The EMS Compact Explained: Smarter Regulation, Faster Care

Transcript

SPEAKER_00: 0:00

This podcast is for educational purposes only, does not constitute legal advice, and does not create an attorney-client relationship. If you need legal assistance about a legal problem, contact an attorney.

SPEAKER_01: 0:13

Welcome back to Know Your Regulator, the podcast that inspires you to engage. I am your host, Simone Murfrey, and today we’re exploring one of the most dynamic tools for emergency medical professionals, the EMS Compact. Whether you’re an EMS license holder, a healthcare administrator, or just EMS curious, today’s episode is going to connect the dots between Interstate Licensure, Emergency Response, and Professional Mobility. Our guest today is Donnie Woodyard Jr., Executive Director of the Interstate Commission for EMS Personnel Practice, the body that administers the EMS Compact. Thank you so much for joining us, Donnie.

SPEAKER_00: 0:48

Yeah, it’s a joy to be here. And as always, you know, anytime I get to talk about the EMS Compact, uh, it makes my day.

SPEAKER_01: 0:55

Awesome. Well, let’s start at the beginning. Can you kind of outline what the EMS Compact is and and why it was created? How did it get started?

SPEAKER_00: 1:05

Yeah, absolutely. I mean, that that’s a pretty big question. So let me tackle the first part of it on well, what is the EMS Compact? And to do that, I have to go back to, well, what are compacts anyway? And one of the things that I like to tell people is that compacts, in many ways, in the United States, is that secret sauce that puts the United in the United States. Now, I can really nerd out on history, but I’m going to keep this short. So if we go back even before the US Constitution, when we had individual colonies, they found out they had to actually cooperate on things. They had their sovereignty, but they had to figure out a way to like cooperate with their neighbor or their neighbor’s neighbor. And that eventually formed this concept of a compact that came into the Constitution as a compact clause. And that is basically, it recognizes state sovereignty, it recognizes federal supremacy, but it’s the legal mechanism for states to enter into contractual agreements to outline terms to accomplish a purpose among states. Now we have all kinds of compacts. We have driver’s license compacts and water compacts and airports, many airports are compacts and you know uh transportation systems and education. The list goes on and on and on. EMS is one of 250 plus compacts. It’s important to us because the EMS compact allows for one state EMS license of a state that’s entered into this contractual agreement to be recognized in other states. Think about it like your driver’s license. Your driver’s license, issued in Texas or Colorado or wherever you may be, is recognized in other states. Well, that’s because states largely are part of a compact. They’ve agreed to standardized terms. They have a contract between the states that says, I recognize your license, you recognize mine. If someone breaks your law, this is how we’re gonna adjudicate it. And that is the model used for the EMS compact. Now, your question also went on to well, why did we even need this compact and what was the origins? So if you go back uh now about 12, 13 years ago, and at the time, uh we have a large federal-based EMS workforce, everything from air marshals through Secret Service through FBI, um, all kinds of homeland security uh initiatives. And our federal workforce said, well, wait a second, we don’t want to be in violation of state law, uh, but at the same time, it’s just not practical for me to carry 50 different licenses. And so they looked at solutions, and the best solution was to form an occupational license compact. Now, at the time, the only ones that had done that in occupational license was nursing. So the Department of Homeland Security funded a project to explore this, explore the legal foundations of it, and actually create uh the foundation for what is today the MS Compact. So that’s the origin, kind of in a nutshell, really quick, but it really started out of a need to figure out how do we solve this issue, which by the way was much bigger than just federal officials. I mean, I at one point in time I held seven state licenses. I meet people who have 20, 25 state licenses. So we needed a solution for that. And today there are 17 occupational uh license compacts. EMS was number two, and we help open the door for so many other professions.

SPEAKER_01: 4:43

And that’s awesome. And when you lay it out like that, it just makes sense, right? You think about, yeah, of course, we’re gonna have to interact with each other, and of course, you know, personnel are gonna have to cross state lines. And like you said, it just it just makes sense to um to have it all compact, not not carrying 50 licenses at one time. Yeah.

