Multi-state Practice & FAQs
Unlock Multi-State EMS Practice with the United States EMS Compact
As an EMS clinician, the United States EMS Compact gives you the flexibility to provide care across 25 Member States with an active EMS license issued by any one of those states. Once you validate your Privilege to Practice status online, you immediately have a Compact Privilege to Practice in every other Member State with no additional applications or fees. This authority is granted by state law and functions similarly to driver's license recognition, streamlining your ability to serve communities where needed. There is no time limit; your Privilege to Practice remains valid as long as you continue to meet eligibility requirements.
To use this legal authorization to practice, you must be affiliated with an EMS agency authorized in the remote state and have a physician medical director. These requirements ensure legal compliance, allowing you to deploy quickly and safely.
Independent Practice Not Permitted
EMS clinicians do not have independent practice, and the EMS Compact does not create it. Under the Compact, clinicians must maintain a relationship with an EMS agency and a physician medical director. The types of authorized EMS agencies vary by state and may include ambulance services, rescue squads, fire departments, and quick response units. In some states, EMS clinicians may also be authorized to work in nontraditional settings, for example medical facilities, clinics, festivals, sporting events, and concerts.
The clinician is responsible for ensuring affiliation with an EMS agency that is legally authorized to operate in the jurisdiction of practice. The agency is responsible for providing physician medical direction and ensuring the clinician practices within the appropriate medical and legal frameworks.
Multi-State Privilege to Practice
If you are licensed by a Member State, you are granted a Privilege to Practice in all other Member States. Core requirements include:
- Be at least 18 years of age.
- Hold a valid, unrestricted license as an EMT, AEMT, Paramedic, or a state-recognized level between EMT and Paramedic.
- Practice under the supervision of a physician (MD or DO) medical director.
- Be affiliated with an EMS agency that is licensed or otherwise authorized in the remote state.
Note: In Compact materials, "EMS certification" is treated as equivalent to an EMS license for PTP eligibility purposes.
Scope of Practice in a Remote State
When operating under the Privilege to Practice, EMS clinicians follow the EMS protocols established by their EMS agency's medical director and must comply with the laws and administrative code of the state in which they are practicing. Some deployments, for example, extended assignments, long-term relocations, or special events, may require orientation to local protocols. Clinicians should perform only those procedures and administer only those medications for which they are trained and authorized.
Important: The Compact law prevents a remote state from requiring a separate state license for a qualified clinician who meets the PTP criteria. Employers may adopt internal hiring or credentialing policies, but they should not impose requirements that contradict state law or Compact provisions.
Restricted License or Restricted Privilege to Practice
Under Section 8 of the REPLICA legislation, a Member State may take action on a clinician's Privilege to Practice.
- Only the state that imposed the restriction on the Privilege to Practice can edit or remove that restriction. Contact that state's EMS office with questions.
- Suspension of the Privilege to Practice by one state removes the Privilege to Practice in all Compact states until resolved.
- Privilege to Practice restrictions do not prohibit a state from issuing a license, subject to that state's laws and rules.
Frequently Asked Questions
Quick Navigation
For EMS Clinicians
If you are licensed by a Member State, you are automatically granted a Privilege to Practice in all other Member States. This legal authorization allows you to provide EMS care across state lines without obtaining additional licenses, similar to how your driver's license is recognized in other states.
There is no time limit—your Privilege to Practice remains valid as long as you continue to meet eligibility requirements.
Core requirements include:
- Be at least 18 years of age
- Hold a valid, unrestricted license as an EMT, AEMT, Paramedic, or a state-recognized level between EMT and Paramedic
- Practice under the supervision of a physician (MD or DO) medical director
- Be affiliated with an EMS agency that is licensed or otherwise authorized in the remote state
No. The EMS Compact applies at all times, not only during declared emergencies. There is no time limit on how long an eligible clinician can practice in another Member State under the Privilege to Practice, as long as the clinician continues to meet Compact and state requirements:
- Hold an active, unrestricted EMS license in a Member State (Home State)
- Be affiliated with an EMS agency that is licensed or authorized in the Remote State
- Practice under a physician medical director and comply with the Remote State's laws and rules
No. The Privilege to Practice is granted automatically to qualified EMS clinicians. No additional applications, approvals, or fees are required.
