Terminology

Common terms used in the United States EMS Compact and its associated rules and processes.

Advanced Emergency Medical Technician (AEMT): An individual licensed with cognitive knowledge and a scope of practice corresponding to the AEMT level in the National EMS Education Standards and National EMS Scope of Practice Model.
Adverse Action: Any administrative, civil, equitable, or criminal action permitted by a state's laws that may be imposed against licensed EMS personnel by a state EMS authority or court. Examples include revocation, suspension, probation, consent agreements, monitoring, limitations or encumbrances on practice, letters of reprimand or admonition, fines, criminal convictions, and court judgments enforcing EMS authority actions.
Alternative Program: A voluntary, non-disciplinary substance use recovery program approved by a state EMS authority.
Certification: The successful verification of entry-level cognitive and psychomotor competency using a reliable, validated, legally defensible examination.
Commission: The national administrative body of which all states that have enacted the Compact are members. Formal name: [Interstate Commission for EMS Personnel Practice](/the-commission/).
Emergency Medical Technician (EMT): An individual licensed with cognitive knowledge and a scope of practice corresponding to the EMT level in the National EMS Education Standards and National EMS Scope of Practice Model.
Home State: A participating state where an individual is licensed to practice emergency medical services.
License: The authorization by a state for an individual to practice as an EMT, AEMT, Paramedic, or a level between EMT and Paramedic. Some states use the term "state certification"; for purposes of the EMS Compact, a state certification is treated as a state license.
Medical Director: A physician licensed in a participating state who is accountable for the care delivered by EMS personnel.
National EMS ID Number: The EMS ID is a unique 12-digit identification number (####-####-####) issued at no cost to all EMS professionals and students seeking to enter the profession. It is generated by the [National Registry](https://www.nremt.org) when an individual creates an account. The number is randomly generated and does not encode personal or credential data.

Locate your EMS ID by logging into your National Registry account, your Home State's licensure portal, or by contacting your state EMS office. If your EMS ID is not found in the [National EMS Coordinated Database](/the-commission/nemscd/), check your Home State's database integration status.
Paramedic: An individual licensed with cognitive knowledge and a scope of practice corresponding to the Paramedic level in the National EMS Education Standards and National EMS Scope of Practice Model.
Participating State: A state that has enacted the EMS Compact.
[Privilege to Practice](/privilege-to-practice/): An individual's authority to deliver emergency medical services in remote states as authorized under the EMS Compact.
Remote State: A participating state in which an individual is not licensed.
Restricted: The outcome of an adverse action that limits a license or the Privilege to Practice.
Rule: A written statement by the Interstate Commission, promulgated under Section 12 of the Compact, that implements or interprets a provision of the Compact or sets an organizational, procedural, or practice requirement of the Commission. A rule has the force and effect of statutory law in a participating state.
Scope of Practice: The defined parameters of duties or services that may be provided by an individual with specific credentials. Whether set by rule, statute, or court decision, it represents the limits of services an individual may perform.
Significant Investigatory Information: Investigatory information that a state EMS authority, after a preliminary inquiry, has reason to believe would, if proved true, result in an adverse action on a license or Privilege to Practice; or investigatory information indicating an immediate threat to public health and safety.
State: Any state, commonwealth, district, or territory of the United States.
State EMS Authority: The board, office, or other agency with the legislative mandate to license EMS personnel.

Key Legal Concepts

These terms describe the legal framework behind the EMS Compact. They are explained in greater depth on the Legal Foundation page.

Compact Clause: Article I, Section 10, Clause 3 of the U.S. Constitution, which authorizes states to enter into agreements or compacts with one another. It is the constitutional basis for every interstate compact, including the United States EMS Compact.
Cooperative federalism: A model of American government in which state and federal authorities work in tandem to manage overlapping responsibilities, often described as a "marble cake" that blends state and federal roles. It emerged in the early-to-mid 1900s, and it is the context in which interstate compacts became essential tools for managing challenges that cross state lines without ceding state sovereignty.
Dual federalism: The earlier model envisioned by the framers, in which state and federal governments operated in separate, clearly defined spheres of authority, often described as a "layered cake." States controlled internal affairs such as health, education, and public safety, while the federal government focused on enumerated powers such as national defense and foreign policy.
Interstate compact: A legally binding contract between two or more states, enacted as state law by each participating state's legislature. Unlike ordinary legislation, a compact cannot be unilaterally amended, repealed, or ignored by an individual state, and its provisions are enforceable in state and federal court.
Mutual recognition: The mechanism by which participating states recognize a qualifying license issued by another participating state, allowing a clinician to practice across state lines without obtaining an additional state license. In the EMS Compact, mutual recognition takes the form of the Privilege to Practice.
Police powers: The authority reserved to the states under the Tenth Amendment to regulate matters affecting public health, safety, and welfare. Occupational licensure, including EMS licensure, is a core exercise of this reserved power, which is why EMS practice is regulated state by state rather than federally.
Regulatory compact: An interstate compact that establishes shared standards and a governing commission to coordinate a regulated activity, such as professional licensure, across participating states while preserving each state's sovereignty. The EMS Compact is a regulatory compact.
Rulemaking authority: The authority of the Interstate Commission, under Section 10 of the model legislation, to promulgate uniform [administrative rules](/the-commission/administrative-rules/) that carry the force and effect of law in every participating state, adopted through a public process with notice and comment.
Statutory contract: The dual legal nature of an interstate compact: it functions simultaneously as state law in each participating state and as a binding contract among the states. This is why every participating state must enact the same model legislation using identical language, and why noncompliance is both a violation of state law and a breach of contract with the other states.