SPEAKER_00: 5:03

You know, just to add on to that real quick, I mean, uh another thing that we have to realize is that our society is mobile. You know, we don’t think about crossing a state border, and the public has an expectation that an EMT in their backyard will provide them the same level of care as an EMT when they’re on vacation four states over, or that a paramedic in one state is pretty much similar to a paramedic in the in another state. Same thing for nursing and physicians. So we look at health care on a national basis for standards. Therefore, it only makes sense that my license in one state can easily be recognized in another state.

SPEAKER_01: 5:44

Right. Yeah, exactly. So, you know, we kind of talked before um that this is goes beyond what you see just on paper. We talked about some, you know, um natural disasters, some big mass casualty events. I would imagine that this could really help save some lives in in real time by crossing state lines when you’ve got situations like hurricanes and you know, maybe even some staffing shortages. I know that’s a big issue.

SPEAKER_00: 6:13

So the the EMS compact is valid 24 hours a day, seven days a week, 365 days a year. There’s no application, there’s no um, you know, you don’t have to like buy a compact license. Yeah, it’s on the basis of you having a home state license, which is a state that’s part of the compact. And then you can immediately practice in any of the other states in the compact. For it could be disasters, it could be surge events, you could have, you know, a staffing shortage in an area, but it can also be for day-to-day work, it could be for going and you know gaining educational experience. It could be, hey, my family moved, or I’m in the fire department, I did a lateral transfer. Um, when it comes to disasters, you know, there’s another compact out there that many of the listeners might be aware of. And it’s the EMAC, it’s the emergency management assistance compact. And in disasters, you know, states E Mac resources all the time. Well, EMAC requires a disaster declaration. You have to request resources through the state-to-state channel, and it’s it’s a wonderful compact. Our compact ball references EMAC and the two work in synergy. The key with the EMS Compact, though, is you don’t have to have a disaster declaration because it’s on, it’s turned on 24 hours a day. So if a hurricane was to hit a state tomorrow or a wildfire, uh you know, you could bring people in right away and they have the legal authority to practice, but also public protection remains intact because there’s a mechanism for accountability, for standards, for knowing like scope of practice. All of that’s worked out in advance. So it really takes the response time down to a zero um delay on response. Now, even this week, I have non-compact states who are bringing in EMS resources for things like wildfires and other types of disasters. And it’s not uncommon for resources to actually have to wait a few days to go through the licensure process. The EMS compact solves that. It’s good for uh state public protection and good for the workforce.

SPEAKER_01: 8:32

Yeah, no, it sounds absolutely like it’s good. I am I am seeing no cons. I mean, this is just fantastic. And I want to go back to something you said a little bit earlier that, you know, uh the public expects that the EMS personnel in their backyard is going to be able to provide them, you know, the the same level of care or same um uh attention to care um as as someone who’s licensed in that state as their home state. So I think, you know, yeah, you’ve just all the way around, it it sounds great. You’ve got the the public is protected and you’ve got uh personnel who want to grow and learn in their profession who are able to, you know, super quickly. So it’s it’s awesome. Let’s talk structure of the compact. So um the EMS Compact is backed by a commission. Can you talk about who makes up the Interstate Commission for EMS personnel practice?

SPEAKER_00: 9:33

Yeah, absolutely. So, I mean, the first thing is we have to clarify that the EMS Compact is a governmental body. And so sometimes people, you know, think, well, you know, are you like an association? Are you a nonprofit? What are you? No, we’re we’re a government regulatory body, uh, established through the compact clause of the constitution. And in the state law that every state passes, which by the way, and I said this subtly, but I want to emphasize it, is also a contract state to state. So it’s governed under both contract law and state law and federal law. And because it’s a contract, every state law is the same. So if you want to join a compact, and like I said, there’s many of them out there, every state passes the same law, so you have the same requirements. One of the things in that state law is it creates the commission. And through that law, it provides the commission certain authority and sorts, certain powers. In every state, it’s the governor or the governor’s office that appoints the commissioner. Now, we have defined in the state law that the commissioner has to be a subject matter expert that’s part of the executive branch of government that’s responsible for licensing EMS personnel. So in almost every state, it’s the state EMS director. But the key is this duty is appointed on behalf of the governor of the state. And think about it kind of like you know, maybe that of like a senator. Um, and so, you know, this person is accountable for representing the needs of the entire state, the views of the state. Um, every state has one vote. So when we make decisions as a governmental body, every state has one vote. That person casts the vote. Maybe it represents their personal view, but more importantly, it needs to represent the view of the entire state and all the stakeholders. So that’s the structure. Now, within the commission, uh, you know, as with any government body or organization, you have to have day-to-day operations. And so those day-to-day operations are carried out by an executive committee, which is five of the commissioners that’s been voted and appointed by all the commissioners collectively. So those five commissioners meet every month and they handle the day-to-day operational decisions.