No. EMS clinicians do not have independent practice authority, and the EMS Compact does not create it. Under the Compact, clinicians must maintain:
- A relationship with an EMS agency authorized to operate in the jurisdiction of practice
- Physician medical direction through their affiliated EMS agency
The types of authorized EMS agencies vary by state and may include ambulance services, rescue squads, fire departments, and quick response units. In some states, EMS clinicians may also be authorized to work in nontraditional settings such as medical facilities, clinics, festivals, sporting events, and concerts.
The clinician is responsible for ensuring affiliation with an EMS agency that is legally authorized to operate in the jurisdiction of practice. The agency is responsible for providing physician medical direction and ensuring the clinician practices within the appropriate medical and legal frameworks.
- Home State: A Member State where an individual is licensed by the State EMS authority to practice EMS
- Remote State: A Member State in which the individual is not licensed and in which the individual may practice under the Compact Privilege to Practice
Yes. You may hold multiple state licenses. When working in a Home State, you practice based on that state license. When working in a different Member State where you are not licensed, you practice under the Compact's Privilege to Practice.
No—but with an important caveat. If you hold licenses in multiple Compact states, all of those states are Home States, not Remote States. The Compact only provides a Privilege to Practice in Remote States (states where you are NOT licensed).
Example:
You're licensed as an EMT in State A and as a Paramedic in State B (both Compact states). Can you work as a Paramedic in State A using the Compact?
No. State A is a Home State because you're licensed there. Your State A EMT license always takes precedence over any Compact privilege in State A. You must practice under the scope of your State A license when working in State A.
However: You CAN practice as a Paramedic in all other Member States (except A and B) under your State B Paramedic license through the Compact's Privilege to Practice—because those are Remote States where you hold no license.
Key principle: When you're licensed in a state, your state license always trumps your Compact Privilege to Practice. The Compact cannot expand the scope of an existing state license.
When operating under the Privilege to Practice, EMS clinicians follow the EMS protocols established by their EMS agency's medical director and must comply with the laws and administrative code of the state in which they are practicing.
Some deployments—for example, extended assignments, long-term relocations, or special events—may require orientation to local protocols. Clinicians should perform only those procedures and administer only those medications for which they are trained and authorized.
Only EMS clinicians with a license issued by a Member State are eligible for the multistate Privilege to Practice. Many clinicians obtain a license in a Compact state that aligns with their career plans and employer needs.
No. Individual clinicians are not required to hold current National Registry certification to use the Privilege to Practice. However, Member States must use National Registry certification as a prerequisite for initial state EMS licensure.
This means if you are already licensed in a Member State and never took the NREMT exam, you still qualify for the Compact (as long as you maintain your current license). All existing state personnel are grandfathered—there is no requirement to obtain NREMT certification retroactively.
No. The EMS Compact legislation requires FBI-compliant background checks for new licenses issued after a state joins the Compact. Existing licensed personnel are not required to undergo new background checks for Compact eligibility.
No. The EMS Compact does not provide a multistate Privilege to Practice for EMRs.
Yes. The Compact applies to EMS personnel licensed as EMT, Paramedic, or a level between EMT and Paramedic (including Advanced-EMT, EMT-Intermediate, or similar state-recognized levels). All clinicians must practice under a physician medical director.
No. Reciprocity typically involves applying for and obtaining a separate license in another state based on your existing license. The Compact is different—you must obtain and maintain a Home State license, and the Compact automatically extends a Privilege to Practice in other Member States based on that Home State license and your ongoing compliance with Compact requirements, including medical direction and agency affiliation.
The Home State issuing the license always maintains ultimate control and authority. Remote States can investigate and impose restrictions, but only the Home State controls the actual license.
Example 1 - Practicing in a Remote State:
You're an EMT or Paramedic licensed in State A, working in State B under Compact privilege. State B can investigate complaints, impose restrictions, or even revoke your multistate privilege to practice under the Compact. However, your State A license remains valid. State B reports findings to State A, and State A reviews to decide whether to pursue additional license discipline.
