Capitalizing off of a portion of Neil Armstrong’s statement as he stepped foot on the moon, the EMS profession is on the verge of taking a giant leap as it pertains to EMS licensure and the ability to work in other states. We all know that we cannot technically work in another state unless we are licensed by that state to do so, yet it happens on a daily basis all across the U.S. From border cities where crews are responding back and forth across state lines; to fire and EMS personnel deploying to other states for wildfires, hurricanes, urban search and rescue (USAR) deployments and other natural disasters; to federal workers who may be in a different state every day; we are all trying to do what is right.

However, by doing so, we are also breaking the law, unless we are operating under the Emergency Management Assistance Compact (EMAC) where this is allowed. In recent years, state EMS officials have been increasingly challenged with federal and other EMS personnel deploying to a state and practicing as an EMS provider without being licensed by that state. While these EMS personnel are providing a valuable service, their actions could be interpreted as practicing medicine without a license, which is a felony in most states. To the best of my knowledge, no EMS providers have been charged for working in another state without a license, but the risk is very real.

EMS personnel from those member states will be allowed to function in their home state as well as the remote member state.

Understanding that this is a significant problem for all federal EMS workers, the Department of Homeland Security contracted with the National Association of State EMS Officials (NASEMSO) to develop a “consensus-based and legally sound” solution in the form of an interstate compact.1 NASEMSO decided that this was the prime opportunity to not only address the federal problem, but the everyday state problem too, with the development of a compact. Compacts are used for a variety of purposes, such as EMAC for state-to-state assistance in times of declared emergencies and the Driver License Compact (DLC), which allows states to share drivers’ information and allows us to drive in other states without having to have a license for each state.

In early 2013, a national advisory panel was established with representatives from all areas of the EMS profession, and this group developed the high-level objectives and provided direction to the drafting team. The drafting team then began work on a document to meet the panel’s objectives while also addressing the necessary components of a compact. NASEMSO’s project proposal stated that, “The outcome is a model compact for states to adopt allowing universal, rapid and, in select circumstances, immediate recognition of state issued EMS personnel licenses by compact states under specified conditions.”¹

This draft model compact was presented to the state EMS officials and all other interested parties on Feb. 18, 2014. The proposed compact is designed to serve as a contract between states; create a governmental commission to establish rules and a national database; allow states to extend privileges to EMS personnel from other compact member states; and gain authority over those EMS personnel from other states when they are functioning in the compact state. The compact also establishes home state obligations that include not only the ability to receive and investigate complaints, but to also notify the commission of actions against EMS personnel; it requires that the member states use the National Registry of Emergency Medical Technicians (NREMT) examination process. Within five years, member states must also have a criminal background check process in place.

EMS personnel from the member states must be at least 18 years old, they must have a current license to function as an EMS provider and they must practice under the supervision of a physician advisor or medical director. Additionally, the individual will function in the remote state under their normal scope of practice and home state protocols until the remote state establishes specific protocols.

Simply put, once the compact has been adopted and is in place, EMS personnel from those member states will be allowed to function in their home state as well as the remote member state. States will need to pass legislation to become a member of the compact, and that process should begin as soon as June 1 of this year.

Ultimately, our EMS personnel will no longer have to worry about the law or maintaining licenses in multiple states.

Ultimately, our EMS personnel will no longer have to worry about the law or maintaining licenses in multiple states. An example given in one of the panel meetings was of a flight medic who had to maintain seven state licenses because his employer flew into all of those states. With this compact in place, he would only need one. Couple this with all of our providers who cross state lines in the course of normal daily operations, and the compact becomes a very realistic solution. For those of us who have been in this profession for any length of time, this will truly be one giant leap for EMS.

For much more information on the interstate compact, visit: www.nasemso.org/Projects/InterstateCompacts/ index.asp.

Reference

1. NASEMSO. (October 2012). Model insterstate compact for emergency medical services personnel licensure for state adoption project proposal. NASEMSO. Retrieved on April 30, 2014, from www.nasemso. org/Projects/InterstateCompacts/documents/NASEMSO-Interstate-Compact-Project-Background-Scope-Oct2012.pdf.