Detroit's emergency medical services (EMS) union is raising concerns about how the Fire Department manages non-fire medical calls, suggesting current practices could put patients at greater risk. These issues have been ongoing since the 2021 consolidation of the EMS Division with the Fire Division, intensifying last year following a new standard operating procedure. An arbitrator sided with the EMS union last March, citing "disorder in the field and detrimental effects on patient care."
EMS Assistant Supervisor Al Saade stated that Fire Department supervisors have been interfering in non-fire medical emergency calls on a nearly daily basis. He recounted an incident on July 4 last year where a Fire Department battalion chief issued contradictory orders to him during patient triage at a multivehicle crash. Saade noted that state law mandates the highest licensed medical authority, in this case his paramedic supervisor, to direct emergency medical care. Saade continued triage despite the chief's attempts to pull him away, later facing disciplinary action for insubordination, which was eventually dismissed. Saade said the incident shows how "wrong things can go" when Fire Department officials attempt to take charge of emergency medical care.
The new standard operating procedure, adopted at the start of last year, placed battalion chiefs in charge of overall incident command and scene management, requiring EMS supervisors to report to them. Despite the arbitrator's ruling that affirmed the EMS Division's position, EMS representatives claim the Fire Department frequently declines to send available paramedics to "Code 1" calls, which involve the most serious medical situations. EMS workers have filed dozens of grievances, including some after the arbitrator’s order, advocating for medically trained staff to lead in medical emergencies.
James Tignanelli, president of the Police Officers Association of Michigan, whose group agreed to represent the Detroit EMS union starting January 2025 due to the internal conflicts, supported the EMS claims. Tignanelli stated that his association has documented more than 5,000 incidents since January 2025 where "Code 1" patients were treated by firefighters or emergency medical technicians in a Basic Life Support unit when an Advanced Life Support unit, equipped with a paramedic and essential medications, should have been dispatched. He emphasized that while direct proof of fatalities is impossible, he believes it is likely that "somebody didn’t get the treatment they deserve." Tignanelli framed the dispute not as a "turf battle" but as a question of whether Detroiters receive the emergency response they should in a medical crisis.
Executive Fire Commissioner Charles Simms disputed claims of withholding advanced life support. He stated the Fire Department has significantly reduced its Code 1 response time from nearly 20 minutes in 2014 to 7.5 minutes today, which he said helps save lives for Detroit residents experiencing life-threatening emergencies. Simms acknowledged a national shortage of paramedics and the challenges in rebuilding Detroit's EMS system. He also noted efforts to train more firefighters as paramedics to create a fully "in-house" staff and a review of deployment policies to ensure the proper response to Code 1 calls. Simms did not address whether Fire Department supervisors are intervening in medical response decisions.
Detroit's EMS Division was consolidated with the Fire Division in 2021. The city experiences over 160,000 calls for medical emergency assistance annually, compared to 1,471 structure fires last year. To manage the high volume of medical calls, the city relies on supplemental ambulance services; the City Council renewed these contracts in June. Councilmembers have discussed investing more in the city's own EMS services, which Fire Department officials indicated would require significant investment. Saade agreed with the long-term goal for the Fire Department to handle all medical calls in-house without private companies. He argued that the data shows emergency medical calls are the "overwhelming day-to-day demand for service," stating, "We need to stop treating EMS as the secondary mission." Saade called for an overhaul of the Fire Department, including a change in approach and resource placement, but stated EMS officials have not been involved in discussions about these goals.