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Are we Upstream? Community Health, Sprinklers, and Logging?

There has been a great focus placed on "upstreamist" thinking in the medical field. An "upstreamist" is one that focuses on preventing people from falling into the river of medical system over-use. They don't focus on only treating their patient's condition, they look at what caused it and what they can do to help remedy the situation so the patient can live a happier and healthier life. This in return lessens the burden placed on the medical system and allows attention to be focused on truly critical patients.

What have we done to embrace the "upstreamist" attitude in the fire and EMS services? There are plenty of agencies adopting the practice of community paramedicine or expanded protocols. This is a great start to upstream EMS. However, once we have accomplished responding the the needs of the patients in a more economical and sensical fashion, we need to look at what is causing this patient to call us in the first place. How many of you have established partnerships with local community health teams and are attending the meetings of your community health partners. You may say "we are not part of the community health system, we answer 911 calls." This is partly true, we do answer 911 calls. However, we are as much part of the community health system as county health departments, mental health services, and health clinics. In fact, I would argue that we are even more involved than these agencies as we get called to see all of their clients in their darkest hour and when they don't know what else to do.

How about our fire prevention efforts. Aren't those "upstreamist" in nature? Yes- they are. However, how often are you teaching stop, drop, and roll? This concept is not a fire prevention model, it is in fact teaching people what to do when you carelessly get fire on your clothes! Shouldn't we be focusing more of our time on how to actually prevent fires? Don't play with matches, the science behind fires, and candle safety are all examples of teaching fire prevention.

Another area of prevention is being involved in the national movements that are occurring on capital hill and across the country. How familiar are you with the fire sprinkler push? Do you know who supports it in your community and who opposes it? Have you taken the opportunity to talk to your City Councils and executive boards about the need for fire sprinklers in all buildings? How familiar are you with the national organizations supporting sprinklers, like the National Fire Sprinkler Association?

How familiar are you with the push to allow the timber industry to get back into the woods and thin forests to reduce the spread of dangerous wildfires? What about prevention and preparedness programs that focus on Wildland-Urban Interface Zones? Do you know your Congressman and Senator's opinions on that program? These real issues facing the nation as a whole and we as a fire service need to be the ones the Senators and Congressmen go to to get information.

Look for opportunities in your community and across the Country to get involved in the "upstreamist" movement. It is where we should be focusing our efforts for the community to get the most out of their emergency services. The ultimate goal is to help our communities be a safe, happy and healthy place to live, work, and play.

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Comment by Devon Wells on January 6, 2015 at 2:57pm: Great insight. Thanks again!

Comment by Bobby Halton on January 6, 2015 at 2:36pm: Devon,

Thank you very much for your kind words but I consider myself more of a fire service promoter then leader some people would call me a cheerleader which is a title I proudly accept and I'm honored to carry. But having been retired as long as I've been although I am still a volunteer in a nonactive training only status I'm always reluctant to consider myself a leader.

To the point of your comment I think what you're actually doing is helping people control change not obscure change. I think when you go upstream at the point of the issue and interject options and opportunities you allow the actual practitioners to direct the change and that is the best change of all. You are doing what a true firefighter would do empower other firefighters and citizens to create the environment we want to live in.

You're not mandating and you're not critiquing that's best left to those who really don't matter. What we do in the fire service creates an intellectual and moral dilemma for those people who don't have a lot of real-world experience /connection and by real-world I mean real fireground experience "up through the ranks"combined with a lifetime of study and introspection a self-awareness about the character of the firefighter.

That intellectual and moral dilemma we see being played out in inane comments and misguided initiatives. Almost a preoccupation with things that are inconsequential and a complete disconnect to the things that matter. There generally folks who don't understand that character and competence creates a philosophy of life that exceeds anything that they could ever vaguely understand. There generally opportunists, who are shallow disloyal and distrustful.

They would be completely confused by your upstream philosophy, but I think that all serious firefighters are going to start using upstream a lot more in their discussions. Again loved every word you wrote brilliant insight, to the point and intelligently written

Comment by Devon Wells on January 6, 2015 at 2:28pm: Thanks Bobby! It's always been a desire of mine to look as far upstream as possible. It has the ability to change things without people even seeing the change happen. It's hard to implement though. I'm trying to make 2015 the year I focus on doing the things I feel are right and saying the things I feel need to be said. Thanks for your kind words. It's great to hear that from a fire service leader like you!

Comment by Bobby Halton on January 6, 2015 at 2:13pm: Devon,

Thank you for one of the smartest most well written to the point blogs I think I have ever read. I loved every word of it. And I would add what are we doing to educate people so that we create a wellspring of desire for sprinklers and not just a mandate that they use them. Absolutely loved this piece thank you thank you thank you. Your friend Bobby

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