Map of the states that have enacted the Recognition of EMS Personnel Licensure Interstate Compact (EMS Compact) in the United States, current October 2025.
The United States EMS Compact, officially the Recognition of EMS Personnel Licensure Interstate Compact (REPLICA), is an interstate compact that enables day-to-day practice by licensed emergency medical services personnel across member state lines by recognizing a privilege to practice.[1][2] The compact was formalized on October 11, 2017, when Georgia became the tenth state to enact the REPLICA model legislation, establishing the Interstate Commission for EMS Personnel Practice.[3]
As of October 2025, 25 states have enacted the compact.[4][5]
Legal basis
The compact is grounded in Article I, Section 10, Clause 3 of the United States Constitution, known as the Compact Clause, which authorizes states to enter into agreements with other states with Congressional consent.[6] In Virginia v. Tennessee (1893), the Supreme Court held that not all interstate compacts require explicit Congressional approval.[7]
Interstate compacts are enacted as state law in each participating jurisdiction. The legal mechanism for the privilege to practice is established in Section 4(A) of the REPLICA model legislation.[8]
Governance
The compact establishes the Interstate Commission for EMS Personnel Practice, a multistate governmental entity composed of one gubernatorial appointee from each member state.[9] The commission administers and enforces the compact's provisions, including rulemaking authority as provided by the compact and member state law.
The commission is recognized in federal interagency documents as playing a role in coordinating EMS workforce policy across state lines.[10]
Composition and representation
Each member state's governor appoints one commissioner to represent the state, typically the senior executive branch official overseeing emergency medical services. Every state has equal representation with one vote per state on all matters before the commission.[11]
As of October 2025, the chair is Kraig Kinney and the executive director is Donnie Woodyard Jr.[12]
Authority and responsibilities
The commission's responsibilities include:
Adopting administrative rules for compact implementation
Overseeing compliance and enforcement among member states
Managing the coordinated database for licensure and disciplinary information
Resolving disputes between member states
Conducting public meetings and soliciting public comment on proposed rules
The commission meets regularly throughout the year, with both virtual meetings and an annual in-person meeting.[13]
The compact recognizes home state licensure for qualified emergency medical services personnel. Under the compact, practice remains subject to the laws, protocols, and medical direction of the state where care is provided.[41][42]
Eligibility requirements
According to the model legislation, an EMS clinician receives recognition when the clinician:[43]
Holds a current, unrestricted home state license as an EMT, advanced EMT (AEMT), a state-recognized level between EMT and paramedic, or paramedic
Is at least 18 years of age
Has a physician medical director
Is affiliated with an EMS agency authorized in the remote state
Eligibility and conditions are set out in Sections 4 and 5 of the model legislation.[44]
Scope of practice
According to compact materials, scope of practice defaults to the home state, but remote states retain authority to modify scope under compact privileges.[45] Practitioners must follow all applicable laws, rules, regulations, protocols, and medical direction requirements in the jurisdiction where they are operating.
National EMS Coordinated Database
The compact establishes a coordinated database for licensure and practice information. The National EMS Coordinated Database (NEMSCD) provides tracking of EMS personnel licensure status and adverse actions across member states.[46]
Member states submit uniform data sets to the database, including identifying information for licensed personnel and adverse actions. The database enables verification of credentials and status through an online portal using a 12-digit National EMS ID number.[47]
Be licensed in good standing in a home state as an EMT, advanced EMT (AEMT), paramedic, or a level in between EMT and paramedic
Have a validated Privilege to Practice in the coordinated database
Be at least 18 years of age
Have a physician medical director
Be affiliated with an EMS agency authorized in the remote state
History
Background
For decades, emergency medical services in the United States operated under state-specific licensure systems. The National Registry of Emergency Medical Technicians provided national certification for clinical competence assessment, but legal authority to practice was defined by individual state law.[50]
The Nurse Licensure Compact and Driver License Compact provided precedents for state-based mutual recognition approaches.[51] In 2012, EMS leaders identified the need for personnel to respond across state lines in day-to-day operations, disaster situations, and large-scale events, and for licensing authorities to share information more effectively.
Federal policy documents in 2019 noted challenges with existing approaches to interstate EMS licensure and referenced the development of the compact.[52]
Development
In 2013, a national advisory panel convened to develop a solution. A drafting team was formed in mid-2013 to create model legislation.[53] The twelve-member drafting team included representatives from:
National Association of State EMS Officials (NASEMSO) (five members)
Council of State Governments, National Center for Interstate Compacts (NCIC)
Association of Air Medical Services (AAMS)
International Association of Flight and Critical Care Paramedics (IAFCC)
International Association of Firefighters (IAFF)
National EMS Management Association (NEMSA)
National Association of EMTs (NAEMT)
Vedder Price (legal counsel)
State legislative committees also reviewed the compact proposal during this period. In 2016, Wyoming's Joint Interim Committee on Labor, Health and Social Services examined the draft compact legislation and its implications for EMS workforce mobility.[54]
On September 7, 2017, the National EMS Advisory Council passed an advisory in support of the compact.[55][56]
Activation
The compact was originally scheduled to become active on July 1, 2020. With emergency services personnel affected by COVID-19 quarantines, the Interstate Commission announced on March 15, 2020, the decision to activate the compact on March 16, 2020.[57][58]
According to EMS trade publications, the compact has been used in disaster response situations and for addressing staffing needs.[59]
Recent developments
State expansion
On March 20, 2025, Arkansas became the 25th state to enact the compact through Act 384 (House Bill 1253), sponsored by Representative Lee Johnson. The legislation received unanimous bipartisan support.[60] Arkansas appointed Christy Kresse as its commissioner to the Interstate Commission.
Database integration
In September 2025, Tennessee integrated its state licensure system with the coordinated database, providing access for licensed Tennessee EMS personnel.[61]
Rulemaking
The commission has issued position papers on workforce privacy protection (2025), code of conduct (2024), and biometric criminal history checks (2023).[62] In 2025, the commission proposed rules regarding provisional privilege to practice status.[63]
Supporting organizations
Organizations that have supported the compact include:[64]
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