# Title 23 — Health and Safety

## Chapter 23-27.1 — Emergency Medical Services Personnel Licensure Interstate Compact

### § 23-27.1-01. Purpose.

To protect the public through verification of competency and ensure accountability for
patient care-related activities all states license emergency medical services personnel, such as
emergency medical technicians, advanced emergency medical technicians, and paramedics.
This compact is intended to facilitate the day-to-day movement of emergency medical services
personnel across state boundaries in the performance of their emergency medical services
duties as assigned by an appropriate authority and authorize state emergency medical services
offices to afford immediate legal recognition to emergency medical services personnel licensed
in a member state. This compact recognizes states have a vested interest in protecting the
public's health and safety through their licensing and regulation of emergency medical services
personnel and state regulation shared among the member states will best protect public health
and safety. This compact is designed to achieve the following purposes and objectives:
1. Increase public access to emergency medical services personnel;
2. Enhance the states' ability to protect the public's health and safety, especially patient
safety;
3. Encourage the cooperation of member states in the areas of emergency medical
services personnel licensure and regulation;
4. Support licensing of military members who are separating from an active duty tour and
their spouses;
5. Facilitate the exchange of information between member states regarding emergency
medical services personnel licensure, adverse action, and significant investigatory
information;
6. Promote compliance with the laws governing emergency medical services personnel
practice in each member state; and
7. Invest all member states with the authority to hold emergency medical services
personnel accountable through the mutual recognition of member state licenses.
### § 23-27.1-02. Definitions.

In this chapter:
1. "Advanced emergency medical technician" means an individual licensed with cognitive
knowledge and a scope of practice that corresponds to that level in the national
emergency medical services education standards and national emergency medical
services scope of practice model.
2. "Adverse action" means any administrative, civil, equitable, or criminal action permitted
by law which may be imposed against licensed emergency medical services personnel
by a state emergency medical services authority or state court, including actions
against an individual's license such as revocation, suspension, probation, consent
agreement, monitoring, or other limitation or encumbrance on the individual's practice,
letters of reprimand or admonition, fines, criminal convictions, and state court
judgments enforcing adverse actions by the state emergency medical services
authority.
3. "Alternative program" means a voluntary, nondisciplinary substance abuse recovery
program approved by a state emergency medical services authority.
4. "Certification" means the successful verification of entry-level cognitive and
psychomotor competency using a reliable, validated, and legally defensible
examination.
5. "Commission" means the national administrative body of which all states that have
enacted the compact are members.
6. "Emergency medical technician" means an individual licensed with cognitive
knowledge and a scope of practice that corresponds to that level in the national
emergency medical services education standards and national emergency medical
services scope of practice model.

7. "Home state" means a member state where an individual is licensed to practice
emergency medical services.
8. "License" means the authorization by a state for an individual to practice as an
emergency medical technician, advanced emergency medical technician, paramedic,
or a level in between an emergency medical technician and paramedic.
9. "Medical director" means a physician licensed in a member state who is accountable
for the care delivered by emergency medical services personnel.
10. "Member state" means a state that has enacted this compact.
11. "Paramedic" means an individual licensed with cognitive knowledge and a scope of
practice that corresponds to that level in the national emergency medical services
education standards and national emergency medical services scope of practice
model.
12. "Privilege to practice" means an individual's authority to deliver emergency medical
services in remote states as authorized under this compact.
13. "Remote state" means a member state in which an individual is not licensed.
14. "Restricted" means the outcome of an adverse action that limits a license or the
privilege to practice.
15. "Rule" means a written statement by the interstate commission promulgated pursuant
to section 23-27.1-12 which is of general applicability; implements, interprets, or
prescribes a policy or provision of the compact; or is an organizational, procedural, or
practice requirement of the commission and has the force and effect of statutory law in
a member state and includes the amendment, repeal, or suspension of an existing
rule.
16. "Scope of practice" means defined parameters of various duties or services that may
be provided by an individual with specific credentials. Whether regulated by rule,
statute, or court decision, it tends to represent the limits of services an individual may
perform.
17. "Significant investigatory information" means:
a. Investigative information that a state emergency medical services authority, after
a preliminary inquiry that includes notification and an opportunity to respond if
required by state law, has reason to believe, if proved true, would result in the
imposition of an adverse action on a license or privilege to practice; or
b. Investigative information that indicates an individual represents an immediate
threat to public health and safety regardless of whether the individual has been
notified and had an opportunity to respond.
18. "State" means any state, commonwealth, district, or territory of the United States.
19. "State emergency medical services authority" means the board, office, or other agency
with the legislative mandate to license emergency medical services personnel.
### § 23-27.1-03. Home state licensure.

