Before the Compact: The Atlantic EMS Council and a Myth That Outlived It
Every so often a document surfaces that quietly rewrites the story you thought you knew. A set of agreements adopted by the Atlantic Emergency Medical Services Council in the 1980s is one of those documents. It has now been added to the EMS-History.com archive, preserved from the Council's own records before the organization dissolved. And it settles, better than any argument I could make, a question the field is still getting wrong forty years later.
Here is the question. Can an administrative agreement, a memorandum, a mutual aid pact, a reciprocity resolution, authorize a clinician to cross a state line and lawfully practice? The belief that it can is one of the most stubborn urban legends in EMS. These Atlantic Council documents are the proof that it cannot, because they are the most sophisticated version of that idea anyone in this profession ever built, and even they could not make it stick.
What the Council Built
The compilation gathers several instruments adopted across roughly a decade by the Atlantic Council (formerly the Mid-Atlantic Emergency Medical Services Council):
Joint Resolution on Reciprocity of Services for Emergency Medical Care (1982). Eight jurisdictions, Virginia, West Virginia, Maryland, the District of Columbia, Pennsylvania, Delaware, New Jersey, and New York, agreed to recognize one another's certified Basic and Advanced Life Support personnel when they crossed a border to provide emergency care.
Resolution on Reimbursement for Trauma Services. A recognition that if patients were going to be routed to the most appropriate facility regardless of state line, neighboring facilities had to be reimbursed equitably for the care they rendered.
Joint Declaration of Interstate Medical Command (1985). A declaration that each jurisdiction's laws permitted physicians to give emergency instructions to certified paramedics across state lines, paired with Good Samaritan civil immunity for the physician giving that command via telecommunications.
Memorandum of Agreement on a shared EMT examination. The Atlantic states pooled resources to build and maintain a common, validated written test bank, housed at Central Connecticut State University under Dr. Richard L. Judd.
Statement of Clarification (1990). A conference-call-driven position statement reconciling the earlier resolutions as new technologies began pushing physician medical direction across state lines in unforeseen ways.
The signatures alone make it worth preserving. These were state health commissioners, secretaries, and EMS directors, among them R Adams Cowley of Maryland, whose name on a page still carries weight in this field.
The Goal They Got Right
What strikes me most is the timing. The Council itself was founded in 1975, two years before the 1977 formalization of the paramedic, and within just a few years of that milestone state leadership already understood something it would take the field decades to fully operationalize: EMS is, by definition, mobile. Patients cross state lines. Clinicians cross state lines. Medical command crosses state lines. The states recognized that they needed a rapid mechanism to align standards, education, and accountability, and they reached for the only tools their offices controlled.
They got the policy goal right. They understood, forty years ago, that emergency care does not respect a state line and that the profession needed a real mechanism for interstate recognition. The problem was never their vision. It was their instrument.
Where the Fragility Shows
The first crack is durability. These agreements were signed by health secretaries, commissioners, and EMS directors in their administrative capacities. They were not enacted by legislatures or executed by governors, and any state could walk away on ninety days' written notice. Recognition that lasts only as long as the current director's signature, and that dissolves on ninety days' notice, is not durable interstate law. It is a handshake. A good-faith, well-intentioned, professionally sophisticated handshake, but a handshake nonetheless.
The Flaw That Still Fools Us
The deeper crack is the one the field still trips over today, and it is worth saying plainly. These instruments never carried the force of law at all. They could not. An MOU is signed by an executive official, and an executive official holds only the authority the legislature has handed them by statute. They can coordinate practice in the gaps where state law is silent, but they cannot override a contrary statute, and they cannot manufacture an authority the legislature never granted. A memorandum does not sit above the law. It sits beneath it, and it survives only on the law's permission.
That is the misreading that refuses to die in EMS. To this day, agencies and even seasoned leaders will point to a mutual aid agreement, a reciprocity memo, or a medical director's signature as if it authorizes a clinician to cross a border and practice. It does not. It never could. And the Atlantic Council proves the point better than any argument I could write, because the people who signed these documents knew it themselves. Read the instruments closely and you can watch them concede it. The Joint Resolution made itself effective “at the time of execution” rather than as law. The Interstate Medical Command declaration does not even purport to create a new obligation. It simply has each official assure that existing state law already provides the protection. That is the careful language of officials who understand they are describing the law, not writing it, because writing it was never a power they held.
So consider the lesson in full. The most capable EMS leaders of their generation, including the founder of modern American trauma care, pooled their offices and their credibility and built the finest interstate arrangement an administrative body could produce, and they still could not make a memorandum overrule a statute. If they could not do it then, no mutual aid agreement signed today can do it either. Only a legislature can.
The Prehistory of What We Have Now
Which is exactly why I appreciate seeing it. This is the prehistory of the modern EMS Compact, and it shows precisely the gap the Compact was built to close. Today we have a compact founded in constitutional law and enacted by legislatures as statute, the same constitutional tool that governs everything from driver licensing to nurse licensure. The privilege to practice is recognized across Participating States because the law of each Participating State says so, not because a single administrator's signature remains on file and not because two agencies shook hands.
The men and women of the Atlantic Council named the goal correctly. They simply did not yet have the instrument to make it stick. It took the field another generation to reach for interstate compact law and build something durable on top of the goal they had already named.
A great relic to have in hand, and a reminder that the questions we are still answering, and a few of the answers we are still getting wrong, are older than we think.
Read the Atlantic EMS Council Interstate Agreements (1982 to 1990) in the archive (PDF), or explore the era in context on the Interactive Timeline.