SPEAKER_01: 12:03

Nice. Okay. You mentioned voting. Can you talk to us about, you know, how decisions are made? Is it a vote? Or um, you know, are there some maybe some subcommittees that are kind of broken up?

SPEAKER_00: 12:17

Oh, absolutely. So, you know, as as a government body, we also have the uh authority to do administrative code, administrative rule, which has the effective law in 25 states, because that’s the number of states in the compact right now. Now, our administrative code is limited to in scope to the interstate practice of EMS, you know, so we don’t write, you know, code or rules uh on that infer on state sovereignty. But when it comes to interstate practice, that’s what we’re accountable for. And usually, like if we are um, you know, coming up with a administrative rule, uh, we really believe that slow is fast and fast is slow, meaning that we slow down, we uh do a long stakeholder process. All of our meetings are open to the public, they’re all public noticed. Uh, we uh, you know, for instance, if we’re we’re looking at a rulemaking process right now, um, you know, we’ve been in that process for nearly a year. Um, countless meetings, countless drafts, uh, lots of input. And then it comes out of committee, and so it’ll be voted out of committee, which this rulemaking has been done. And then that is publicly noticed for 90 days. Um, it’s published on every state website that’s out there, and then we go through, and on November 5th, we will have a vote on this administrative rule, and we’ll see if it carries or not. Um, most of our rules, by the time they get to the final process, um, they pass unanimously just because we’ve put in so much effort to work them out in advance. But you know, that’s a rulemaking committee, but we also have other committees. Um, the government body of the commission has put out position papers. So that’s one of the tools we put out, and and these are non-binding positions of the commission. So, for instance, we put out a commission paper recently on code of conduct. Um, so we we put out, hey, this is the code of conduct. If you want to be an empt or a paramedic, this is what we believe professional conduct looks like. And so it’s um uh the position of of the commission and representing the 25 states. This is what this is what it means to be a paramedic or an EMT and and treat your patients with compassion and dignity and stuff that we all know.

SPEAKER_01: 14:44

Right.

SPEAKER_00: 14:45

But it hadn’t been written down before. So we wrote it down. We have another one about protecting the EMS workforce against uh you know things like doxing and cyber hacks and cybersecurity, and how do we uh ensure that nation states are not gaining access to EMS personnel records? So, you know, we do a lot of things. Um, all of those require votes. And uh, like I said, we do our best to make sure we represent all the stakeholders. Currently, it’s about 500,000 EMS personnel in the United States that’s uh got a privilege to practice through our office.

SPEAKER_01: 15:20

That’s awesome. No, it sounds like you guys are doing a really good job of making sure, you know, I’m sure it’s a delicate balance, but you’ve got to make sure that you protect the public, but also make the profession itself more accessible, better than it was before, and just keep building upon that. But it sounds like you guys have an awesome plan and and that you uh have a lot of, like you said, stakeholder input, that there’s a lot of options for EMS personnel to get involved and um and kind of shape the future of their profession.

SPEAKER_00: 15:52

Yeah, you know, there’s a lot of opportunity. We invite people, please come to our meetings, uh, make your voice heard. Uh, you know, if there’s something that you know works or doesn’t work, let us know. And then I think the other thing, you know, this would be a great time to point out in our enabling legislation, and when I talk about the compact, most of the conversation is about the mobility of EMS personnel. How do I go from you know Texas to Colorado to Virginia to West Virginia, what whatever. But the compact law also includes another section that’s very important, and that section is that every state is committed to collaboration on everything related to EMS personnel, license and standards and um how the EMS system works. So, you know, our commission is charged with unifying states, unifying solutions. Um, EMS is no longer on this fragmented path of everyone doing whatever they want. No, through legislation, we have bound together to look at things through a larger national collective lens, and that’s about advancing the profession and improving it for everyone.