Example 2 - Remote Personnel in Your State:
An EMT or Paramedic from State C is operating in your State D. They are responsible for knowing and following all State D laws and regulations. State D can investigate complaints and limit or revoke the privilege to practice in State D (and all Compact states!), then report findings to State C for potential license action.
Yes. A Remote State may investigate complaints arising in that state and may suspend the clinician's Privilege to Practice in that state. If a state suspends the Privilege to Practice, the Privilege to Practice is suspended in all Member States until resolved.
No. A Remote State cannot alter a license issued by your Home State. It can act on your Privilege to Practice within its jurisdiction and share findings with other states through the Coordinated Database.
Under the Compact legislation, a Member State may take action on a clinician's Privilege to Practice:
- Only the state that imposed the restriction on the Privilege to Practice can edit or remove that restriction. Contact that state's EMS office with questions.
- Suspension of the Privilege to Practice by one state removes the Privilege to Practice in all Compact states until resolved.
- Privilege to Practice restrictions do not prohibit a state from issuing a license, subject to that state's laws and rules.
For EMS Agencies & Employers
Yes—when agencies choose to use it. EMS agencies gain immediate access to qualified EMS personnel from 25+ states, but agencies are never required to hire anyone. The decision always remains local:
- Agencies decide whether to utilize Compact personnel
- Agencies decide who meets their hiring standards
- Agencies decide their credentialing requirements
- Agencies decide whether to affiliate Compact personnel
This flexibility helps agencies address staffing challenges, special events, seasonal demand, or recruitment gaps, if and when they choose. No mandates. No obligations. Complete local control.
Absolutely not. The EMS Compact is strictly for qualified EMS personnel—EMS agencies are not participants in the Compact and have no obligations under it.
The Compact provides new options for recruitment and retention of EMS personnel. EMS agencies maintain complete autonomy over:
- All hiring decisions and employment practices
- Local credentialing standards and operational protocols
- Personnel qualifications and training requirements
- Union agreements, civil service rules, and employment policies
The Compact removes state licensure barriers for agencies that choose to access personnel for short-term, medium-term, or long-term solutions. Agencies that prefer not to use the Compact can continue operating exactly as they do today.
No. The EMS Compact does not obligate any agency to hire or utilize any clinician. It removes unnecessary licensing barriers so affiliation and onboarding can occur faster when agencies choose to hire.
No. The EMS Compact applies to qualified EMS personnel only. EMS agencies, ambulances, and employers must continue to meet all applicable state and local laws and regulations.
No. The Compact governs personnel licensure only and has zero impact on:
- COPCN requirements or application processes
- EMS agency licensing or authorization requirements
- Ambulance service territories or operating authorities
- Transport regulations or patient destination protocols
- Local government service delivery frameworks
States retain complete authority over agency operations, service areas, and transport regulations. The Compact addresses only the ability of individual qualified personnel to practice across state lines when affiliated with a locally authorized agency.
Absolutely not. This is factually impossible under the Compact. The Compact has no provisions governing EMS agencies, ambulance operations, or service delivery. It only addresses personnel licensure.
Any out-of-state agency attempting to operate must still:
- Obtain all required state agency licenses and authorizations
- Meet COPCN requirements where applicable
- Comply with all local ordinances and service agreements
- Follow state regulations for ambulance operations and equipment
The Compact does not and cannot bypass these requirements. State and local control over agency operations remains completely unchanged.
Agencies maintain complete control over credentialing requirements. The Compact establishes that qualified personnel have the legal authority to practice, but agencies decide:
- Internal credentialing standards and processes
- Orientation and training requirements
- Protocol familiarization and competency verification
- Background checks beyond state requirements
- Employment conditions and probationary periods
The Compact's legal authorization to practice does not override agency employment policies or quality standards.
For State Officials & Policymakers
No. The Commission is a governmental body established by law, identical to the structure used in other interstate compacts. Examples include:
- Interstate Medical Licensure Compact Commission (physicians)
- Nurse Licensure Compact Commission
- Psychology Interjurisdictional Compact Commission
- Emergency Management Assistance Compact Commission
- Interstate Compact for Adult Offender Supervision Commission
Each commission is formed by Member States through legislation, operates under state law, and consists of governor-appointed commissioners. This is standard interstate compact structure used nationwide.
