federal government to intervene.

Could the Commission, over time, be able to pass rules and impact state rights?

Answer: No, the Commission can write rules only related to the Compact operations through a public process, including public comment, and the availability of public hearings.

REPLICA states 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

The Commission is a “body politic,” a group of people that is politically organized under a single government authority. What is the single government authority under which this agency will be organized?

Answer:  Interstate compacts are empowered under the United States Constitution (Article 1, Section 10, Clause 3).  A compact commission is the government authority informed by the member states' collective authority and is charged with promulgating rules. Upon activation, REPLICA will join over 200 other governmental commissions or administrations of interstate compacts already in place, organized and provided the same authority to their compact.  The Interstate Commission for EMS Personnel Practice will comprise one representative from each member state’s authority responsible for EMS, with one vote.

By instituting an immunity clause for unelected officials, is there a way to ensure quality controls, or how commissioners can be held accountable?

Answer: Commissioners will be state employees who already have immunity due to their governmental employment. As such, the state leadership that appointed them to the Commission will hold them accountable for their work.

Can a member state withdraw from the EMS Compact?

Answer: Withdrawal from the Compact is permitted pursuant to Section 14 of the Model Legislation. A state may withdraw by enacting a statute specifically repealing the agreement. Withdrawal shall not affect the continuing requirement of the withdrawing state's EMS authority to comply with the investigative and adverse action reporting requirements of this act before the effective date of withdrawal.

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Endorsements

The EMS Compact is the result of a multi-year, nationwide collaborative process. As a result, many national organizations and associations strongly support it.

The Council of State Government - Resolution of Support 

The Council of State Governments (CSG) was the first to pass a formal resolution of support for REPLICA. CSG is the only organization that serves all three branches of government and hosts an exchange of ideas and perspectives that support the development of public policy and state government leadership.

“NOW, THEREFORE BE IT RESOLVED, that The Council of State Governments supports the establishment of the Recognition of EMS Personnel Licensure Compact (REPLICA) and encourages its member jurisdictions to consider the new interstate agreement as an innovative policy solution to the challenge of interstate EMS personnel emergency and life-saving operations.“ - August 13, 2014

International Association of EMS Chiefs – Statement of Support

"The International Association of EMS Chiefs is pleased to support the efforts of REPLICA. As a stakeholder since the inception of this project, we recognize the need for a systematic way for EMS providers to cross jurisdictional boundaries during their daily operations and in the times of disasters. REPLICA meets this need without the confusion and complications often accompanying interstate patient care. This compact directly benefits the boots on the ground provider and the patients they treat." - October 29, 2017

National Registry of Emergency Medical Technicians – Statement of Support

“The National Registry is excited to announce a commitment to support the Recognition of EMS Personnel Licensure Interstate Compact project. Every day, EMS practitioners cross state lines while caring for patients, responding to disasters, or performing other work duties. ” - August 2016

National EMS Advisory Council – Final Advisory on REPLICA

“Activation of REPLICA in every State and Territory is in line with the NEMSAC core values of being visionary, strategic, and diligent. Having REPLICA activated nationwide is visionary because it promotes a seamless and integrated workforce across the continuum of emergency care. “ - September 8, 2016

Read the National EMS Advisory Council's Final Advisory statement.

National Volunteer Fire Council

“The adoption of the compact will make it easier for EMS personnel in different states to cooperate in the delivery of services. I encourage volunteer fire, EMS, and rescue personnel to work to have REPLICA is adopted in their states.” NVFC - September 25, 2014
 

Supporting National Associations and Organizations

• American Ambulance Association
• Association of Air Medical Services
• Association of Critical Care Transport
• Council Of State Governments
• International Association of EMS Chiefs
• International Association of Fire Chiefs
• National Association of EMS Educators
• National Association of EMS Physicians
• National Association of Emergency Medical Technicians
• National Association of State EMS Officials
• National EMS Management Association
• National Registry of Emergency Medical Technicians
• National Volunteer Fire Council