SPEAKER_01: 17:11

Absolutely. Very well said.

unknown: 17:13

Yeah.

SPEAKER_01: 17:14

So let’s say that I am a licensed EMT or a paramedic and I’m in a compact state. What does this mean for me?

SPEAKER_00: 17:22

Yeah. So I mean, uh a lot of the 500,000, you know, EMS personnel that have a privilege of practice may not even know the power that the gift that they’ve been given by 25 states. So, you know, why don’t we break down as to like how you can use the privatity practice and what does it mean for you individually? And the very first thing is you need to know what your national EMS ID number is. Now, uh, this has a fascinating history, but you know, at one point in time I went through and like found all my individual license numbers and certification numbers, and I had something like 20, 25, right? I mean, it was a huge amount. One of the keys about the compact is you have a coordinated database, which we’ll hopefully talk about in a minute, but you have to be able to share licensure information. So the way that we do that is through this new national EMS identification number. It’s a 12-digit number. And the easiest way to find it is either through your state website or through the National Registry website. And it’s printed right there and you can see it. So it’s 12 digits, kind of looks like a credit card number. Um, and so it’s 4-4-4. You can put that in on our website and it will show if you have a privilege to practice or not. So if you have a privilege to practice, and after you put that number in, that means that your license is now valid everywhere else. Now, how do you use that privilege? Well, there’s a few key things. One is you have to have the privilege, it has to be visible. Your home state license has to be unrestricted, so you can’t be under discipline. If so, your privilege to practice status will have a red box around it. And and then you have to be with an agency. Now, I get a lot of questions about this requirement. And at the core, it’s not even a pure compact issue. It’s just about being an EMT or paramedic. But the core is you have to be with an entity, an agency. Uh, we don’t have independent practice in EMS. Um, you know, yeah, I’m a paramedic. I can’t just go and freelance as a paramedic, right? I have to have an agency, and that agency has things like DEA licenses and the ability to buy the stuff and insurance and medical direction and a patient care reporting system, and and all of that is part of an agency. So the compact requires you’re with an agency. And it’s really as simple as that. So the moment an agency affiliates you in another state that’s part of the compact, your home state license is valid and you can work on that agency. It’s the agency’s responsibility to make sure that you’re competent and that you know the local scope of practice and that you know the local protocol. But that’s also a personal, professional, uh, ethical responsibility. As a healthcare professional, you’ve got to know what your scope of practice is where you’re working, and you adhere to that.

SPEAKER_01: 20:26

Absolutely. Speaking of that scope of practice, what are those limitations and those responsibilities that EMS personnel should have on their top-of-mind awareness? You know, those really big ones that could could cause some some major damage.

SPEAKER_00: 20:42

Yeah. Well, let me go back to the driving example. You know, I I love living in western uh United States right now. And, you know, we have roads here where you know the speed limit is 85. And um, and you know, there’s even a few roads out where you know there’s no real posted speed limit. Um but you know, say that I go back and I’m driving on the I-95 corridor, um, you know, up on the east coast, and I decide, well, you know, my speed limit in Colorado is 85, I’m gonna do that here. That’s not gonna work, right? And and so, and it’s real key to understand that if I’m exercising my driving privilege in another state, I have to know and follow the laws of that state. Same thing with working in the EMS Compact. Yeah, you have a license to practice, you have a privilege to practice, but you have to know the law of that state and you’re held accountable to the laws of that state. So let’s take a scope of practice issue. Um, you know, I have a privilege in all 25 states. Um, and one state, um, as a paramedic, I can do surgical crikes, I could do uh finger thoracotomies, um, I can administer blood. Um, and that would be part of my scope of practice. Another state that may not be in the scope. So I have to know and understand that. So I don’t get to uh you know ignore the local scope or law. So when I accept an employment opportunity, uh paid or unpaid, um, then I have to know what that scope is, and I follow that local scope of practice with my local medical director. Um now, you know, this this also one of the examples or one of the questions I get is really kind of I can break this down into two scenarios. Let me say that I am a Virginia paramedic on a Virginia ambulance service and I transport a patient to West Virginia. What protocols do you think I’m gonna follow for the duration of that patient care? I’m gonna follow my Virginia protocol. I work for a Virginia service in a Virginia ambulance. I happen to be transporting a patient into another state, my compact license is valid, I’m good to go. Scenario B. I’m a Virginia paramedic, but I’m hired in Texas for a Texas service. What scope of practice and what protocol do you think I’m gonna follow? Texas.

