Recognition of EMS Personnel Licensure Interstate CompAct

The United States EMS Compact, officially known as the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA), is an interstate compact designed to facilitate the day-to-day practice of emergency medical services personnel across state lines. The compact provides a framework for states to extend a "privilege to practice" for licensed EMS clinicians from a "home state" to "remote states," enhancing workforce mobility and ensuring efficient emergency responses. 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. ^[1]

EMS Compact member states as of January 5, 2025

Governance

The Interstate Commission for EMS Personnel Practice serves as the governing body of the EMS Compact. Established by legislation in each member state, the commission is a governmental entity responsible for implementing and overseeing the compact's provisions. It is recognized as the highest EMS regulatory body in the United States, operating above individual state EMS offices for matters related to the compact.

Key governance features include

• State representation:
  • Each member state's governor appoints one commissioner to represent the state.
  • Every state has equal representation, with one vote per state on all matters before the commission.
• Rule-making authority:
  • The commission has the power to adopt rules necessary for the compact's implementation.
  • These rules carry the full effect of state law, ensuring uniform application across all member states.
• Responsibilities:
  • Administering and enforcing the compact's provisions.
  • Managing the data system that enables licensure and disciplinary information sharing.
  • Addressing disputes and ensuring member state compliance.
  • Collaborating with federal entities and other compact commissions to enhance the compact's functionality.

This governance structure ensures the compact operates effectively, with all states contributing equally to its success. The commission's authority as the preeminent EMS regulatory body and its power to make binding rules solidify its critical role in shaping the future of EMS across the United States. ^[2]

Participating states

• Alabama^[3]
• Colorado^[4]
• Delaware^[5]
• Georgia^[6]
• Idaho^[7]
• Indiana^[8]
• Iowa^[9]
• Kansas^[10]
• Louisiana^[11]
• Mississippi^[12]
• Missouri^[13]
• Nebraska^[14]
• Nevada^[15]
• North Dakota^[16]
• Oklahoma^[17]
• Pennsylvania^[18]
• South Carolina^[19]
• South Dakota^[20]
• Tennessee^[21]
• Texas^[22]
• Utah^[23]
• Virginia^[24]
• West Virginia^[25]
• Wyoming^[26]

Requirements

^[27]

For states

• Pass the REPLICA model legislation
• Utilize the National Registry of EMTs (NREMT) examination as a condition of issuing initial licenses at the EMT and paramedic levels
• Utilize a fingerprint or biometric criminal history check that is compliant with the FBI requirements

For personnel

A qualified EMS personnel must:

• Be licensed in good standing in a home state as an emergency medical technician (EMT), advanced EMT (AEMT), a paramedic, or a level in between EMT and paramedic^[28]
• Must be at least 18 years of age
• Must practice under the supervision of a physician medical director

History

Early history

In 2012, EMS leaders recognized the need for qualified EMS personnel to respond across state lines in both day-to-day duties, in non-governor level declared disaster situations, and planned large-scale events, and the requirement for state EMS licensing authorities to better share licensure information. In 2013 a national advisory panel held multiple meetings conceptualize the solution.

On the recommendation of the National Advisory Panel, a draft team was formed in mid-2013 to draft the model legislation.^[29] The twelve member drafting team included:

• Five members from National Association of State EMS Officials (NASEMSO)
• The Council of State Government, (CSG) 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 EMT's (NAEMT)
• Vedder Price (legal counsel)

On 7 September 2017, the National EMS Advisory Council passed a final advisory in support of the Recognition of Emergency Medical Services Personnel Licensure Interstate CompAct.^[30]

Early activation

The EMS Personnel Licensure Compact was originally scheduled to become active on July 1, 2020. However, with so many emergency services personnel taken out of action by quarantines associated with the COVID-19 outbreak, the decision was made to go live on March 16, 2020. Interstate Commission Chairman Joe Schmider reported that this type of emergency was what the EMS Compact was developed to accommodate.^[31]

Supporting associations and organizations

Source:^[32]

• American Ambulance Association^[33]
• Association of Air Medical Services
• Association of Critical Care Transport
• Council Of State Governments^[34]
• International Association of Fire Chiefs^[35]
• National Association of EMS Educators
• National Association of EMS Physicians
• National Association of Emergency Medical Technicians
• National Association of State EMS Officials^[36]
• National EMS Management Association
• National Registry of Emergency Medical Technicians^[37]
• National Volunteer Fire Council