The Commission is the highest regulatory body for interstate practice of EMS—but states retain complete sovereignty over their own EMS systems. Understanding this distinction is critical:
The Commission's Authority (Interstate Practice):
The Commission IS the highest regulatory authority for the interstate practice of EMS in the United States, functioning as a governmental body of collaborating states. For this purpose, the Commission has:
- Rule-making authority for interstate practice standards and procedures
- Regulatory authority over the Privilege to Practice framework
- Administrative authority over the coordinated database and information sharing
- Convening authority to facilitate state collaboration on EMS personnel and licensure matters
Additionally, the Compact law encourages (and in some cases requires) states to collaborate on matters related to EMS personnel and licensure. The Commission produces non-binding position papers, best practices, and standards designed to help unify and promote the profession across state lines.
What States Retain Complete Authority Over:
- All EMS scope of practice and protocols within their borders
- State licensure standards, requirements, and renewal processes
- Investigation and discipline of personnel (both home state licenses and privilege to practice)
- Agency licensing and COPCN requirements
- EMS system design and service delivery models
- Training and education requirements
- Medical direction and quality assurance programs
The Key Distinction:
The Commission regulates interstate practice (how personnel move and practice across state lines). States regulate EMS systems and operations within their borders. The Commission cannot mandate how states regulate their EMS systems, cannot override state investigations, and cannot change state laws governing EMS delivery.
Think of it this way: The Commission sets the framework that allows State A to recognize State B's license, but State A still determines what that person can do, how they practice, and under what conditions—just as states do with driver's licenses from other states.
The Commission operates under a one-state, one-vote model—the same structure used in all interstate compacts, including those your state already participates in. This ensures:
- No single state can dominate decision-making
- Broad consensus is required for any rule changes
- Each state's interests are equally represented
- Small states have the same voice as large states
Each state's governor appoints commissioners who represent that state's interests. This is the standard governance model used in the Interstate Medical Licensure Compact, Nurse Licensure Compact, Psychology Compact, and dozens of other compacts.
Most states participate in 40+ interstate compacts covering diverse areas of governance. Examples include:
Emergency Management & Public Safety:
- Emergency Management Assistance Compact (EMAC): All 50 states, the District of Columbia, Puerto Rico, Guam, and the U.S. Virgin Islands participate, making it the flagship mutual aid compact for disasters and emergencies
- Driver's License Compact: Facilitates interstate recognition of driver's licenses and shares traffic violation information
Healthcare-Related Compacts:
- Interstate Medical Licensure Compact (IMLC): Physicians
- Nurse Licensure Compact (NLC): Registered Nurses and Licensed Practical Nurses
- Psychology Interjurisdictional Compact (PSYPACT): Psychologists
- Physical Therapy Compact: Physical Therapists
- Physician Associate Compact: Physician Associates (PAs)
- Occupational Therapy Compact: Occupational Therapists
- Audiology and Speech-Language Pathology Compact: Audiologists and Speech-Language Pathologists
- Counseling Compact: Professional Counselors
- Social Work Compact: Social Workers
The EMS Compact operates identically to these compacts—all preserve state sovereignty while facilitating professional mobility or interstate cooperation. EMS personnel deserve the same interstate practice framework as physicians, nurses, and other healthcare professionals.
Curious to see what compacts your state participates in? Search the Council of State Governments Interstate Compacts Database.
$0. The Commission has never charged state assessments or required states to share operational costs. There are zero fees for:
- State participation or ongoing operations
- EMS personnel Privilege to Practice
- Database access or connectivity
The Commission is authorized to be funded through federal grants and private foundation support.
Home States are responsible for conducting FBI fingerprint-based criminal background checks as part of initial licensure.
For personnel already licensed: No additional background check is required by the Compact when practicing in Remote States. Remote States benefit from the coordinated database that provides real-time notification of any disciplinary actions or license changes.
For new personnel: The FBI background check conducted by the Home State provides the foundation for multi-state practice, reducing duplicative screening while maintaining public safety.
25 states represent strong adoption with overwhelming bipartisan support. The Compact would welcome all 50 states to participate and continues working toward that goal.
