Detroit’s emergency medical services (EMS) union alleges the city’s Fire Department is mishandling non-fire medical calls, potentially increasing risks to patients. These concerns stem from the 2021 consolidation of the EMS Division with the Fire Division, with EMS representatives reporting that Fire Department supervisors have interfered in non-fire medical emergencies on a nearly daily basis.
In March, an arbitrator sided with the EMS Division regarding a new standard operating procedure. The arbitrator noted that the union had “articulated the disorder that has arisen in the field and the detrimental effects on patient care.” EMS representatives further claim that the Fire Department frequently declines to send available paramedics via Advanced Life Support (ALS) units to “Code 1” calls, which are the most serious medical situations. Instead, Basic Life Support (BLS) units, staffed by firefighters or emergency medical technicians, are often dispatched.
James Tignanelli, President of the Police Officers Association of Michigan, which will represent the Detroit EMS union starting in January 2025, has confirmed his group handles numerous grievances on this issue. Tignanelli stated that his organization has documented over 5,000 incidents since January 2025 where Code 1 patients were treated by BLS units when an ALS unit should have been dispatched. He believes it is likely that some individuals have not received the appropriate treatment they needed during a medical crisis.
One specific incident last July 4 highlighted these tensions. Detroit paramedic and EMS Assistant Supervisor Al Saade responded to a multi-vehicle crash where three people were injured. Saade's EMS supervisor, Capt. Robert Calandro, assigned him to patient triage. However, a Fire Department battalion chief at the scene began issuing contradictory orders regarding the triage process. Saade stated that state law mandates the highest licensed medical authority present—in this case, his paramedic supervisor Calandro—is responsible for directing emergency medical care. Saade ignored the battalion chief’s orders and continued triage, even as the chief attempted to pull him away to argue about the chain of command. Saade subsequently faced disciplinary action for insubordination, though it was later dismissed. He views the incident as an example of Fire Department officials attempting to take charge of medical care, disregarding medical expertise.
The new standard operating procedure adopted at the start of last year intensified these tensions. It placed Fire Department battalion chiefs in charge of overall incident command and scene management, requiring EMS supervisors to report to and coordinate all actions through the incident commander. This policy change led the EMS staff to bring the issue to arbitration.
Executive Fire Commissioner Charles Simms disputes claims that the Fire Department is withholding advanced life support from patients. Simms stated that the department has significantly reduced its Code 1 response time from nearly 20 minutes in 2014 to 7.5 minutes today, indicating faster medical response for life-threatening emergencies. Simms attributes challenges in providing advanced care to the ongoing process of rebuilding the EMS system and a national shortage of paramedics. He noted that the Fire Department is actively training more firefighters to become paramedics to build an “in-house” paramedic staff and is reviewing deployment policies to ensure proper response to Code 1 calls. Simms did not address the concerns raised about Fire Department supervisors intervening in medical response decisions.
Detroit faces a substantial demand for medical emergency assistance, with over 160,000 calls annually. In contrast, firefighting operations were required for 1,471 fires last year, and structure fires in the city have declined by 50% since 2017. To manage the high volume of medical calls, the city currently supplements its own emergency response services with private ambulance companies. In June, the City Council renewed these supplemental contracts. Discussions among council members have raised questions about whether the city should instead invest more in its own EMS services, though Fire Department officials have indicated this would require significant financial investment.
Al Saade agrees with the long-term objective of the Detroit Fire Department handling the city’s emergency medical calls entirely in-house, without relying on private companies. However, he emphasized that EMS is currently treated as a secondary mission despite data indicating it represents the overwhelming day-to-day demand for service. Saade believes the Fire Department requires an overhaul, including a shift in approach and a revamp of resource placement, adding that EMS officials have not been involved in discussions about these departmental goals.
