Designing for Upstream Work: Learnings from Co-Design for Preventative Solutions with Urban Fire Departments

Paper Title

Designing for Upstream Work: Learnings from Co-Design for Preventative Solutions with Urban Fire Departments

Publication Info

• Topic area: Human-centered computing for preventative public health interventions.
• Keywords: upstream work, alternate EMS response, co-design, fire departments, preventative solutions, data dashboard, risk work, infrastructuring, public health, community organizations.

Background and Problem

• Problem / challenge: Fire departments face rising 911 call volumes, particularly for low-acuity medical issues, straining resources and personnel. Existing upstream initiatives like alternate EMS response programs lack the infrastructure and quantitative metrics to demonstrate their success, hindering scalability and sustainability.
• Significance: Addressing root causes of 911 calls can reduce strain on emergency services, improve community health outcomes, and optimize resource allocation, but these initiatives require robust evidence to secure funding and institutional support.
• Motivation and related work: Previous HCI research has explored preventative health and risk work but has not explicitly addressed upstream initiatives in fire departments. Existing studies highlight challenges in measuring success and the need for tools to support data practices in community organizations. This paper builds on these insights to address gaps in the design and evaluation of upstream initiatives.

Solution

• Proposed approach: Co-design of a data dashboard to support fire departments in demonstrating the value of alternate EMS response programs.
• Novelty:
  1. Empirical investigation of upstream initiatives in fire departments, focusing on alternate EMS response programs.
  2. Development of a prototype data dashboard to demonstrate program value to diverse stakeholders.
  3. Identification of good practices for designing tools to support upstream initiatives.
  4. Integration of infrastructuring and participatory design principles to address local and multi-organizational challenges.
• Procedure and key techniques:
  1. Conducted 1,200 hours of ethnographic observation across four fire departments to understand alternate EMS response programs.
  2. Organized co-design sessions and workshops to identify challenges, ideate solutions, and prototype a data dashboard.
  3. Iteratively refined the dashboard through feedback from fire department personnel, public health professionals, and other stakeholders.
  4. Developed a measure bank for customizable metrics to address local needs and data constraints.

Results

• Concrete findings:
  • Alternate EMS response programs reduce 911 call volumes and improve patient outcomes by addressing root causes (e.g., homelessness, substance use disorders).
  • Prototype dashboard includes metrics such as 911 calls prevented, cost savings, and public health outcomes (e.g., Disability Adjusted Life Years).
  • Programs are hyper-local, multi-organizational, and involve complex outcomes that are difficult to measure.
• Advantage over baselines: Provides a systematic way to quantify and communicate the value of upstream initiatives, addressing a key barrier to funding and scalability.
• Experiments / evaluation:
  • Ethnographic observations and co-design sessions with four fire departments (Los Angeles County, Columbus, Fairfax County, Fort Worth).
  • Iterative feedback from stakeholders to refine the dashboard.
• Limitations and future work:
  • Prototype is still under development and requires further funding for deployment.
  • Challenges remain in standardizing metrics across departments and addressing unintended consequences of data use.
  • Future work includes developing a measure bank and advocating for national data standards.

Summary

This paper investigates upstream initiatives in fire departments, focusing on alternate EMS response programs that address root causes of 911 calls. Through ethnographic research and co-design, the authors developed a prototype data dashboard to demonstrate program value to stakeholders, enabling scalability and sustainability. The study highlights the hyper-local, multi-organizational nature of upstream work and the challenges of measuring success. The findings contribute to HCI literature on designing data tools for community organizations and provide actionable insights for supporting preventative public health initiatives.