Legislative support by the numbers: Since 2015, the EMS Compact has received extraordinary bipartisan support in state legislatures. In the 25 Member States, more than 3,300 legislators have voted on Compact legislation, with only 59 "no" votes in state Houses and 2 "no" votes in state Senates. This represents 98% approval across thousands of legislators from both parties.
Context matters: The Compact activated in March 2020—during the COVID-19 pandemic. In the years following activation, state EMS legislative priorities understandably focused on pandemic response, workforce recovery, and other critical issues. Despite these challenges, 25 states representing over 450,000 EMS personnel have enacted the Compact with near-unanimous legislative support.
Comparison to other healthcare compacts:
- Psychology Compact: 41 states over 8 years
- Interstate Medical Licensure Compact: 40 states over 10 years
- Nurse Licensure Compact: 39 states over 25+ years
Additional states have legislation pending or under consideration. Momentum continues building as states recognize benefits for workforce flexibility, disaster response, military families, and public protection. The remarkable bipartisan support demonstrates that the Compact addresses real needs without partisan division.
A national drafting team of compact and subject-matter experts developed the model legislation through a structured, time-tested process in 2013-2014. The drafting team met in June, August, and October 2013 to translate National Association Policy guidance into uniform statutory language.
Organizations that co-authored and approved the Model Legislation:
- National Association of State EMS Officials (NASEMSO)
- Council of State Governments
- Association of Air Medical Services
- International Association of Flight and Critical Care Paramedics
- International Association of Fire Fighters (IAFF)
- National EMS Management Association
- National Association of EMTs
- Vedder Price Law Firm
The model legislation was approved and released for state consideration in June 2014. The Compact was developed by EMS professionals, for EMS professionals, with input from state officials, labor organizations, and industry stakeholders.
For Military Families & Service Members
The EMS Compact is officially recognized by the U.S. Department of Defense as a critical tool for supporting military family employment and financial readiness.
The challenge: Many states host multiple military installations with thousands of service members and military families. These families move every 2-3 years on average. According to DOD surveys, 35% of military spouses require an occupational license to work, and 28% of spouses who experienced a move needed new licensure at their new location.
The Compact solution: The EMS Compact eliminates licensure barriers for military spouses who are EMTs or Paramedics, allowing them to maintain employment continuity with each military move. The DOD designates occupational licensure compacts as the "gold standard" for license portability and has established a cooperative agreement with the Council of State Governments to develop and promote compacts.
Benefits for military communities:
- Military spouse EMTs/Paramedics can work immediately upon arrival at new duty stations
- EMS agencies gain access to qualified personnel from military families
- Military communities benefit from improved family financial stability
- Service member retention improves when spouses can maintain careers
Public Safety & Oversight
Automatically and immediately. The Compact requires reporting of adverse actions within two business days. States receive:
- Automatic alerts when their licensed or practicing personnel receive sanctions elsewhere
- Complete licensure and disciplinary history across all Member States
- Access to coordinated investigation information and evidence
Critical distinction: States maintain complete sovereignty. Receiving notification does not equal automatic action. Each state independently determines if sanctions have standing and conducts its own investigations.
This coordinated database provides superior oversight compared to the current system where states must individually query each other and disciplinary actions may not be discovered for months or years.
The Compact operates 24/7 without requiring disaster declarations, providing capabilities that complement emergency management systems:
- Zero-notice deployment as situations develop
- Pre-positioning personnel before hurricanes or predicted events
- No emergency licensure processing during crises
- Superior public protection through verified credentials and background checks
The Compact complements emergency management assistance compacts by reducing administrative burden while maintaining verified credentials, background checks, and real-time oversight—critical for public protection during disasters.
Yes. Interstate healthcare compacts serve personnel in all employment sectors, including government employers:
- Nurse Licensure Compact: VA hospitals, state mental health facilities, county health departments, public hospitals, correctional facilities, public schools
- Interstate Medical Licensure Compact: Federal VA physicians, state hospital physicians, county health departments, public universities
- Psychology Compact: State correctional system psychologists, VA psychologists, public school psychologists, county mental health
The EMS Compact follows the same model, serving EMS personnel regardless of whether they work for fire departments, hospital-based services, private companies, or other agencies. Learn more about how multistate nurse licensure works.