SPEAKER_01: 23:09

Texas, yes.

SPEAKER_00: 23:11

Absolutely. So it really the the answer to the question is to like scope of practice and you know what do you follow? Well, you follow the scope of practice and the protocols of the your primary employer that you’re working for at the time.

SPEAKER_01: 23:24

Yeah, no, that makes sense, and thank you for laying it out like that. Because absolutely, I’m sure that there may be some listeners going, oh no, but um, yeah, no, that that that does make sense. And it seems kind of easy to follow when you think about it like that. So let’s talk about some tools to help license holders be aware of, you know, maybe some of these regulatory pitfalls. What kind of resources does the EMS Compact Commission offer to help EMS professionals navigate interstate practice?

SPEAKER_00: 23:55

Yeah, well, first and foremost, it’s our website. So and that’s EMS Compact, one word.gov. And so EMSCompact.gov, that’s the primary place. So that’s where you as an individual or as an employer, you’re gonna put in that national MS ID number. You can validate that. We have all of the uh links to all the states. So if you’re wondering, hey, is my state part of it? Absolutely. You can see that map there. And if you click on the map, you’ll see who your governor-appointed commissioner is and their contact information. Uh, we have another section of resources and videos and training material there that you can download and look at. We have information sheets. Uh, so we have a wealth of resources there. We have a YouTube channel that has some educational videos, um, and also all of our uh commission meetings are on there. So if you want to learn about governance and what we talk about and how we vote, you know, you can go back and watch those. Um, you know, get a good cup of coffee. Um but uh, you know, those are some of the main resources we have, and they’re available. And I’d also say if you are in a compact state, then contact your state office and ask them for some help and resources as well. And then um, I do a lot of speaking, and so you know, it’s very common. I’m happy to speak to agencies and customize. You know, if you have an agency and you have questions, I’m happy to come and do an in-service for you and provide some continuing ed. Um, the EMS Compact Education series is counts for con ed credit. Um, it’s part of operations, and it’s a key part of that. So those are some of the resources we have.

SPEAKER_01: 25:42

That’s fantastic. Yeah, websites always a great place to start, but man, you guys have a ton of resources. A lot of I know video content is really big right now, and so I think that’s awesome. It sounds like you’ve got content for everyone, for every attention span, and any way they want to digest it. Fantastic. So for those um who are listening, you said that they can check the website, right? If they’re not sure if their state is part of the compact. Um, are there any states who are working on maybe entering the compact that you know of right now?

SPEAKER_00: 26:17

Yeah, you know, that that’s always a tough question for me to answer. So um I I can tell you that in the past uh two months, we’ve had 12 states request the copy of the law, uh, the contract. And so, you know, at least 12 states are looking at it. I suspect some more are. You know, but it let me pivot on that question if if you allow me, real quick. I frequently get asked, well, you’ve got 25 states, but why are the other 25 states not part of the compact? And, you know, the simple answer to that is stakeholders in those states have not asked their legislators to prioritize passing this piece of legislation. Um, you know, as a government body, I can’t lobby, I don’t lobby. Um, I can answer technical questions, but someone’s got to simply ask your state legislators to do this. And um, you know, state legislators uh respond to their stakeholders saying, hey, this is a priority for me. Um of the 25 states that’s in the compact, uh 98.8% of all elected officials have voted yes for this legislation. It’s one of the strongest, most partisan pieces of legislation in the history of EMS. Um, so ask your state, tell your local officials, uh, tell your elected officials that this is a priority for you. And uh it’s a pretty simple bill uh in most states to get through.

SPEAKER_01: 27:48

Yeah, no, that’s awesome. I can absolutely see why it’s got such strong backing from both sides. I mean, it’s a no-brainer, right? Um, so what is next for the compact? Are there any initiatives, any trends, or any developments that um we should keep our eyes on?

