How to Build the Crew Chain of Safety

Safe driving is a priority for Richmond Ambulance Authority crews


The Richmond Ambulance Authority (RAA) is an organization embracing the EMS Culture of Safety in every department, from field staff to administrative offices.

New employees are told by everyone from the CEO to their field training officer (FTO) how our desire for them to be able to go home at the end of the shift is our inspiration. When it comes to vehicle operations, RAA takes its task to provide safe crews in safe vehicles very seriously.

Hard to believe, but statistically an ambulance in the wrong or poorly trained hands can become a weapon of mass destruction. Statistics have proven EMS workers in the United States are a “high-risk” population and have a fatality rate of 6.3 per 100,000 workers, 1.4% greater than the national average. Among the 65 fatalities for EMTs between 2003 and 2007, emergency medical technicians and paramedics accounted for 60 deaths, while “ambulance drivers” and attendants accounted for the remaining five deaths.1

In addition to fatal injuries, around 19,900 nonfatal injuries requiring treatment occur to EMS workers each year.2 Against this backdrop, the RAA leadership team is committed to a “crew chain of safety,” establishing a level of safe and skilled vehicle operations. They are developed and sustained while also being measured and managed.

The “crew chain of safety” (CCS) is very similar to the American Heart Association’s Chain of Survival. Each link, although distinct and specific in nature, is only as effective as the next one. Their collaborative and overlapping efforts are what create the ultimate success. RAA’s CCS has a minimum of nine links. Each one contributes specific content; however, none is mutually exclusive of another (see Figure 1 on page 28).

Staff Selection

The process begins before any potential employee begins the first day of new employee orientation (NEO).

The initial selection process for RAA recruitment begins with an application evaluation. RAA has taken the proactive position by instituting a set of parameters by which potential candidates are compared. Experience, provider development, driving record and criminal history are just a few of the factors considered to offer an applicant an interview. The safety and risk director (SRD) has a significant role in considering the applicants. There is an adage stating “past behavior is a predictor of future performance.” If the applicant has significant vehicle operating infractions such as speeding, improper driving or accidents, then the process stops. RAA knows the mission cannot be completed if vehicle operators make poor decisions and cause accidents. RAA’s vehicle liability insurance carrier has repeatedly mentioned this as a best practice among its customers.

Members of management from the operations and clinical departments meet with human resources staff to review information on the applicant and make certain candidates meet our required standards. The next step is having the candidate come in for an interview. This is also done in a team approach with staff from operations, clinical and human resources conducting the question period. The candidate is then sent to an operations supervisor for a critical thinking exercise. The interview team then tabulates the results and determines whether the candidate will be a proper fit for the organization.

Emergency Vehicle Operators Course (EVOC)

Previous driver education notwithstanding, all new employees are required to complete the RAA Emergency Vehicle Operators Course during the first week of their employment. This is the first phase of virtually continuous monitoring and assessment throughout the operator’s employment at RAA. This course is based on national curriculum and enhanced to meet RAA’s expectations. Recently, one of the FTOs took on the task of updating and personalizing the presentation. RAA EVOC has been approved by the Commonwealth of Virginia, Department of Health, Office of Emergency Medical Services. Classroom didactic sessions in conjunction with cone course sessions are just one phase of the program.

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