1. Any member state in which an individual holds a current license is deemed a home
state for purposes of this compact.
2. Any member state may require an individual to obtain and retain a license to be
authorized to practice in the member state under circumstances not authorized by the
privilege to practice under the terms of this compact.
3. A home state's license authorizes an individual to practice in a remote state under the
privilege to practice only if the home state:
a. Currently requires the use of the national registry of emergency medical
technicians examination as a condition of issuing initial licenses at the emergency
medical technician and paramedic levels;
b. Has a mechanism in place for receiving and investigating complaints about
individuals;
c. Notifies the commission, in compliance with the terms herein, of any adverse
action or significant investigatory information regarding an individual;
d. No later than five years after activation of 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 title 5, Code of
Federal Regulations, section 731, part 202 and submit documentation of such as
promulgated in the rules of the commission; and
e. Complies with the rules of the commission.
### § 23-27.1-04. Compact privilege to practice.

1. Member states shall recognize the privilege to practice of an individual licensed in
another member state that is in conformance with section 23-27.1-03.
2. To exercise the privilege to practice under the terms and provisions of this compact, an
individual must:
a. Be at least 18 years of age;
b. Possess a current unrestricted license in a member state as an emergency
medical technician, advanced emergency medical technician, paramedic, or state
recognized and licensed level with a scope of practice and authority between
emergency medical technician and paramedic; and
c. Practice under the supervision of a medical director.
3. An individual providing patient care in a remote state under the privilege to practice
shall function within the scope of practice authorized by the home state unless and
until modified by an appropriate authority in the remote state as may be defined in the
rules of the commission.
4. Except as provided in subsection 3, an individual practicing in a remote state is subject
to the remote state's authority and laws. A remote state may, in accordance with due
process and that state's laws, restrict, suspend, or revoke an individual's privilege to
practice in the remote state and may take any other necessary actions to protect the
health and safety of its citizens. If a remote state takes action, that remote state shall
promptly notify the home state and the commission.
5. If an individual's license in any home state is restricted or suspended, the individual is
not eligible to practice in a remote state under the privilege to practice until the
individual's home state license is restored.
6. If an individual's privilege to practice in any remote state is restricted, suspended, or
revoked, the individual is not eligible to practice in any remote state until the
individual's privilege to practice is restored.
### § 23-27.1-05. Conditions of practice in a remote state.

An individual may practice in a remote state under a privilege to practice only in the
performance of the individual's emergency medical services duties as assigned by an
appropriate authority, as defined in the rules of the commission, and under the following
circumstances:
1. The individual originates a patient transport in a home state and transports the patient
to a remote state;
2. The individual originates in the home state and enters a remote state to pick up a
patient and provide care and transport of the patient to the home state;
3. The individual enters a remote state to provide patient care or transport within that
remote state;
4. The individual enters a remote state to pick up a patient and provide care and
transport to a third member state; and
5. Other conditions as determined by rules promulgated by the commission.
### § 23-27.1-06. Relationship to emergency management assistance compact.

Upon a member state's governor's declaration of a state of emergency or disaster that
activates the emergency management assistance compact, all relevant terms and provisions of
the emergency management assistance compact apply and to the extent any terms or
provisions of this compact conflict with the emergency management assistance compact, the

terms of the emergency management assistance compact prevails with respect to any individual
practicing in the remote state in response to such declaration.
### § 23-27.1-07. Veterans, service members separating from active duty military, and their

spouses.
1. Member states shall consider a veteran, active military service member, and member
of the national guard and reserves separating from an active duty tour, and a spouse
thereof, who holds a current valid and unrestricted national registry of emergency
medical technicians certification at or above the level of the state license being sought
as satisfying the minimum training and examination requirements for such licensure.
2. Member states shall expedite the processing of licensure applications submitted by
veterans, active military service members, and members of the national guard and
reserves separating from an active duty tour, and their spouses.
3. All individuals functioning with a privilege to practice under this section remain subject
to the adverse actions provisions of section 23-27.1-08.
### § 23-27.1-08. Adverse actions.

