Seattle, WA
Seattle patient’s 10-hour wait for ambulance raises concerns about 911 triage systems
By Daniel Beekman
The Seattle Times
SEATTLE — A Seattle woman’s nightmarish ambulance wait in the days before her death might have played out differently in another community, because U.S. cities have set up their 911 systems and nurse lines in various ways.
Many cities, like Seattle, have added 911 nurse lines in recent years to divert low-level patients away from crowded hospitals. But some have equipped their systems with more protections against extreme delays, like the 10 hours a woman named Pamela Hogan waited for a nurse-ordered ambulance in 2022.
| EARLIER: 10-hour ambulance delay puts Seattle’s 911 call triage under scrutiny
It’s not clear that Hogan’s wait is what caused her death, but her estate is suing and her ordeal is raising questions about the city’s 911 medical system.
As Seattle leaders like new Mayor Katie Wilson deal with scrutiny over Hogan’s case and as additional communities consider adding 911 nurse lines, they may be able to learn from choices by policymakers elsewhere.
The Seattle Fire Department and its ambulance contractor, American Medical Response, say they’re generally guiding 911 patients to appropriate care. They declined to comment on Hogan’s case and a Seattle Times investigation.
But in Washington, D.C., as well as closer to home in Washington state and in other places, there are examples of more cautious approaches, say independent experts, including emergency response leaders and health care watchdogs.
“When we call our local Fire Department, we don’t expect to be passed off to a multibillion-dollar corporation without public oversight or transparency,” said Emily Brice, co-executive director of Northwest Health Law Advocates.
In Seattle
Seattle’s Nurse Navigation program went live in 2022 and is operated by the parent company of the city’s for-profit ambulance contractor, AMR.
When someone phones 911 with a low-level medical problem, Fire Department dispatchers can now route the call to a nurse. The nurse can try to resolve the problem with options like telemedicine or an Uber ride to a clinic.
Or the nurse can order an ambulance from the company’s dispatch office.
| Nurse Navigation Program
AMR was already providing ambulances for Seattle, but the nurse line was new. Before it launched, AMR was racking up financial penalties for violating the city’s contractual time standards, which said ambulances had to arrive within an hour.
Seattle and AMR officials promised the nurse line would relieve pressure on ambulance crews and thereby reduce delays to patients with more serious needs. They didn’t publicize some important details, however.
AMR’s nurses are located at a call center in Texas. They order ambulances for most patients they triage: more than 4,600 last year. And Seattle officials have excluded the nurse-ordered ambulances from the city’s time standards, giving the company more operational flexibility and shielding it from late penalties, experts say.
Patients like Hogan can’t update the nurse line directly as their conditions evolve, their AMR ambulances aren’t subject to contractual penalties for delays and the Fire Department doesn’t document how long the rides end up taking.
Those details and staffing issues may help explain why Hogan waited so long on a busy night, despite a nurse recommending she get care within four hours and despite Hogan calling 911 back multiple times, some experts said.
“If you don’t track it, you don’t know what’s happening,” added Cheryl Kauffman, who owns the health care consulting service Seattle Patient Advocates, describing the city’s setup as “a perfect recipe for poor outcomes.”
In other cities
Nurse lines and 911 systems vary from place to place. For example, Spokane uses AMR and exempts nurse-ordered ambulances from strict time limits, like Seattle does. But Vancouver, Wash., also uses AMR and doesn’t do that.
When the nurses order ambulances for Vancouver patients, the city’s time standards apply, the wait times are tracked and AMR can be penalized for delays, said Michelle Bresee, an emergency medical services analyst at the city.
“They’re still a person waiting for service and we want to make sure that person gets a response in a reasonable amount of time,” Bresee said.
Washington, D.C., also maintains ambulance wait standards and reporting, directing nurses to bounce patients back to 911 for ambulance dispatching.
“We want every call to have the same response standards,” said David Vitberg, the district’s Fire Department medical director and the lead editor of a textbook on emergency care and transportation. “There’s an inherent risk in not holding (ambulance) units to some sort of response time metric.”
D.C. requires AMR’s parent company to embed a nurse in the district’s 911 center, integrate its computer system with the district’s and check medical histories to help triage patients. Seattle’s contract lacks those guardrails.
