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.