1. A home state shall have exclusive power to impose adverse action against an
individual's license issued by the home state.
2. If an individual's license in any home state is restricted or suspended, the individual is
not eligible to practice in a remote state under the privilege to practice until the
individual's home state license is restored.
a. All home state adverse action orders must include a statement that the
individual's compact privileges are inactive. The order may allow the individual to
practice in remote states with prior written authorization from both the home state
and remote state's emergency medical services authority.
b. An individual currently subject to adverse action in the home state may not
practice in any remote state without prior written authorization from both the
home state and remote state's emergency medical services authority.
3. A member state shall report adverse actions and any occurrences that the individual's
compact privileges are restricted, suspended, or revoked to the commission in
accordance with the rules of the commission.
4. A remote state may take adverse action on an individual's privilege to practice within
that state.
5. Any member state may take adverse action against an individual's privilege to practice
in the member state based on the factual findings of another member state, so long as
each state follows its own procedures for imposing such adverse action.
6. A home state's emergency medical services authority shall investigate and take
appropriate action with respect to reported conduct in a remote state as it would if
such conduct had occurred within the home state. In such cases, the home state's law
shall control in determining the appropriate adverse action.
7. Nothing in this compact may override a member state's decision that participation in an
alternative program may be used in lieu of adverse action and that such participation
must remain nonpublic if required by the member state's laws. Member states must
require individuals who enter any alternative programs to agree not to practice in any
other member state during the term of the alternative program without prior
authorization from such other member state.
### § 23-27.1-09. Additional powers invested in a member state's emergency medical

services authority.
A member state's emergency medical services authority, in addition to any other powers
granted under state law, is authorized under this compact to:
1. Issue subpoenas for both hearings and investigations that require the attendance and
testimony of witnesses and the production of evidence. Subpoenas issued by a
member state's emergency medical services authority for the attendance and

testimony of witnesses or the production of evidence from another member state, or
both, must be enforced in the remote state by any court of competent jurisdiction,
according to that court's practice and procedure in considering subpoenas issued in its
own proceedings. The issuing state's emergency medical services authority shall pay
any witness fees, travel expenses, mileage, and other fees required by the service
statutes of the state where the witnesses or evidence, or both, are located; and
2. Issue cease and desist orders to restrict, suspend, or revoke an individual's privilege to
practice in the state.
### § 23-27.1-10. Establishment of the interstate commission for emergency medical

services personnel practice.
1. The compact states hereby create and establish a joint public agency known as the
interstate commission for emergency medical services personnel practice.
a. The commission is a body politic and an instrumentality of the compact states.
b. Venue is proper and judicial proceedings by or against the commission must be
brought solely and exclusively in a court of competent jurisdiction where the
principal office of the commission is located. The commission may waive venue
and jurisdictional defenses to the extent it adopts or consents to participate in
alternative dispute resolution proceedings.
c. Nothing in this compact may be construed to be a waiver of sovereign immunity.
2. a. Each member state shall have and be limited to one delegate. The responsible
official of the state emergency medical services authority or the official's designee
shall be the delegate to this compact for each member state. Any delegate may
be removed or suspended from office as provided by the law of the state from
which the delegate is appointed. Any vacancy occurring in the commission must
be filled in accordance with the laws of the member state in which the vacancy
exists. If more than one board, office, or other agency with the legislative
mandate to license emergency medical services personnel at and above the level
of emergency medical technician exists, the governor of the state shall determine
which entity is responsible for assigning the delegate.
b. Each delegate is entitled to one vote with regard to the promulgation of rules and
creation of bylaws and shall otherwise have an opportunity to participate in the
business and affairs of the commission. A delegate shall vote in person or by
such other means as provided in the bylaws. The bylaws may provide for
delegates' participation in meetings by telephone or other means of
communication.
c. The commission shall meet at least once during each calendar year. Additional
meetings must be held as set forth in the bylaws.
d. All meetings must be open to the public, and public notice of meetings must be
given in the same manner as required under the rulemaking provisions in section
23-27.1-12.
e. The commission may convene in a closed, nonpublic meeting if the commission
must discuss:
(1) Noncompliance of a member state with its obligations under the compact;
(2) The employment, compensation, discipline, or other personnel matters,
practices or procedures related to specific employees or other matters
related to the commission's internal personnel practices and procedures;
(3) Current, threatened, or reasonably anticipated litigation;
(4) Negotiation of contracts for the purchase or sale of goods, services, or real
estate;
(5) Accusing any person of a crime or formally censuring any person;
(6) Disclosure of trade secrets or commercial or financial information that is
privileged or confidential;
(7) Disclosure of information of a personal nature where disclosure would
constitute a clearly unwarranted invasion of personal privacy;
(8) Disclosure of investigatory records compiled for law enforcement purposes;