In Fort Worth, Texas, the 911 agency maintained time standards for nurse-ordered ambulances and built its nurse line in-house to guard against potential communication gaps, said former administrator Matt Zavadsky, who set up that system. Seattle couldn’t afford to do that, the Fire Department said.
Fort Worth automatically upgraded its responses based on triggers like repeated callbacks or unexpected ambulance delays, sometimes routing a patient back to a nurse or sending a paramedic to check on them, said Zavadsky, now a nationally recognized consultant on emergency medical systems. Seattle’s system has no such automatic triggers, the Fire Department said.
There are other considerations, said Conrad Fivaz, medical director for Priority Solutions, another nurse-line vendor that operates internationally.
Priority Solutions only works with 911 agencies that employ nurses in-house, integrate their computer systems and are accredited by the International Academy of Emergency Dispatch, Fivaz said. Seattle doesn’t tick those boxes, he said.
Priority Solutions also only works with registered nurses, Fivaz added, whereas AMR has used less-qualified nurses for some patients. Josephine Ensign, professor emeritus at the University of Washington School of Nursing, said she believes nurses assigned to triage vulnerable 911 patients should hold Bachelor of Science degrees in nursing with training in public and community health.
“You have to put things in place to mitigate the risk,” Fivaz said.
What’s next
Ken Miller worked with AMR to launch a nurse line when he served as medical director for the 911 system in Santa Clara County, Calif.
His system agreed to a contract like Seattle’s, exempting nurse-ordered ambulances from time standards, said Miller, who’s since left the county.
But Miller was “never satisfied I had enough transparency,” he said, describing what happened to Hogan in Seattle as his “nightmare” scenario.
“This goes beyond Seattle,” as cities across the U.S. continue experimenting with nurse triage lines to reduce strain on 911 systems, said Miller, who has served on the National Emergency Medical Systems Advisory Council.
A nurse-ordered ambulance should at least be required to reach a patient within whatever period the patient’s nurse recommends, some experts said.
“If your own staff say the patient needs care within this time frame, you should provide that,” said Amber Sabbatini, an associate professor of emergency medicine at the University of Washington who researches health care systems.
Seattle just missed a potential opportunity to secure more accountability, because officials signed a new, five-year contract with AMR in September and chose to continue exempting nurse-ordered ambulances from oversight.
But with a new mayor, city attorney and two new City Council members, it’s possible Seattle leaders will revisit the matter.
Kevin Mackey, medical director for the Sacramento Fire Department, said Seattle’s 911 system enjoys a stellar reputation; its Medic One program broke ground decades ago by training firefighters as paramedics. Yet he agreed with other experts that Hogan’s case and Seattle’s guidelines are worthy of review.
“The public expectation should not and cannot be perfection,” Mackey said. “But it also should not and cannot be that people are going to die.”
A public feud in Clinton Township is raising questions about EMS response models, as officials push for more EMT-based responses while firefighters warn reducing paramedic staffing could cut advanced care
With 76% of EMS professionals facing burnout, agencies must prioritize recovery, resilience and leadership modeling to protect provider health and patient safety
A career in public safety or emergency response can take a toll on your loved ones; here’s what you need to know
Forget protein bars — the best “exercise snack” happens in the patrol car, between calls or while restocking the rig
© 2026 The Seattle Times.
Visit www.seattletimes.com.
Distributed by Tribune Content Agency, LLC.
First Due named to Government Technology’s 2026 GovTech 100 for second consecutive year
I have always been in love with cities. I joke with friends that I have crushes on cities the way they have crushes on good-looking strangers. Sometimes—as with Paris and London—my unrequited crush meant finding an excuse to move there. With Seattle, however, that initial attraction grew into a long-term relationship.
Liz Dunn
Phot by TRAVIS GILLETT
I arrived here as a “tech baby,” coming from Canada to work at Microsoft as a college intern. For a long time, I felt as though I were living in a bubble—until I realized I could pivot my career and work in and on the city I’d come to call home. Through my company, Dunn & Hobbes, I’ve done just that, spending more than 25 years building and renovating spaces for retail, restaurants, and creative work. I love old buildings—but what I love more is what happens inside and around them. I love making space for creative people and then watching them fully inhabit those places and thrive. I also love how a collection of structures on a block can become an economic and artistic ecosystem.
