By Daniel Beekman
The Seattle Times
SEATTLE — For more than two years, a Denmark -based company’s artificial intelligence technology has been listening to Seattle residents’ 911 medical calls without their knowledge.
And the Seattle Fire Department has been using the company’s AI to help dispatchers decide which callers don’t deserve a rapid response.
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Corti’s technology is prompting the dispatchers to route certain 911 patients to a nurse-staffed Texas call center, rather than send them ambulances right away. It’s analyzing what patients are saying and, in some cases, nudging the dispatchers with pop-up alerts.
This has happened without any disclosure to callers and without any public review, the Fire Department confirmed in late May, two months after The Seattle Times started asking about the topic.
On top of that, fire officials can’t explain how they’re measuring the technology’s success or what their current contracts with Corti look like, further leaving residents in the dark.
“The potential that this company could be a part of the experience that Seattle 911 callers have and they don’t know it, that raises serious concerns,” said Ryan Calo , a University of Washington law professor and co-director of the university’s Tech Policy Lab . “I’m troubled on a number of levels.”
For its part, the department says it has taken a conservative approach to using AI technology during live calls, despite being one of the first 911 agencies in the country to experiment with the technology.
“The dispatcher still has the ultimate authority” to decide how to handle each 911 call, even when they receive AI prompts, said Chris Lombard , SFD’s assistant chief of resource management.
Every determination on a 911 call ... is made by a trained SFD dispatcher following SFD’s protocols,” a Corti spokesperson wrote this past week, more than two months after The Times requested an interview. “Corti’s role is to support that work, not replace or override clinical judgment.”
Although Corti has been using residents’ calls to train its AI for SFD, the company says it doesn’t own the Seattle data and is barred from using it to train its AI models for other customers. Lombard said patients’ confidential information is not at risk.
Still, some experts say the department’s under-the-radar use of AI in medical calls brings up questions about transparency, privacy and accountability, especially because there are also questions about Seattle’s 911 nurse line.
Managed by the city’s ambulance contractor, American Medical Response, the nurse line is exempt from SFD standards that normally require ambulances to arrive quickly. Callers transferred to the nurse line may be forced to wait hours for their ambulances to come pick them up, The Times reported earlier this year. The city isn’t tracking these waits.
In the wake of The Times’ reporting on the nurse line, including the alleged wrongful death of one 911 caller, Mayor Katie Wilson and City Councilmember Bob Kettle promised to take another look at the system. They have yet to take action, however, and the involvement of AI could complicate the picture.
“AI seems to be prompting dispatchers to push certain calls to the nurse line,” said Calo, from UW . “A person who is erroneously routed outside of the 911 environment has a right to know how it happened.”
Although AI assistants are becoming more common in doctor’s offices and on customer-service calls generally, “I can’t imagine” ordinary people in Seattle guessing that AI is involved in their 911 calls, added Cheryl Kauffman , who owns the healthcare consulting service Seattle Patient Advocates.
“I don’t think I’m categorically against the idea of using AI” for 911 calls, said Jevan Hutson , a privacy and cybersecurity attorney who directs UW’s Technology Law and Public Policy Clinic . “But the governance needs to match the stakes here, and the governance is not matching the stakes.”
Yearslong relationship
The Fire Department’s relationship with Corti dates to before the pandemic. That’s when Corti started listening to Seattle calls to test its ability to detect symptoms of cardiac arrest, according to a report by the company.
Research from Denmark was showing that Corti’s artificial intelligence could detect cardiac arrest in emergency calls more quickly than human dispatchers, although with more false positives than the dispatchers had.
In 2019, SFD and Corti signed a data-sharing agreement.
“Corti is developing an AI application that can analyze voices, listen for intonation, filter background noises, etc.,” the agreement said. “Using machine learning, the application trains itself by listening to actual calls to identify important factors and continue improving its model. To accomplish this, having access to 911 calls to build the knowledge base is critical.”
Around that time, fire officials rebuilt their 911 call-taking process with custom Corti software, said Lombard, the assistant chief. They initially used Corti’s AI only for quality assurance checks on completed calls, Lombard said.
Whereas SFD’s human employees can review just a small percentage of the department’s 911 medical calls, the AI can quickly check more “to make sure that we’re asking the right questions every time,” Lombard said.
Boston’s Emergency Medical Services department has similarly used Corti’s AI for quality assurance of 911 medical calls, according to the company.
Corti, which calls itself an “AI platform for healthcare,” has repeatedly touted its work in Seattle while seeking to grow its business in the U.S. Its CEO has written that, “In cities like Seattle , AI has been integrated into emergency dispatch systems since 2019, providing real-time, data-driven support.”
Now SFD is downplaying AI’s role. The department didn’t begin using AI during live 911 calls until more recently, Lombard said, and then only in connection with its ambulance contractor’s nurse line.
Live prompts
The nurse line is supposed to reduce strain on emergency services by offering other options, such as telemedicine and community clinics, to 911 callers who have low-level problems. In practice, the nurse line also allows Seattle’s ambulance contractor to sidestep accountability.
In 2022, retiree Pamela Hogan waited more than 10 hours for an ambulance after calling 911 and being sent to the nurse line. This was acceptable under American Medical Response’s contract with Seattle. Hogan never got care and was later found dead in her apartment, and her estate is now suing.
