By Daniel Beekman
The Seattle Times
SEATTLE — The Seattle Fire Department may seek more accountability from its ambulance contractor after being questioned by the City Council about using an out-of-state nurse line and an artificial intelligence program to help triage 911 calls.
Councilmember Bob Kettle invited Fire Department officials to a meeting of his public safety committee Tuesday in reaction to reporting by The Seattle Times this year that raised concerns about the nurse line and AI program.
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In an interview after the meeting, Kettle said he wants to see enhanced oversight of ambulance responses ordered through the nurse line.
“That’s the main to-do item,” the public safety committee chair said.
Seattle 911 callers transferred to the Texas -based nurse line, operated by the city’s ambulance contractor, can wait hours for their ambulances to come pick them up and the city isn’t tracking their waits, The Times reported.
Meanwhile, a different contractor’s AI program is listening to Seattle’s 911 emergency medical calls and prompting the Fire Department’s dispatchers to transfer certain patients to the nurse line, The Times also reported.
Experts and watchdogs have said the system should be reviewed.
“That’s part of our duty, in terms of once issues are raised, that we look at them,” said Kettle, who later quoted from a Times story about a Seattle woman’s nightmarish wait for an ambulance ordered through the nurse line.
Seattle’s contractors need to be accountable to the city, he said.
“If it’s the council’s will for us to negotiate something on the backstop,” then the Fire Department can try to do that in future contract talks, fire Chief Harold Scoggins said.
Nurse line
Most basic life support 911 hospital transports in Seattle are handled by the city’s ambulance contractor, American Medical Response.
In 2022, the Fire Department started transferring some 911 patients to AMR’s nurse line. The idea was to reduce strain on a busy system by diverting callers with minor issues to other options. The nurses can give advice, connect patients to virtual care, send them in Ubers to clinics or order ambulances.
“We only have so many units to go out the door,” Scoggins told Kettle’s committee. “This was the tool that was implemented to help with that.”
The Fire Department removed a guardrail at the same time. Previously, AMR ambulances were generally subject to city standards requiring them to arrive promptly or face penalties. In 2022, the department changed AMR’s contract to exempt nurse-ordered ambulances from time standards and tracking.
That year, 71-year-old Pamela Hogan waited more than 10 hours for an ambulance after being transferred to the nurse line, despite calling 911 back several times. She later died without receiving care, her estate alleged in a lawsuit against the city and AMR that was settled this summer by AMR.
The city can’t know whether her experience was an aberration because it is no longer tracking ambulance waits like hers, Kettle pointed out Tuesday.
“That (type of) call is up to AMR to track,” Scoggins said. “Because these calls have been identified as a lower-level medical emergency, they are now out of our system.”
The average 911 caller may not make that distinction, given that AMR is a Seattle contractor providing a service for the city, Kettle replied.
“At the end of the day,” Seattle residents want to know, “is there going to be a response, and then the time to that response,” Kettle said.
AI program
Since 2023, an AI program provided by a Danish company called Corti has been listening to all of the Fire Department’s 911 medical calls and sending live prompts suggesting dispatchers transfer some patients to the nurse line.
The Fire Department says the AI program is supporting its human dispatchers and has said Corti can’t use Seattle calls to train its other AI models.
But the department introduced the AI without any disclosure to 911 callers and used it for more than two years without any public review, stirring concerns from some experts about transparency, safety and accountability.
The dispatchers are still in control, not the AI, Scoggins stressed Tuesday.
“It can pop a message up on the screen based on the words that the caller is using, the pace, the tone, the tenor, he said. “The dispatcher can send that call to the nurse line or not. That still rests with the dispatcher.”
Councilmember Rob Saka expressed appreciation for that approach.
“It’s really important to make sure humans remain in the loop,” he said.
In May, the Fire Department didn’t have metrics to share with the public about how the AI is improving outcomes for 911 callers or not. On Tuesday, officials said the University of Washington is evaluating the program’s effectiveness. They didn’t immediately share details.
Next steps
The Fire Department holds quarterly meetings with AMR about the nurse line, Scoggins noted. More oversight may be appropriate, Kettle said.
Kettle believes the city should track waits for nurse-ordered ambulances and consider holding them to time standards, he said after Tuesday’s meeting.
That would need to be negotiated with AMR, Scoggins said, and the company signed a new five-year contract last year. Theoretically, changes could be made before the current contract expires, but AMR would need to agree and the details could be complicated, Scoggins said in an interview.
“We haven’t asked that question. We can ask that question,” he said.
Some other cities that use nurse lines have stronger guardrails, including tracking and time standards when nurses order ambulances.
Kettle hopes the Fire Department and AMR can work something out, and he plans to follow up with Mayor Katie Wilson’s office about it, he said.
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