The Recognition of EMS Personnel Licensure Interstate Compact (REPLICA) contains provisions that apply to cross-border practice. REPLICA has given us the tools to allow for EMS personnel on a mission specific, time limited or intermittent basis to cross state lines, do their job and return to their home state. An umbrella of accountability covers licensed EMS personnel before, during and after authorized cross-border practice through REPLICA elements of which include:

  • REPLICA requires that all states whose EMTs, AEMTs and Paramedics work across state lines use a common ‘fitness test’ for EMS licensure and via the current educational and performance standards in their home state.*
  • REPLICA requires all EMS personnel exercising the privilege to practice in a remote state to function under a defined scope of practice from their home state function under the supervision of a physician medical director in their home state.
  • REPLICA increases safety for patients and EMS coworkers by requiring member states adopt a requirement that EMS personnel undergo an FBI compliant background check with biometric data at the time of initial licensure.**
  • REPLICA member states’ EMS licensing authority will have access to a national EMS personnel coordinated database. State EMS Officials will have the ability to rapidly share licensure, investigation, and disciplinary history of personnel for the first time in our profession.
  • REPLICA gives member states authority over EMS personnel from other member states as though the remote state had licensed those personnel themselves.

Each state has a strong sense of pride and its own unique EMS system features. EMS personnel and their state EMS office staff leaders are proud of their home state status and are quick to tell you why.  It is clear to me that there is more that unites us in the work that we all do. Patients are patients, their needs are the same, and our job to protect them and each other is the number one priority. For the first time in our profession this unprecedented level of accountability will exist and will unify patient ad co-worker protections under one umbrella.  The nurses were the first to build and test out a healthcare licensure interstate compact and paved the way for the physicians, EMS and the physical therapist.   REPLICA has benefited from the experiences of other the compacts, in particular in the areas of information sharing and accountability. For information on how REPLICA increases accountability in the EMS profession as please visit

*From the point of joining the compact moving forward, states must utilize the NREMT exam for initial licensure at all levels.

** No later than five years after activation, the Compact requires a criminal background check of all applicants for initial licensure, including the use of the results of fingerprint or other biometric data checks compliant with the requirements of the Federal Bureau of Investigation with the exception of federal employees who have suitability determination in accordance with US CFR §731.202 and submit documentation of such as promulgated in the rules of the Commission.  REPLICA was enacted on May 8, 2017.