EMS Compact

Compact Governance

Compact Governance

The Interstate Commission for EMS Personnel Practice is the multistate governmental body established by state law to administer and enforce the United States EMS Compact. The Commission oversees implementation among Member States, adopts rules, facilitates information sharing, and provides a forum to resolve interstate issues related to Compact operations. Each Member State is represented by one voting delegate (the “Commissioner”), appointed by the Governor or the Governor’s designee. The Commission is an instrumentality of the Compact states and acts on their collective authority within the scope of the Compact.

Legal basis: REPLICA Section 10 establishes the Commission as a joint public agency of the Member States and outlines its composition, voting, and meeting requirements.

Commissioner Appointments

In most states, the Commissioner is the senior executive-branch official responsible for EMS regulation (for example, State EMS Director, Branch Chief, or Bureau Chief). Where more than one state entity licenses EMS clinicians, the Governor designates which entity appoints the Commissioner. Each Member State holds one seat and one vote on matters before the Commission.

Commission Authority

The Commission’s authority is limited to matters authorized by the Compact and related to interstate (cross-border) practice. Core functions include:

  • Representation and Voting: One Commissioner per Member State, one vote per state.
  • Rulemaking: Adoption of bylaws and promulgation of rules to administer cross-border practice under the Compact.
  • Policies and Procedures: Establishment of uniform policies to support consistent state implementation.
  • Coordinated Data: Governance of the National EMS Coordinated Database (NEMSCD) framework and related information-sharing rules.
  • Enforcement & Compliance Support: Compliance monitoring, dispute resolution processes, and coordination among Member States to address interstate issues.
  • Sovereign Immunity & State Authority: Operations consistent with each state’s sovereign immunity and preservation of state control over licenses issued by that state.
  • Transparency: Public meetings and notice consistent with the Compact’s open-meeting and rulemaking requirements.

Through shared governance, uniform rules, and real-time data sharing, the Commission enables qualified EMS clinicians to practice across state lines while preserving state sovereignty and protecting the public.