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.

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Frequently Asked Questions

Does the EMS Compact only apply during emergencies, and is there a time limit?

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.

Note on data integration: A qualified clinician may have a valid Privilege to Practice even if a state has not completed database integration. When a PTP record is not yet visible in the database, contact the state EMS office for assistance with verification.

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

No. The Privilege to Practice is granted automatically to qualified EMS clinicians. No additional applications, approvals, or fees are required.

Are EMS agencies required to hire me or utilize me?

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.

Is the Privilege to Practice the same as reciprocity?

No. You must obtain and maintain a Home State license. The Compact 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.

Does the EMS Compact cover EMS agencies, ambulances, or employers?

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.

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

No. The EMS Compact does not provide a multistate Privilege to Practice for EMRs.

Are EMT-Intermediates covered by the EMS Compact?

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.

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

No. Individual clinicians are not required to hold current National Registry certification to use the Privilege to Practice. Member States, however, must use National Registry certification as a prerequisite for initial state EMS licensure.

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

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.

What are the requirements for the Privilege to Practice?

Eligibility includes:

• Licensed, in good standing, as an EMT, AEMT (or level between EMT and Paramedic), or Paramedic in a Member State.
• Have a physician medical director through your affiliated EMS agency.
• At least 18 years old.

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

• 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.

Can I have more than one Home State license?

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.

Can a Remote State investigate or discipline an EMS clinician working under the Privilege to Practice?

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.

Can a Remote State suspend or revoke my EMS license?

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.