Working in real estate is not just about making deals—you’re crafting pieces of the city, and that comes with both impact and responsibility.
Small businesses are the heart and soul of any neighborhood. Research shows that locally owned businesses generate a much higher multiplier effect in the regional economy than national chains. Beyond economics, the independent shops, restaurants, and designers that comprise the core fabric of a city are the secret sauce that makes it feel unique.
Nowhere is that more evident than Capitol Hill’s Pike/Pine corridor, where I’ve conducted most of my work and lived out large chunks of my adult life. During the past 25 years, it has become a case study in what happens when you preserve character and invest in small business. The area was once filled with old auto-row buildings that had fallen into disuse. Instead of wiping the slate clean, local developers, including me, saw an opportunity for creative reuse. Those buildings turned out to be perfectly scaled for independent retailers and restaurants, creating a unique critical mass that offers a popular destination for locals and tourists alike.
What makes Pike/Pine special is its texture and grit—the layered history you feel in both the physical architecture and the spirit of the shops and restaurants. A large percentage of businesses are owned by members of the LGBTQ+ community, women, immigrants, and people of color. The density of independent retailers and studios—and the inclusive community that supports them—creates omething you can’t replicate with a formula. It evolved over decades, shaped by artists, musicians, designers and small entrepreneurs willing to take risks and plant their flags.
Today, neighborhoods like Pike/Pine face challenges that threaten the tightly woven ecosystem that makes them thrive. There’s a difference between gritty and too gritty, and during the past six years, it’s become harder to attract people. Foot traffic in neighborhood retail districts is dropping, even as downtown begins to recover with tourism. Small businesses are dealing with crushing cost pressures, many tied to public safety concerns and well-intentioned policies with unintended consequences. Public safety has been the elephant in the room—though I do believe we are starting to see improvements. At the same time, our habits have changed. Seattleites have been hibernating, whether because of repercussions from the COVID-19 pandemic or the convenience of delivery apps, streaming, and gaming.
And yet, people still deeply crave connection.
That’s why what’s happening in Pike/Pine right now is inspiring and hopeful. Many of the people who helped shape the neighborhood are still here, investing their time, money, and creativity because they care deeply about its future. We’re doubling down on what makes it special—art walks, a slate of new murals, the On The Block street fair, and Capitol Hill Block Party—all invitations for the community to come back out and re-engage.
This spring, on Saturday, May 16th, we’re launching something new: the Pike/Pine Spring Fashion Walk and Social. It’s designed to be an annual celebration that stretches across the neighborhood, anchored by a collection of activations at Melrose Market, and a runway show on the “catwalk” at Chophouse Row that will include Seattle fashion apparel leaders Glasswing, JackStraw, the Refind, the Finerie, and Flora and Henri. Neighborhood-based designer and brand activations up and down the corridor will include open studios, DJs, wine tastings, in-store pop-ups, and involvement from local college students—bringing in the next generation of designers and entrepreneurs. One of the goals is to remind everyone that Seattle still has amazing fashion “game,” offering a scene that is just as creative and diverse as anything you might find in New York or LA. At its core, this event is not about shopping. It’s about creating a reason for people to come together, to reconnect, and to experience the neighborhood as a shared space.
Because that’s the point. Cities work best when we show up—for them and for each other. Seattle’s culture is not something that exists just for us to consume; we are all participants in shaping it. So, my call to action is simple: come out. Walk around and meet your neighbors. Engage in what’s happening. It feels good—and it does good.
SEATTLE — Memorials are growing outside popular beer garden The Growler Guys in North Seattle, as friends and family honor the life of a young employee found dead at the business Saturday morning.
Seattle police said coworkers found the victim’s body with apparent fatal gunshot wounds inside The Growler Guys around 9 a.m. Saturday. Authorities have not publicly identified the victim yet. He was in his 20s.
PREVIOUS COVERAGE | Seattle beer garden employee found shot to death inside workplace
The young man’s death has shocked and shaken the surrounding North Seattle community.
Dozens of family members, friends, and regular customers surrounded the taped-off homicide scene for hours throughout the day Saturday. Several people who knew the victim described him as a friend to all, a family man, and a stand-out employee to his boss, Kelly Dole.
