Last June in EMS Insider, I wrote about the opportunity that EMS had with a forthcoming initiative that would make our lives easier and represent “one giant leap for EMS.”1 So, as you read this article, it may seem a little like déjà vu. However, now that the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) has been finalized, it is absolutely imperative that all members of the EMS community reach out to their state EMS officials and their state legislatures to strongly encourage the adoption of this new interstate compact.


As a recap, we’ve known for years that when our personnel cross state lines to perform any type of EMS care, they are technically supposed to be licensed in that state as well as their own home state, unless they were operating under the emergency management assistance compact (EMAC). While this generally has not been enforced on a consistent basis, it was a difficult position for state EMS directors to accept knowing that this was occurring regularly and in some cases daily, within their states. To make things even more complicated, we developed urban search and rescue (USAR) task forces, established ambulance strike teams to respond anywhere in the country, and requested local resources to cross state lines to assist in fire and EMS delivery in major disasters. With the creation of the Department of Homeland Security (DHS) and its associated tasks (which very much includes EMS), this was eventually the final straw that resulted in some form of required action.



DHS understood the problems of having approximately 5,000 EMS personnel licensed in only one state, but working in many others depending on the assignment. In an attempt to resolve this issue, DHS approached the National Association of State EMS Officials (NASEMSO), explained what they wanted to see done, and eventually a contract was issued by DHS to generate a solution this problem. While the focus was on federal employees, NASEMSO saw this as an opportunity to resolve this ongoing problem for public and private EMS providers as well as potentially address the ability for military personnel to cross over into civilian EMS—and the best way to do this was through an interstate compact.


Working with the Council of State Governments National Center for Interstate Compacts, NASEMSO formed a national advisory panel representing 23 different EMS organizations. That group was directed to establish a framework and put together a drafting team. The drafting team then took the framework, worked through the details and challenges, and after a number of reviews and edits, REPLICA was finally created.


When REPLICA was finalized and ready for release last fall, Dia Gainor, who currently serves as executive director of NASEMSO, said, “In one of the most labor-intensive projects of national significance in its history, the National Association of State EMS Officials brought industry partners and experts in the field of interstate compacts together over the last two years to develop model legislation for states’ consideration and enactment.”


Gainor continued by stating, “EMS is at the leading edge of a growing wave of medical disciplines’ national bodies of state regulatory agencies that have discovered that interstate compacts are a novel yet time-tested way to solve the pervasive dilemma of providing appropriately credentialed individuals from other states the legal ability to practice under specified conditions, introduce unprecedented accountability related to those personnel, and create means of information sharing among states that have never existed before.”


REPLICA was designed to:

  • Invest all member states with the authority to hold EMS personnel accountable through the mutual recognition of member state licenses
  • Facilitate the exchange of information between member states regarding EMS personnel licensure, adverse action and significant investigatory information
  • Promote compliance with the laws governing EMS personnel practice in each member state
  • Increase public access to EMS personnel
  • Enhance the states’ ability to protect the public’s health and safety, especially patient safety
  • Encourage the cooperation of member states in the areas of EMS personnel licensure and regulation
  • Support licensing of military members who are separating from an active duty tour, veterans and their spouses2

This compact essentially allows EMS personnel from one member state to function in another member state without having to be licensed in that other state. Yes, there are a number of requirements that the states must abide by, but there are also a number of checks and balances in place that preserve each member state’s ability to maintain control over their EMS system. Regardless of reason (i.e., natural disaster, planned special event, normal daily operations, etc.), REPLICA ensures that these critical EMS resources are allowed to legally operate across state lines.


REPLICA does not become effective until 10 states adopt the compact through their state legislative bodies. Each state must agree to the requirements of the compact, pass legislation without significantly changing the wording of the compact, and the governor must then sign the legislation into law. As of March 2015, Colorado, Missouri and Virginia all have proposed legislation in different stages of adoption within their legislative bodies, so that means seven more states are still needed for REPLICA to become effective.


Here is my challenge to you: Begin work now with your state EMS official as well as your state senators and representatives to start the adoption process. Understanding that each state has a different legislative cycle, it could be a couple of years before we can get 10 states to adopt the compact. But, if we press the issue to solve this problem, we could potentially see REPLICA enacted by late 2015 or early 2016. The solution has been developed for you, so act now to ensure that your EMS personnel and your state are protected the next time that an EMT or paramedic crosses your state line. It really is as easy as REPLICA.


For more detailed information on REPLICA, visit



1. Croom N. One giant leap for EMS. EMS Insider. 2014;41(6):2–3.
2. NASEMSO. (2014) Review of final draft for state directors and invitees. Retrieved on March 9, 2015, from