Between 2013-2014 Phase 2 of the interstate compact building process was in full swing.  A Drafting Team had been established and was working under the guidance provided by the National Advisory Panel (NAP) to build an Interstate Compact for EMS Personnel Practice.  Their work including building the main pillars – tenants of REPLICA.  While drafting, each section of the Compact was discussed, debated and given careful consideration.  In the end of Phase 2, the team members released the model language in September 2014.  This group was comprised of :

  • National Association of State EMS Officials
  • National Association of Emergency Medical Technicians
  • Council of State Governments, National Center for Interstate Compacts
  • Association of Air Medical Services
  • International Association of Flight and Critical Care Paramedics
  • International Association of Firefighters
  • National EMS Managers Association
  • Vedder Price – Law Firm

Even though we have moved into Phase 4 of this process, Compact Administration, there is still education and advocacy work ahead for REPLICA.  Efforts are already underway to support states that are considering a move to introduce REPLICA in this upcoming session.  I felt it would be helpful share the top 4 areas most frequently discussed when working with EMS system leaders, legislators and personnel throughout the nation giving careful consideration to introducing REPLICA;

Multistate License versus a Privilege to Practice (PTP): Central to REPLICA has been reducing regulatory barriers for licensed personnel in cross border scenarios, increasing access to services for patients and bringing about unprecedented accountability in our profession.  States mutually agree to uniform standards for entry and maintenance /monitoring as well recognize the ways each other operates their ongoing state licensing process.  This falls within the model of a Mutual Recognition Compact.  In the case of REPLICA, states have agreed to use the NREMT as the common fitness test for initial licensure at the EMT – Paramedic levels.  Additionally, states have agreed to utilize the FBI compliant background check with biometric data*.   REPLICA is not a multi-state license, but a PTP within member states under authorized circumstances.  These circumstances include cross border day-to-day personnel responses and transport(s), mass casualty incidents (MCI) up to the point where a governors deflation of a disaster is issued (this includes pre-staging of personnel) and other circumstances untimely vetted and approved in rulemaking by the commission. **

Military Recognition: REPLICA requires that member states develop and implement a process by which to move veterans, members of the military separating from active duty and their spouses, including the members of the National Guard, to the front of the line when processing license applications. Although some states have already adopted similar ways to recognize these important members of our EMS community’s for their sacrifices in service to our nation, many states still have a first come first serve process.  REPLICA solves this problem for these states by giving statutory authority in a place where it did not previously exist.  A current NREMT card with no restrictions is required for eligibility under the military recognition section.

Accountability Across State Lines:  Like the Nurse Licensure and the Drivers License Compacts, REPLICA boasts the implementation of a real-time Coordinated National EMS Personnel Database. For the first time in the nation’s history, the licensure information of EMS personnel from member states will be at the fingertips of state EMS authorizes.  Significant investigatory information and licensure actions will be readily available.  The Coordinated Database will report to the National Practitioners Databank on behalf of member states.  In the end, member states will now know who is moving back and forth across state lines, a key public and workforce protection attribute of REPLICA.

Quality Across State Lines:  Changing practice based in zip code is a patient and EMS personnel safety issue.  REPLICA adds another level of accountability to cross border practice where there was once none. In order for EMS personnel to be eligible under the Compact, they must be 18 years of age, hold an unrestricted license and work under the supervision of an EMS Medical Director.  EMS personnel in member states will practice under their home state EMS protocols while in a remote state, across state lines, unless modified by an appropriate authority in accordance with the rules of the Commission.**

I often reach back and talk with members of the NAP and the Drafting Team to better understand the careful consideration given along the way to the full development of REPLICA.   American novelist Pearl Buck once said, “If you want to understand today, you have to search yesterday”.    For more information on REPLICA, please visit

*from five years of the Compact’s enactment.  Effective May 8, 2017.

**the Commission has not yet officially assembled.  The Commission will have the ability to promulgate rules and address only those areas the Compact is applicable, EMS Personnel in cross border practice.