(9) Disclosure of information related to any investigatory reports prepared by, on
behalf of, or for use of the commission or other committee charged with
responsibility of investigation or determination of compliance issues
pursuant to the compact; or
(10) Matters specifically exempted from disclosure by a federal or member state
statute.
f. If a meeting, or portion of a meeting, is closed under this section, the
commission's legal counsel or designee shall certify that the meeting may be
closed and shall reference each relevant exempting provision. The commission
shall keep minutes that fully and clearly describe all matters discussed in a
meeting and shall provide a full and accurate summary of actions taken, and the
reasons therefore, including a description of the views expressed. All documents
considered in connection with an action must be identified in the minutes. All
minutes and documents of a closed meeting must remain under seal, subject to
release by a majority vote of the commission or order of a court of competent
jurisdiction.
3. The commission shall, by a majority vote of the delegates, prescribe bylaws or rules,
or both, to govern its conduct as may be necessary or appropriate to carry out the
purposes and exercise the powers of the compact, including:
a. Establishing the fiscal year of the commission;
b. Providing reasonable standards and procedures:
(1) For the establishment and meetings of other committees; and
(2) Governing any general or specific delegation of any authority or function of
the commission;
c. Providing reasonable procedures for calling and conducting meetings of the
commission, ensuring reasonable advance notice of all meetings, and providing
an opportunity for attendance of such meetings by interested parties, with
enumerated exceptions designed to protect the public's interest, the privacy of
individuals, and proprietary information, including trade secrets. The commission
may meet in closed session only after a majority of the membership votes to
close a meeting in whole or in part. As soon as practicable, the commission must
make public a copy of the vote to close the meeting, which includes the vote of
each member with no proxy votes allowed;
d. Establishing the titles, duties and authority, and reasonable procedures for the
election of the officers of the commission;
e. Providing reasonable standards and procedures for the establishment of the
personnel policies and programs of the commission. Notwithstanding any civil
service or other similar laws of any member state, the bylaws exclusively govern
the personnel policies and programs of the commission;
f. Promulgating a code of ethics to address permissible and prohibited activities of
commission members and employees;
g. Providing a mechanism for winding up the operations of the commission and the
equitable disposition of any surplus funds that may exist after the termination of
the compact after the payment or reserving of all of its debts and obligations;
h. The commission shall publish its bylaws and file a copy thereof, and a copy of
any amendment, with the appropriate agency or officer in each of the member
states, if any;
i. The commission shall maintain its financial records in accordance with the
bylaws; and
j. The commission shall meet and take such actions as are consistent with the
provisions of this compact and the bylaws.
4. The commission shall have the following powers:
a. The authority to promulgate uniform rules to facilitate and coordinate
implementation and administration of this compact. The rules have the force and
effect of law and are binding in all member states;