The relaxed ambulance response standards that applied in Hogan’s case remain in place for the nurse line — and AI is now also part of the picture.
SFD started using live AI prompts in December 2023 to help dispatchers more consistently identify 911 calls to divert to the nurse line, Lombard said.
Corti’s AI now listens to all 911 medical calls and, when it detects a call it thinks should go to the nurse line, sends the dispatchers a message.
Dispatchers who ignore the advisory prompts aren’t penalized, Lombard said.
That’s important, because there should always be a human “at the end of the review chain” making decisions about care, said Emily Brice , co-executive director of the nonprofit Northwest Health Law Advocates. This could be eroded if the dispatchers were incentivized to agree with the AI, she said.
In a 2024 news release from Corti, SFD Medical Director Michael Sayre credited the company’s “cutting-edge technology and real-time prompting” for driving a 50% increase in 911 calls sent to the nurse line.
The increase was actually 32%, a Fire Department spokesperson clarified in late May, and it aligned with SFD’s protocols, a Corti spokesperson added.
Although Sayre hoped the AI prompts would get dispatchers to use the nurse line more consistently, rather than at different rates, that didn’t occur, he said in a symposium presentation last year, according to a report on the event.
Sayre struck a positive tone, all the same.
“The work presents real challenges, but we have now validated that this AI system can work. The next step is to turn it on for higher-acuity calls, as well,” Sayre said, according to the 2025 symposium report.
“We are just scratching the surface,” he added. “Healthcare technologies are already in use that can revolutionize the way we provide care.”
Benefits, risks
It’s possible that Seattle’s use of AI is benefiting 911 callers by helping fire officials hone their call-taking practices and triage patients faster.
SFD is so bullish on Corti that it hosted tours and demonstrations of the company’s technology last year for visitors from the Coast Guard, Dallas, Alaska and Taiwan, according to an annual report.
“Corti is more than just an AI solution we use, it’s a collaboration where every day we strive to save more lives,” SFD’s lead dispatcher, Hilton Almond , was quoted as saying in a 2024 promotional video by Corti.
Without much public information, however, it’s hard to assess whether callers are better off, said Franziska Roesner, a UW computer science professor who codirects the university’s Security and Privacy Research Lab.
Mayor Wilson, in a vision document she released May 4 after taking office in January, said the city’s use of AI “requires careful consideration of impacts on our workforce and environment, and a careful analysis of privacy and bias.”
But 911 medical callers aren’t told their calls are being monitored by AI. There are no public disclaimers on the Fire Department’s website. The department has no metrics to share with the public on how AI is improving or not improving outcomes for Seattle 911 callers, Assistant Chief Lombard said.
SFD hasn’t been able to share a detailed accounting of what it’s paying Corti. The total annual cost is currently about $260,000.
“It’s not clear this is a bad thing, but it’s also not clear that it’s a good thing,” Roesner said. “I think we need to know a lot more.”
Research on AI has revealed the potential for biased treatment depending on race, gender and socioeconomic class, Roesner added.
“I have no idea how they’ve taken that into account,” she said.
SFD’s use of AI has not been assessed under Seattle’s surveillance ordinance, which mandates review of technologies that observe or analyze individuals in ways likely to raise concerns about social justice.
That puzzles experts like Hutson, the UW privacy and cybersecurity attorney. Although 911 calls have long been recorded and are semipublic — patients’ medical information may be redacted — AI adds complexity, Hutson said.
“I don’t know how you escape a surveillance review,” he said.
People in Seattle who may not like the Fire Department’s use of AI can’t really avoid it, because there’s no alternative when you’re dealing with a medical emergency, Calo, from UW’s Tech Policy Lab, pointed out.
“When you’re calling 911, you’re doing it because you have to,” he said.
Looking ahead
Many doctors are optimistic about AI in healthcare, and many already use some AI in their work, according to recent surveys.
But the tech can be plagued by bugs, hallucinations and other problems, said Soham Gadgil, a UW computer science doctoral student who co-authored a recent paper on transparency in medical AI.
Callers and SFD need to know how the AI is using their information to make recommendations and how it’s performing, Gadgil said.
SFD will be open from now on about its AI use, said Lombard, the assistant chief, after The Times asked about public awareness. For example, the department plans to deploy AI note-taking for firefighters responding to medical emergencies, he said.
“We’re running it through the whole city process,” he said.
The Wilson administration is “currently in the process of developing a public-facing framework around usage and governance of AI going forward,” a spokesperson for the mayor said when asked about AI and 911.
“We will also develop a framework for assessing whether uses of AI which were previously authorized continue to reflect our values, center human flourishing and serving the public good,” the spokesperson said.
Kettle, who chairs the City Council’s public safety committee, offered no comment on SFD’s use of AI, saying he needed to “do some due diligence.
Bill Schrier , who once led Seattle’s information technology department, thinks AI will become widespread in emergency triaging over time, despite some residents’ fears, “because it’s going to improve the service.”
But there could be a slippery slope for local governments struggling with budget constraints, warned AI critic Kevin De Liban .
“At some point, you’re going to be talking with an AI voice agent,” rather than a human, said De Liban, whose nonprofit TechTonic Justice advocates for low-income people in the AI age.
That’s not necessarily far-fetched. The 911 agencies for Snohomish and Kitsap counties recently began using AI agents to answer nonemergency lines. The Snohomish agency is also using an AI co-pilot for emergency calls.
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