Auditing demographic bias in AI-based emergency police dispatch: a cross-lingual evaluation of eleven large language models
Authors: William Guey, Wei Zhang, Pierrick Bougault, Yi Wang, Bertan Ucar, Vitor D. de Moura, José O. Gomes
Abstract
Large language models (LLMs) are rapidly being integrated into high-stakes public safety systems, including emergency call triage and dispatch decision support, yet their demographic fairness in this context remains largely untested. Here we introduce a cross-lingual audit framework that operationalizes the Police Priority Dispatch System as a five-level ordinal classification task and applies a controlled minimal-pair design to isolate the effect of demographic cues. Across 19,800 model outputs spanning 11 frontier models, 15 scenario pairs, three demographic categories (religious appearance, gender, and race), and two languages (English and Mandarin Chinese), we find that demographic bias emerges systematically when incident severity is ambiguous but largely disappears when the operational priority is clearly determined by call content. Bias magnitude varies by demographic axis, with the largest effects observed for religious appearance, followed by gender and race. Critically, bias does not transfer consistently across languages: gender bias is substantially amplified in Mandarin Chinese, whereas race bias is more pronounced in English, revealing cross-lingual asymmetries that aggregate analyses obscure. In several scenarios, demographic cues produce counter-directional effects, challenging simple stereotype-amplification accounts of model behavior. These findings suggest that bias in LLM-based dispatch is not a fixed property of models alone, but arises from the interaction between demographic signals, contextual ambiguity, and language. Beyond these empirical results, the proposed framework provides a scalable audit infrastructure that enables deploying agencies to evaluate candidate models on jurisdiction-relevant scenarios prior to real-world adoption.
Emergency department triage assigns patients an acuity score that determines treatment priority, and clinical evidence documents persistent gender disparities in human acuity assessment. As hospitals pilot large language models (LLMs) as triage decision support, a critical question is whether these models reproduce or mitigate known biases. We present EQUITRIAGE, a fairness audit of LLM-based ESI assignment evaluating five models (Gemini-3-Flash, Nemotron-3-Super, DeepSeek-V3.1, Mistral-Small-3.2, GPT-4.1-Nano) across 374,275 evaluations on 18,714 MIMIC-IV-ED vignettes under four prompt strategies. Of 9,368 originals, 9,346 are paired with a gender-swapped counterfactual. All five models produced flip rates above a pre-registered 5% threshold (9.9% to 43.8%). Two showed directional female undertriage (DeepSeek F/M 2.15:1, Gemini 1.34:1); two were near-parity; one had high sensitivity with weak male-direction asymmetry. DeepSeek's directional bias coexisted with a low outcome-linked calibration gap (0.013 against MIMIC-IV admission), a Chouldechova-style dissociation between within-group calibration and between-pair counterfactual invariance. Demographic blinding reduced Gemini's flip rate to 0.5%; an age-preserving blind variant left DeepSeek with residual F/M 1.25, implicating age as a residual channel. Chain-of-thought prompting degraded accuracy for all five models. A two-model ablation reveals opposite underlying mechanisms for the same directional phenotype: in Gemini the signal is emergent in the combined name+gender swap, while in DeepSeek the gender token alone carries it. EQUITRIAGE shows that group parity, counterfactual invariance, and gender calibration are distinct fairness properties, that intervention effectiveness is model-dependent, and that per-model counterfactual auditing should precede clinical deployment.
Prior benchmarking work has shown that a single large language model (LLM), forced to make life-or-death resource-allocation decisions, exhibits measurable demographic bias. Real deployments, however, rarely use a single agent: they use pipelines, with review steps meant to catch exactly this kind of failure. We study what happens to bias when the same decision is distributed across a role-differentiated multi-agent pipeline (assessment, allocation, independent audit) instead of made and checked by one model alone. Using a synthetic disaster-triage simulator with paired cases that are clinically identical except for one demographic attribute, we run 192 episodes (2,304 resolved case pairs) on GPT-4o-mini comparing a single-agent control condition to a nine-agent pipeline under three independently varied pressure dimensions. We find no measurable difference in how often biased outcomes occur between the two conditions (6.9% vs. 6.1%, p = 0.498). We do find a large and significant effect of audit capacity on whether bias is caught: 30.0% of biased outcomes go entirely undetected, rising to 43.8% when the auditor is overloaded and falling to 18.4% when it is not. Decomposing this effect shows it is driven almost entirely by coverage (whether a case is reviewed at all, which collapses from 100.0% to 65.6% under load, p < 0.001) rather than by degraded judgment on the cases that are reviewed (81.6% vs. 85.7%, p = 1.000, direction reversed). A follow-up experiment shows that reordering the audit queue by estimated risk, rather than first-come-first-served, recovers most of the lost coverage under the same capacity constraint (65.6% to 91.7%, p = 0.028). We discuss the implications for any system that adds independent oversight to an LLM agent pipeline under resource constraints, and report the study's limitations honestly: one model, modest sample sizes, and no adversarial replication.
As state-of-the-art Large Language Models (LLMs) have become ubiquitous, ensuring equitable performance across diverse demographics is critical. However, it remains unclear whether these disparities arise from the explicitly stated identity itself or from the way identity is signaled. In real-world interactions, users' identity is often conveyed implicitly through a complex combination of various socio-linguistic factors. This study disentangles these signals by employing a factorial design with over 24,000 responses from two open-weight LLMs (Gemma-3-12B and Qwen-3-VL-8B), comparing prompts with explicitly announced user profiles against implicit dialect signals (e.g., AAVE, Singlish) across various sensitive domains. Our results uncover a unique paradox in LLM safety where users achieve better'' performance by sounding like a demographic than by stating they belong to it. Explicit identity prompts activate aggressive safety filters, increasing refusal rates and reducing semantic similarity compared to our reference text for Black users. In contrast, implicit dialect cues trigger a powerful dialect jailbreak,'' reducing refusal probability to near zero while simultaneously achieving a greater level of semantic similarity to the reference texts compared to Standard American English prompts. However, this dialect jailbreak'' introduces a critical safety trade-off regarding content sanitization. We find that current safety alignment techniques are brittle and over-indexed on explicit keywords, creating a bifurcated user experience where standard'' users receive cautious, sanitized information while dialect speakers navigate a less sanitized, more raw, and potentially a more hostile information landscape and highlights a fundamental tension in alignment--between equitable and linguistic diversity--and underscores the need for safety mechanisms that generalize beyond explicit cues.