Trending Topics

Richmond Ambulance Authority’s secrets to onboarding success

RAA focuses on a culture of safety, resilience training and face time with the chiefs when orienting new employees to the organization


Classroom training for new employees includes a focus on clinical topics which are expanded upon once the provider is on the street.

Courtesy/Richmond Ambulance Authority

The cost of replacing a medic, both financially and in time invested, is steep. Finding and hiring promising candidates is only one piece of the staffing puzzle. In an EMS1 Special Coverage Series, “Year One: Creating a career path for new EMTs,” learn how to onboard team members to set them up for long-term success, through the first 90 days, the first 6 months and beyond.

As we have all been experiencing of late, there is a shortage of staff, and many organizations are going to ever more expensive lengths to bring employees through the door. But what about once they arrive? How are new employees inducted and oriented to the organization, ground, environment and clinical practice?

An unfortunate phrase in EMS identifies that to work in some agencies, one simply needs a “badge and a pulse.” This is not helpful as agencies have an essential responsibility to bring qualified new people into the workplace and prepare them for the street.

One agency that takes time and effort to induct its staff is the Richmond Ambulance Authority, in Richmond, Virginia. RAA has one of the highest call volumes per capita in the United States and it has gained a national and international reputation as a premier, high-performing EMS system. RAA is one of only a very few systems in the United States that has received accreditation from both the Commission on Accreditation of Ambulance Services (CAAS) and the National Academy of Emergency Dispatch (NAED).

RAA’s new employee orientation process takes place over several phases and initially brings staff administratively into the organization; and then conducts familiarization, documentation and safety training in a classroom phase.

This is followed by a shift perception process under the instruction and guidance of a field training officer (FTO). For paramedics, the induction concludes with a one-to-one clearance with the Authorities Operational Medical Director, Dr. Joseph P. Ornato, an internationally renowned, triple board-certified physician and longtime Eagle.

New employee orientation classroom phase

RAA’s new employee orientation classroom phase begins with HR onboarding to include benefits, IT, email log-ins, and the initial welcome from the CEO and chief officers. Importantly, the classroom week sees two interactions with chiefs:

  • The first occurs on day 1, including welcomes and laying out expectations
  • The second meeting, toward the end of the week, offers new employees a chance to ask questions as they have had a few days to acclimatize to the organization

As an organization that operates within a total culture of safety, this is stressed from day 1, and at the highest level.

The week progresses with the introduction to electronic patient care reporting, an area that will receive much attention once out on the street.

A 2-day emergency vehicle operators’ course (EVOC) provides state-required emergency vehicle certification and offers all an introduction to the nuances of the RAA fleet. New employees are not only familiarized with the regular type II ambulances but also with specialty vehicles, such as the 6-wheel, off-road, ASAP ambulances.


The RAA orientation includes classroom time and two interactions with the chiefs, one to lay out expectations and a later meeting allowing questions.

Courtesy/Richmond Ambulance Authority

The last classroom day is spent covering clinical topics (which again are expanded on once on the street).

Resiliency training

The classroom week rounds out with an afternoon of resiliency training. This module consists of an overview of mental health injuries that providers may incur while working at RAA and how to handle those injuries.

The program covers anxiety, PTSD, depression, suicidal ideation, burnout and compassion fatigue, as well as conditions that may exacerbate those injuries, such as lack of sleep and substance abuse. In addition to recognizing the injury in themselves, students are taught how to recognize warning signs in their crewmates.

The resilience class also teaches the ACE (Ask, Care and Escort) suicide intervention method and highlights as well as resilience training from the 911 Training Institute and resilience techniques from Doctor of Psychology, Tiana Glenn.

This element reflects RAA’s focus on provider wellbeing and safety and was developed by RAA Communications Supervisor, Rebecca Szeles.


Watch for more:

View on-demand: How to create a mental health-friendly environment at your service

Learn how mental health support programs can alleviate stress in the workplace

Street phase

At the end of the classroom week, new employees meet and pair with their FTOs, mirror their shifts and proceed to the street. Students ride as the third crew member while conducting tasks and reviews as contained in the RAA Field Training Manual. Each preceptee has their own manual, which not only contains clinical protocols but also shift summary and sign-off sheets that provide an opportunity to debrief at the end of each shift.


Once all training elements have been successfully completed, the student paramedic meets with the operational medical director. This usually lasts for 2-3 hours and is a mixture of skills confirmation, and an individual and personalized master class with one of the country’s leading emergency medicine professors. EMTs go through a similar confirmatory process.

Once complete, they are awarded their badges, assigned a shift and partner, and are released to the street.


RAA’s new employee orientation includes a classroom week focused on ePCR, EVOC, clinical topics and resiliency training.

Courtesy/Richmond Ambulance Authority

EMT cadets

In addition to general recruitment of already qualified staff, RAA also offers a cadet program for EMTs which is an approved EMS Training Course through the Office of Emergency Medical Services in the Commonwealth of Virginia.

First, the cadets are trained as emergency medical responders (EMRs), consisting of both EVOC and CPR training, which allows them to function as BLS vehicle operators.

EMR complete, the training program consists of every-other-day classroom days, completing the EMTB syllabus and street time as part of a BLS response crew.

RAA is a two-tier, ALS BLS 911 response system and street time spent as an EMR allows the student to gain valuable insight and experience as they progress through their classroom phase. Those in the cadet program must complete their EMT-B training course and pass the NREMT exam within 120 days of course completion, and complete the preception at RAA as a cleared EMT-B attendant-in-charge (AIC). After becoming a cleared EMT-B AIC, new cadets agree to a full-time 2-year employment obligation.

RAA – like many organizations in the pandemic – is constantly seeking new staff, but the robust training and education program serves those who pass through orientation well as they progress into a very busy, city-based EMS system.

Rob Lawrence has been a leader in civilian and military EMS for over a quarter of a century. He is currently the director of strategic implementation for PRO EMS and its educational arm, Prodigy EMS, in Cambridge, Massachusetts, and part-time executive director of the California Ambulance Association.

He previously served as the chief operating officer of the Richmond Ambulance Authority (Virginia), which won both state and national EMS Agency of the Year awards during his 10-year tenure. Additionally, he served as COO for Paramedics Plus in Alameda County, California.

Prior to emigrating to the U.S. in 2008, Rob served as the COO for the East of England Ambulance Service in Suffolk County, England, and as the executive director of operations and service development for the East Anglian Ambulance NHS Trust. Rob is a former Army officer and graduate of the UK’s Royal Military Academy Sandhurst and served worldwide in a 20-year military career encompassing many prehospital and evacuation leadership roles.

Rob is a board member of the Academy of International Mobile Healthcare Integration (AIMHI) as well as chair of the American Ambulance Association’s State Association Forum. He writes and podcasts for EMS1 and is a member of the EMS1 Editorial Advisory Board. Connect with him on Twitter.