b. To bring and prosecute legal proceedings or actions in the name of the
commission, provided that the standing of any state emergency medical services
authority or other regulatory body responsible for emergency medical services
personnel licensure to sue or be sued under applicable law may not be affected;
c. To purchase and maintain insurance and bonds;
d. To borrow, accept, or contract for services of personnel, including employees of a
member state;
e. To hire employees, elect or appoint officers, fix compensation, define duties, grant
such individuals appropriate authority to carry out the purposes of the compact,
and to establish the commission's personnel policies and programs relating to
conflicts of interest, qualifications of personnel, and other related personnel
matters;
f. To accept any and all appropriate donations and grants of money, equipment,
supplies, materials, and services, and to receive, utilize, and dispose of the same;
provided that at all times the commission shall strive to avoid any appearance of
impropriety or conflict of interest;
g. To lease, purchase, accept appropriate gifts or donations of, or otherwise to own,
hold, improve or use, any property, whether real, personal, or mixed; provided
that at all times the commission shall strive to avoid any appearance of
impropriety;
h. To sell, convey, mortgage, pledge, lease, exchange, abandon, or otherwise
dispose of any property, whether real, personal, or mixed;
i. To establish a budget and make expenditures;
j. To borrow money;
k. To appoint committees, including advisory committees comprised of members,
state regulators, state legislators or their representatives, and consumer
representatives, and other interested persons as may be designated in this
compact and the bylaws;
l. To provide and receive information from, and to cooperate with, law enforcement
agencies;
m. To adopt and use an official seal; and
n. To perform such other functions as may be necessary or appropriate to achieve
the purposes of this compact consistent with the state regulation of emergency
medical services personnel licensure and practice.
5. a. The commission shall pay, or provide for the payment of, the reasonable
expenses of its establishment, organization, and ongoing activities.
b. The commission may accept appropriate revenue sources, donations, and grants
of money, equipment, supplies, materials, and services.
c. The commission may levy on and collect an annual assessment from each
member state or impose fees on other parties to cover the cost of the operations
and activities of the commission and its staff, which must be in a total amount
sufficient to cover its annual budget as approved each year for which revenue is
not provided by other sources. The aggregate annual assessment amount must
be allocated based upon a formula to be determined by the commission, which
shall promulgate a rule binding upon all member states.
d. The commission may not incur obligations of any kind prior to securing the funds
adequate to meet the same; nor may the commission pledge the credit of any of
the member states, except by and with the authority of the member state.
e. The commission shall keep accurate accounts of all receipts and disbursements.
The receipts and disbursements of the commission are subject to the audit and
accounting procedures established under its bylaws. However, all receipts and
disbursements of funds handled by the commission must be audited yearly by a
certified or licensed public accountant, and the report of the audit must be
included in and become part of the annual report of the commission.
6. a. The members, officers, executive director, employees and representatives of the
commission are immune from suit and liability, either personally or in their official

capacity, for any claim for damage to or loss of property or personal injury or
other civil liability caused by or arising out of any actual or alleged act, error, or
omission that occurred, or that the person against whom the claim is made had a
reasonable basis for believing occurred within the scope of commission
employment, duties, or responsibilities. This subdivision may not be construed to
protect any such person from suit or liability for any damage, loss, injury, or
liability caused by the intentional or willful or wanton misconduct of that person.
b. The commission shall defend any member, officer, executive director, employee,
or representative of the commission in any civil action seeking to impose liability
arising out of any actual or alleged act, error, or omission that occurred within the
scope of commission employment, duties, or responsibilities, or that the person
against whom the claim is made had a reasonable basis for believing occurred
within the scope of commission employment, duties, or responsibilities; provided
that nothing herein may be construed to prohibit that person from retaining his or
her own counsel; and provided further, that the actual or alleged act, error, or
omission did not result from that person's intentional or willful or wanton
misconduct.
c. The commission shall indemnify and hold harmless any member, officer,
executive director, employee, or representative of the commission for the amount
of any settlement or judgment obtained against that person arising out of any
actual or alleged act, error, or omission that occurred within the scope of
commission employment, duties, or responsibilities, or that such person had a
reasonable basis for believing occurred within the scope of commission
employment, duties, or responsibilities, provided that the actual or alleged act,
error, or omission did not result from the intentional or willful or wanton
misconduct of that person.
### § 23-27.1-11. Coordinated database.

1. The commission shall provide for the development and maintenance of a coordinated
database and reporting system containing licensure, adverse action, and significant
investigatory information on all licensed individuals in member states.
2. Notwithstanding any other provision of state law to the contrary, a member state shall
submit a uniform data set to the coordinated database on all individuals to whom this
compact is applicable as required by the rules of the commission, including:
a. Identifying information;
b. Licensure data;
c. Significant investigatory information;
d. Adverse actions against an individual's license;
e. An indicator that an individual's privilege to practice is restricted, suspended, or
revoked;
f. Nonconfidential information related to alternative program participation;
g. Any denial of application for licensure, and the reason for such denial; and
h. Other information that may facilitate the administration of this compact, as
determined by the rules of the commission.
3. The coordinated database administrator shall promptly notify all member states of any
adverse action taken against, or significant investigative information on, any individual
in a member state.
4. Member states contributing information to the coordinated database may designate
information that may not be shared with the public without the express permission of
the contributing state.
5. Any information submitted to the coordinated database that is subsequently required
to be expunged by the laws of the member state contributing the information must be
removed from the coordinated database.

