EMS Compact...A Big Benefit for Providers
Each state licenses or certifies its EMS personnel, and it is through this governmental approval that providers care for patients. For some states, their approval covers a provider throughout the entire state, and for others, it (essentially) only allows him or her to practice within a county, or at a specific location – like a business. When Paramedics and EMTs transport patients outside of the area in which they are licensed or certified, the legality of what they do for patients is a potential issue that has been considered since at least the early 1980s when I started in EMS. Typical scenarios considered have been Paramedics needing to deploy in anticipation of a possible disaster, an EMS unit transporting a patient outside of its call area, or one that has responded to an emergency call for help outside of its response area. All of these could be seen as being “unsanctioned” by a State authority for those events in question. In general, States have allowed EMS units to routinely cross State-borders and have simply not enforced licensing rules upon visiting agencies (or personnel) unless there was an actual or suspected problem.
A real solution for the somewhat nebulous situation of jurisdictional clarity is the creation of an interstate compact, known as REPLICA (“Recognition of EMS Personnel Licensure Interstate CompAct”). The overall goal of the compact is to provide a legal mechanism for providers to operate when going from the HOME state that does credential them into a REMOTE state that does not. If a State restricts a responder’s credential to an area smaller than the State (like a county or city), REPLICA will not overrule that restriction to practice.
REPLICA was result of efforts by the National Association of EMS State Officials (NAEMSO) and a many other national leaders. Once approved by 10 or more states, REPLICA will become active and provide the following benefits to member states (and individual EMS responders):
- When applying for certification, “(m)ember states shall consider a veteran … a spouse thereof… as satisfying the minimum training and examination requirements for … licensure.” And the applications for veterans’ and veterans’ spouses’ licensure will be expedited.
- Providers can cross State lines for emergency and non-emergency calls using a HOME state’s credential to practice into a REMOTE state (a state in which they do not have a credential) (Note: they will be accountable to the HOME state and the state to which they have traveled)
- States can (continue to) require that EMS Agencies obtain a license to do business in their borders if they cross the State’s line routinely
- Federal workers (e.g., wildland fire fighters, FEMA Paramedics) can function during deployments using their HOME state’s license
- Rules drafted by the Commission that operates the compact will be open to public review and comment
- The National Registry of EMTs (NREMT) will provide States with the ability to quickly verify the credentials, adverse actions, license discipline, and significant investigatory findings provided by EMS authorities in the of the compact by means of a centralized database
REPLICA is an agreement about the licensure (certification) of EMS personnel, and not of agencies. States will continue to have the right to require that agencies obtain business licenses. Personnel might continue to have multiple licenses or certifications in HOME states; REPLICA will allow the provider to practice in a REMOTE compact member State in which the provider is not credentialed. Veterans of the military (and their spouses) will be assumed to have met training requirements for their level of credentialing when requesting certification and their applications will be expedited. Each State that wants to join the compact must pass the agreement through its legislative body. States will NOT lose any rights and or powers, but will gain the ability to better oversee the emergency personnel entering their borders to provide care. The NREMT will provide a database by which states can immediately verify the status (e.g., credentials, disciplinary actions) of all providers in member States.
Sandy Hunter, PhD, NRP
Dr. Sandy Hunter is a Nationally Registered Paramedic and Professor; he has been with the Paramedicine program for nearly 20 years. Dr. Hunter earned an undergraduate degree in emergency medical care from Western Carolina University, a Master’s degree in health education from EKU and a Ph.D. in educational psychology from University of Kentucky. He has 35 years of experience in EMS, including working as a Paramedic and educator in Saudi Arabia. His publications can be found in JEMS, EMS Magazine, Occupational Health and Safety Magazine, and (the) Domain. He has co-authored a national curriculum for the National Association of EMS Educators and been a curriculum taskforce member for the U. S. Department of Health and Human Services - Office of Minority Health. Dr. Hunter has previously served on the Boards of Directors for the National Association of EMS Educators and the Committee on Accreditation of Educational Programs for the Emergency Medical Services Professions. He currently serves on the Board of Directors for the National Registry of EMTs.
With additional information provided by:
Paul R. Patrick, Deputy Division Director
Family Health and Preparedness
Compact Director, NREMT
Published on August 11, 2016