Seattle scrutinizes AI-assisted 911 triage, nurse line delays

Seattle officials demand answers on AI-driven emergency response

Seattle's City Council is pressing the fire department for greater oversight of its ambulance contractor after revelations that an AI program screens 911 medical calls and routes some patients to a Texas-based nurse line—where they can wait hours for ambulances with no city tracking of response times.

Councilmember Bob Kettle convened a public safety committee meeting this week following reporting by The Seattle Times that raised concerns about both the nurse line operated by ambulance contractor American Medical Response (AMR) and an AI triage system that has been listening to all emergency medical calls since 2023.

"That's part of our duty, in terms of once issues are raised, that we look at them," Kettle said, adding that Seattle's contractors need to be accountable to the city.

The nurse line exemption

In 2022, Seattle Fire Department began transferring some 911 callers to AMR's nurse line to reduce strain on the emergency system. Nurses can provide advice, connect patients to virtual care, arrange transportation to clinics, or order ambulances.

At the same time, the department removed a critical safeguard: AMR ambulances ordered through the nurse line were exempted from city response-time standards and tracking requirements that apply to other 911 calls.

The consequences became tragically clear when 71-year-old Pamela Hogan waited more than 10 hours for an ambulance after being transferred to the nurse line, despite calling 911 multiple times. She later died without receiving care, according to a lawsuit her estate filed against the city and AMR. The case was settled by AMR this summer.

"The city can't know whether her experience was an aberration because it is no longer tracking ambulance waits like hers," Kettle noted during the meeting.

Fire Chief Harold Scoggins acknowledged that "these calls have been identified as a lower-level medical emergency, they are now out of our system." But Kettle countered that Seattle residents expect to know "is there going to be a response, and then the time to that response."

AI screening without disclosure

Since 2023, an AI program from Danish company Corti has been analyzing all Seattle Fire Department 911 medical calls in real time, sending prompts to dispatchers suggesting which patients should be transferred to the nurse line. The system analyzes caller word choice, pace, tone, and tenor.

The fire department deployed this AI without any disclosure to 911 callers and operated it for more than two years without public review, raising transparency and accountability concerns among experts.

Scoggins emphasized that human dispatchers retain control: "The dispatcher can send that call to the nurse line or not. That still rests with the dispatcher."

Councilmember Rob Saka expressed support for keeping humans in the decision loop, but questions remain about effectiveness. In May, the department had no metrics to share about whether the AI improves outcomes. Officials now say the University of Washington is evaluating the program, though details were not immediately available.

Why it matters

The Seattle case illustrates a broader challenge as emergency services adopt AI tools: how to balance operational efficiency with patient safety and public accountability. By exempting AI-routed calls from performance tracking, cities may create blind spots in their emergency response systems. Other cities using nurse lines maintain stronger guardrails, including response-time standards and tracking for nurse-ordered ambulances—protections Seattle eliminated.

Next steps

Kettle said he wants the city to track waits for nurse-ordered ambulances and consider holding them to time standards. However, AMR signed a new five-year contract last year, and any changes would require the company's agreement and complex negotiations.

"We haven't asked that question. We can ask that question," Scoggins said in an interview.

Kettle plans to follow up with Mayor Katie Wilson's office about potential contract modifications.

These details were first reported by The Seattle Times.