### § 23-27.1-12. Rulemaking.

1. The commission shall exercise its rulemaking powers pursuant to the criteria set forth
in this section and the rules adopted thereunder. Rules and amendments are binding
as of the date specified in each rule or amendment.
2. If a majority of the legislatures of the member states rejects a rule, by enactment of a
statute or resolution in the same manner used to adopt the compact, then such rule
has no further force and effect in any member state.
3. Rules or amendments to the rules must be adopted at a regular or special meeting of
the commission.
4. Prior to promulgation and adoption of a final rule or rules by the commission, and at
least sixty days in advance of the meeting at which the rule will be considered and
voted upon, the commission shall file a notice of proposed rulemaking:
a. On the website of the commission; and
b. On the website of each member state emergency medical services authority or
the publication in which each state would otherwise publish proposed rules.
5. The notice of proposed rulemaking must include:
a. The proposed time, date, and location of the meeting in which the rule will be
considered and voted upon;
b. The text of the proposed rule or amendment and the reason for the proposed
rule;
c. A request for comments on the proposed rule from any interested person; and
d. The manner in which interested persons may submit notice to the commission of
their intention to attend the public hearing and any written comments.
6. Prior to adoption of a proposed rule, the commission shall allow persons to submit
written data, facts, opinions, and arguments, which must be made available to the
public.
7. The commission shall grant an opportunity for a public hearing before it adopts a rule
or amendment if a hearing is requested by:
a. At least twenty-five persons;
b. A governmental subdivision or agency; or
c. An association having at least twenty-five members.
8. If a hearing is held on the proposed rule or amendment, the commission shall publish
the place, time, and date of the scheduled public hearing.
a. All persons wishing to be heard at the hearing shall notify the executive director
of the commission or other designated member in writing of their desire to appear
and testify at the hearing not less than five business days before the scheduled
date of the hearing.
b. Hearings must be conducted in a manner providing each person who wishes to
comment a fair and reasonable opportunity to comment orally or in writing.
c. No transcript of the hearing is required, unless a written request for a transcript is
made, in which case the person requesting the transcript shall bear the cost of
producing the transcript. A recording may be made in lieu of a transcript under the
same terms and conditions as a transcript. This section does not preclude the
commission from making a transcript or recording of the hearing if it so chooses.
d. Nothing in this section may be construed as requiring a separate hearing on each
rule. Rules may be grouped for the convenience of the commission at hearings
required by this section.
9. Following the scheduled hearing date, or by the close of business on the scheduled
hearing date if the hearing was not held, the commission shall consider all written and
oral comments received.
10. The commission shall, by majority vote of all members, take final action on the
proposed rule and shall determine the effective date of the rule, if any, based on the
rulemaking record and the full text of the rule.
11. If no written notice of intent to attend the public hearing by interested parties is
received, the commission may proceed with promulgation of the proposed rule without
a public hearing.

12. Upon determination that an emergency exists, the commission may consider and
adopt an emergency rule without prior notice, opportunity for comment, or hearing,
provided the usual rulemaking procedures provided in the compact and in this section
are retroactively applied to the rule as soon as reasonably possible, in no event later
than ninety days after the effective date of the rule. For the purposes of this provision,
an emergency rule is one that must be adopted immediately in order to:
a. Meet an imminent threat to public health, safety, or welfare;
b. Prevent a loss of commission or member state funds;
c. Meet a deadline for the promulgation of an administrative rule that is established
by federal law or rule; or
d. Protect public health and safety.
13. The commission or an authorized committee of the commission may direct revisions to
a previously adopted rule or amendment for purposes of correcting typographical
errors, errors in format, errors in consistency, or grammatical errors. Public notice of
any revisions must be posted on the website of the commission. The revision is
subject to challenge by any person for a period of thirty days after posting. The
revision may be challenged only on grounds that the revision results in a material
change to a rule. A challenge must be made in writing and delivered to the chair of the
commission before the end of the notice period. If a challenge is not made, the
revision will take effect without further action. If the revision is challenged, the revision
may not take effect without the approval of the commission.
### § 23-27.1-13. Oversight, dispute resolution, and enforcement.