“He was a part of my community at The Growler Guys,” Dole said. “It’s been a joy just to see them together day after day, and for him to lose his life this way is just a shame and such a loss.”
The victim was also a close friend of Dole’s son for years.
The Growler Guys is closed for the time being, but many people stopped by on Sunday to drop off flowers, cards, or to stop to take a moment and reflect.
A note left at the corner of NE 85th St. and 20th Ave. NE was written by a family that had the victim serve them at The Growler Guys. “While we were only lucky enough to know you for one evening,” the note reads, “I know there are many, many more lives you have made a lasting impact on.”
Left next to the note was a child’s apple juice box. Coworkers of the victim said he always gave kids free apple juice.
“Don’t tell my boss,” they said the victim would say with a smile.
He really was important to the guests and always had a smile, Dole said of his young employee. He had worked at The Growler Guys for about a year.
The victim was killed sometime between Friday night and Saturday morning, and police are still investigating a possible motive and suspect. So far, no arrests have been made.
People living nearby, who wanted to remain anonymous, said they didn’t hear any gunshots but called the death shocking: “Well, my heart breaks. My first thought is that it’s a tragedy,” one man said.
Anyone with information or surveillance video in the surrounding Lake City area should contact Seattle police or 911 immediately.
Dole said he hopes justice is served to offer a small piece of closure to the victim’s grieving family.
“My heart goes out to his mom and his dad, his brother and other family members,” Dole said. “It’s just so tragic.”
Seattle, WA
‘Do you care more about the kids or the drug addicts?’: Jake calls out Seattle for potential homeless shelters near schools – MyNorthwest.com
After the Seattle City Council moved forward with legislation that would expand temporary homeless shelters without buffer zones near schools, KIRO host Jake Skorheim questioned who the city really cares about.
Jake wondered aloud about what goes on in a Seattle City Council member’s head, assuming they even read the proposal.
“They see the thing, they go like, ‘Well, what do we think about this one here, about school zones?’ They’re like, ‘I don’t know about that. Let’s scratch that out. We can have homeless people around school zones, drug addicts, people who are trying to get their fix,’” he said on “The Jake and Spike Show” on KIRO Newsradio.
Seattle legislation would increase shelter capacity by 50%
If approved, the legislation would let temporary shelter sites, including tiny home villages, RV safe lots, and tent encampments, increase capacity by 50%, raising the maximum from 100 to 150 residents.
Approved amendments would require sites with more than 100 beds to maintain public safety plans and around-the-clock staffing. Another amendment would require shelters to establish agreements with surrounding neighborhoods outlining expectations for resident behavior and site management. A final amendment mandates at least one manager for every 15 high-needs residents.
Still, several nonprofits urged council members to pass the bill without amendments, arguing the added restrictions could slow resources to people experiencing homelessness and further stigmatize them.
Jake had a question for city leaders: “Who do you care more about? You care more about the kids or the homeless drug addicts?”
Watch the full discussion in the video above.
Listen to “The Jake and Spike Show” weekdays from noon to 3 p.m. on KIRO Newsradio 97.3 FM. Subscribe to the podcast here.
-
Nebraska3 minutes agoInside America’s Only Federal Quarantine Unit for Hantavirus Cruise Passengers
-
Nevada9 minutes agoWhat hikers should do if they spot a rattlesnake in Nevada
-
New Hampshire15 minutes agoNewly naturalized US citizens pledge allegiance in Exeter, N.H., where revolutionaries made history – The Boston Globe
-
New Jersey21 minutes agoRock legend Steven Van Zandt celebrates New Jersey launch of Malvado Maple Mezcal at Hard Rock Atlantic City
-
New Mexico26 minutes agoFour New Mexico companies nominated for ‘Best Hot Air Balloon Ride’ by USA Today
-
North Carolina33 minutes agoNorth Carolina (NCHSAA) High School Softball 2026 State Playoff Brackets, Matchups, Schedule – May 11
-
North Dakota38 minutes agoFire burns at Pallet Green Recycling storage yard in rural Williston
-
Ohio45 minutes ago60% of Ohio children aren’t ready for kindergarten when they start; what’s the plan?