SPEAKER_00: 28:04

Yeah, so I mean, first and foremost is more education. Um, and so, you know, we’re trying to work with our EMS education partners and our con ed partners. Uh, every EMS clinician in the United States should know about the compact. And I would even go as far as saying every EMS clinician should probably seek to get licensed in an EMS compact state. I mean, it really opens up opportunities for you and it’s a safeguard for your future, and it’s a new tool for recruitment and retention and workforce mobility. Um, really, really uh important things, especially when we realize the average age of like an you know EMS clinician is kind of in that you know younger spectrum. Um, and we know that that age group, just like you know, when you are you and I are in that age group, I mean we we want to explore the world, we want to see the US. Uh, your license shouldn’t, you know, tie you down. Um, and so the compact allows you to do that. So education is number one on our awareness right now. And then number two is actually the coordinated database. So kind of like the central brain to the compact is what we call the national MS Coordinated Database. And this is the system that takes every state licensure system, deduplicates it, puts it into one system. And that system is essential for things like planning and workforce understanding. Do you know that right now in the United States, no one can answer the question how many EMTs and how many paramedics do we have? No one knows. Yeah, no one knows the answer. And and there’s a lot of reasons for that. But you know, we have 50 different state licensure systems. Um, people are licensed in multiple states. So if you just call every state and say how many paramedics you have, cool. But how many of those are licensed in 5, 10, 15, 20 states? Our system deduplicates that. So for the first time in the history across 25 states, we can answer that question. But we have some projects going on on uh expanding that coordinated database. We want to add functionality, we want to add new functionality that’s going to enhance the way individual clinicians use it. And we want to add functionality of how employers use that. Um, we know that EMS across the nation, um, funding is a very important issue for EMS. And one of the biggest tragedies that uh I see as a regulator is when an EMS service has to do what we call insurance reversions and repayments. And that happens because someone let their license expire or the license wasn’t valid, uh, you know, your employer has to pay that money back to the insurance company. That is millions of dollars every year. So we’re working in on a solution in our database that would allow employers to sign up for a push notification that if anyone on their roster has a license that’s not valid or it becomes expired or becomes suspended, that they would know immediately without delay. So those are some of the technology things we’re working on. And then finally, advancing EMS with a unified voice. And that’s very important. Um, you know, like I said, our office is responsible for interstate practice of EMS, but also to uh, you know, reduce barriers to align best practices and to really come up with common solutions. And so that’s what we’re looking forward to as well.

SPEAKER_01: 31:46

Awesome. Well, it sounds like you guys have a ton of things that we can keep our eyes on and see how it uh how it plays out. That’s great. You know, um I I do want to go back, you said you mentioned um talking about the database and uh that you have finally uh solved the mystery of how many EMS professionals are in um, you know, you said across the US, right? Or in the 25 states that are in the compact, how many?

SPEAKER_00: 32:17

I was afraid you to ask that. I don’t have it up in front of me right now. Um so I don’t have that put up in front of me. But you know, but the key is um, you know, the deduplication is very important. And to, you know, truly understand what our workforce looks like of those who are licensed. Um, you know, it’s not good for me to be counted multiple times, especially when we come to think about things like, okay, what’s truly happening to our workforce? Um are we growing as a workforce? I believe we are, but now you know, we’ll have data for that. Um, so I’d say stay tuned. Um, you know, as we continue to um advance uh the work that we do. I anticipate we’ll have some, you know, research that’ll be coming out and you know, be able to answer some of those questions in a more academic, scientific way here in the near future.

SPEAKER_01: 33:10

Well, awesome. Well, thank you so much for joining me today, Donnie. This has been an awesome conversation, just full of insight. And I think that it’s really gonna help EMS professionals just understand how it can empower them in their practice. So thank you again so much.

SPEAKER_00: 33:28

Yeah, it was my honor. Thanks for asking.

SPEAKER_01: 33:30

And to our listeners, if you’re a licensed EMS professional, make sure to visit emscompact.gov to see what your rights and responsibilities are under the compact. Thanks for tuning in to Know Your Regulator. And until next time, stay inspired and continue engaging with your regulatory agency.

SPEAKER_00: 33:47

Know your regulator, the podcast that inspires you to engage.