1. a. The executive, legislative, and judicial branches of state government in each
member state shall enforce this compact and take all actions necessary and
appropriate to effectuate the compact's purposes and intent. The provisions of
this compact and the rules promulgated hereunder have standing as statutory
law.
b. All courts shall take judicial notice of the compact and the rules in any judicial or
administrative proceeding in a member state pertaining to the subject matter of
this compact which may affect the powers, responsibilities, or actions of the
commission.
c. The commission is entitled to receive service of process in any such proceeding,
and has standing to intervene in such a proceeding for all purposes. Failure to
provide service of process to the commission renders a judgment or order void as
to the commission, this compact, or promulgated rules.
2. a. If the commission determines that a member state has defaulted in the
performance of its obligations or responsibilities under this compact or the
promulgated rules, the commission shall:
(1) Provide written notice to the defaulting state and other member states of the
nature of the default, the proposed means of curing the default, or any other
action to be taken by the commission; and
(2) Provide remedial training and specific technical assistance regarding the
default.
b. If a state in default fails to cure the default, the defaulting state may be terminated
from the compact upon an affirmative vote of a majority of the member states,
and all rights, privileges, and benefits conferred by this compact may be
terminated on the effective date of termination. A cure of the default does not
relieve the offending state of obligations or liabilities incurred during the period of
default.
c. Termination of membership in the compact may be imposed only after all other
means of securing compliance have been exhausted. Notice of intent to suspend
or terminate shall be given by the commission to the governor, the majority and
minority leaders of the defaulting state's legislature, and each of the member
states.

d. A state that has been terminated is responsible for all assessments, obligations,
and liabilities incurred through the effective date of termination, including
obligations that extend beyond the effective date of termination.
e. The commission may not bear any costs related to a state that is found to be in
default or that has been terminated from the compact, unless agreed upon in
writing between the commission and the defaulting state.
f. The defaulting state may appeal the action of the commission by petitioning the
United States district court for the District of Columbia or the federal district where
the commission has its principal offices. The prevailing member shall be awarded
all costs of such litigation, including reasonable attorney's fees.
3. a. Upon request by a member state, the commission shall attempt to resolve
disputes related to the compact that arise among member states and between
member and nonmember states.
b. The commission shall promulgate a rule providing for both mediation and binding
dispute resolution for disputes as appropriate.
4. a. The commission, in the reasonable exercise of its discretion, shall enforce the
provisions and rules of this compact.
b. By majority vote, the commission may initiate legal action in the United States
district court for the District of Columbia or the federal district where the
commission has its principal offices against a member state in default to enforce
compliance with the provisions of the compact and its promulgated rules and
bylaws. The relief sought may include both injunctive relief and damages. In the
event judicial enforcement is necessary, the prevailing member shall be awarded
all costs of such litigation, including reasonable attorney's fees.
c. The remedies herein are not the exclusive remedies of the commission. The
commission may pursue any other remedies available under federal or state law.
### § 23-27.1-14. Date of implementation of the interstate commission for emergency

medical services personnel practice and associated rules, withdrawal, and amendment.
1. The compact becomes effective on the date on which the compact statute is enacted
into law in the tenth member state. The provisions, which become effective at that
time, are limited to the powers granted to the commission relating to assembly and the
promulgation of rules. Thereafter, the commission shall meet and exercise rulemaking
powers necessary to the implementation and administration of the compact.
2. Any state that joins the compact subsequent to the commission's initial adoption of the
rules is subject to the rules as they exist on the date on which the compact becomes
law in that state. Any rule that has been previously adopted by the commission has the
full force and effect of law on the day the compact becomes law in that state.
3. Any member state may withdraw from this compact by enacting a statute repealing the
same.
a. A member state's withdrawal may not take effect until six months after enactment
of the repealing statute.
b. Withdrawal may not affect the continuing requirement of the withdrawing state's
emergency medical services authority to comply with the investigative and
adverse action reporting requirements of this act prior to the effective date of
withdrawal.
4. Nothing contained in this compact may be construed to invalidate or prevent any
emergency medical services personnel licensure agreement or other cooperative
arrangement between a member state and a nonmember state that does not conflict
with the provisions of this compact.
5. This compact may be amended by the member states. No amendment to this compact
may become effective and binding upon any member state until it is enacted into the
laws of all member states.

### § 23-27.1-15. Construction and severability.

This compact shall be liberally construed so as to effectuate the purposes thereof. If this
compact is held to be contrary to the constitution of any state member thereto, the compact
shall remain in full force and effect as to the remaining member states. Nothing in this compact
supersedes state law or rules related to licensure of emergency medical services agencies.
