Solutions
A look at current and future options to solving the problem of interstate medical transport
Office of EMS Recommendations
In 2002 the National Highway Traffic Safety Administration’s Office of EMS gathered stakeholders and convened the Interfacility Transfer Planning Group (NHTSA, 2003). This group made recommendations that became the Guide for Interfacility Patient Transfer. This guide makes recommendations for all aspects of interfacility medical transport except, notably, interstate transfer. On this matter the guide defers to the states and suggests they work on making interstate compacts (NHTSA, 2003). The past 20 years and the COVID-19 pandemic have proven this to be an ineffective strategy as even locals that have interstate trauma compacts like the DC-Maryland-Virginia region, still have not been able to form an interstate inter-facility medical transport agreement (D.C. Health, 2010).
Interstate Compacts
One way to overcome the differences in state requirements is to have interstate compacts. In such compacts, states agree to meet a minimum standard set by statutory agreement. These minimums included education, standards of practice, and licensure requirements like background checks and standardized examinations (Interstate Commission for EMS Personnel Practice, 2022). Currently the Nurse License Compact has 39 states that are members, or in the process of becoming members (Special Delegate Assembly, 2015). The nursing compact began in 2000 with 4 member states (Oyeleye, 2019). The EMS Compact is much newer. It was ratified in 2017 and has 21 member states today (EMS). While this is a possible long-term solution, it will take some time to get all 50 states and the US territories signed on to the compact. This is especially true for the EMS compact as all nurses in the US take the same licensing exam, the NCLEX-RN. This is not true for EMS examination where the requirements vary across the nation. While I do believe that eventually all states will see the benefit of being in the compact, there are several states that currently have no interest in making changes to their practices in order to join. These hold outs make interstate compacts a future goal, but not a plausible solution for interstate inter-facility medical transport today.
The Commerce Clause & Driver’s Licenses
Let common sense be a final solution. Everyday drivers take for granted their privilege to operate a motor vehicle outside of their state of residence. In fact, it is illegal to hold a driver’s license in more than one state. Drivers are expected to obtain a new license only after they have moved their residence. Driver’s licenses work this way because Article I Section 8 Clause 3 of the US Constitution, the commerce clause, gives Congress the power to regulate interstate commerce. As of National Traffic and Motor Vehicle Safety Act of 1966, this includes driver’s licenses. It was from this act that what is now NHTSA came to be.
Interstate Inter-facility medical transport is a type of interstate commerce. It makes no sense for licensed professionals to be licensed in every state they may pass through. Nor does it make sense for a competent licensed team to be stripped of their credentials when crossing state lines. Just as drivers are expected to follow the rules of the road in the state they are moving through, so too, transport teams must be cognizant of the regulations of the local jurisdiction.