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Safe driving is a priority for Richmond Ambulance Authority crews T he Richmond Ambulance Authority (RAA) is an organization embracing the EMS Culture of Safety in every department, from feld staff to administrative offces. New employees are told by everyone from the CEO to their feld training offcer (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 fve deaths. 1 In addition to fatal injuries, around 19,900 nonfatal injuries requiring treat- ment 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 devel- oped 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 poten- tial 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 param- eters by which potential candidates are compared. Experience, provider develop- ment, 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 oper- ating infractions such as speeding, improper driving or accidents, then the process stops. RAA knows the mission cannot be completed if vehicle opera- tors make poor decisions and cause acci- dents. 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 | By Bryan S. McRay, MBA, Rob Lawrence, MCMI, & Dan Fellows How to Build the Crew Chain of Safety 26 APRIL 2014 | EMSWORLD.com EMS_26-36_CoverReport0414.indd 26 3/13/14 2:39 PM