PORTLAND — Fifteen years ago, a Portland fire paramedic and Multnomah County’s emergency medical director headed to New Orleans during Hurricane Katrina as part of a FEMA disaster response team and helped run a makeshift medical triage station at the airport.
The two learned a lot about what not to do — and now are using that knowledge to help prevent hospital emergency departments in Oregon from being overwhelmed with a surge of COVID-19 patients amid the coronavirus pandemic.
Portland Fire Lt. Rich Chatman and Multnomah County’s Dr. Jonathan Jui, with the help of a tech expert, contacted the creators of an online self-diagnosis site, c19check.com, and convinced them to tailor the free global tool for Oregon.
The basic tool directs people with the most extreme symptoms to hospital emergency rooms, those with more moderate symptoms to clinics, and advises people with minor symptoms to stay home.
But a new one that Portland officials pushed for goes a step further to allow public health officials to track the cases, providing the first state-focused online triage tool for the pandemic.
So far, the city of Portland, Multnomah, Clackamas and Washington counties have signed on to what’s being rolled out as c19oregon.com.
These initial counties each will pay $3,300 a month for the tool. It also will be available to other area counties at monthly fees that range from $1,500 to $5,000, depending on their population.
The developers from Atlanta-based Vital Software, working with Portland native and tech consultant Benjamin Diggles, said they hope to replicate the Oregon model across the country.
Local emergency medical workers will be able to direct users, based on their ZIP codes, to specific hospitals or clinics in real time so ERs don’t get overrun with patients. Further, developers are in discussions with Oregon Health & Science University Hospital to allow people still unsure of how to evaluate their moderate symptoms to call a hospital-run nurse triage phone line.
In turn, the local emergency medical and public health managers will be able to trace, solely by ZIP code and age, who’s reporting severe symptoms to try to identify clusters or areas where the virus has spread and determine where more resources may be needed before a hospital is inundated with patients.
“I think it’s very forward-looking of Oregon to do this, and to do this now before Portland becomes New York," said Aaron Patzer, one of the founders of Vital Software. “Let’s hope that doesn’t happen and maybe this can help avoid that.’’
Patzer previously founded the financial management tool mint.com. He got involved in online health care after visiting his brother-in-law, Dr. Justin Schrager, an emergency room doctor at Emory University Hospital, and noticed how long it took Schrager to enter his medical notes online through old Windows 98 software.
Last month, Vital partnered with other physicians at Emory’s School of Medicine and the Emory Office of Critical Event Preparedness and Response to create the worldwide tool.
“This is a concept called forward triage,’’ said Schrager, also a Vital Software co-founder and an assistant professor of emergency medicine.
“Instead of waiting until patients crowd into the emergency department and you have to figure out who to treat first, this idea enables people in the community to effectively triage themselves safely.’’
Message that’s going to make a difference
When Chatman and Jui arrived in New Orleans in 2005 during the hurricane, they were horrified to see the crush of patients with a wide range and severity of injuries in the medical center at the airport.
The team of medical workers from Oregon spent the night in sleeping bags and cots at Baggage Carousel No. 5.
There weren’t enough people to staff the stopgap center. Medical supplies were sorely lacking. And emergency medics wasted too much time trying to distinguish truly sick people from those who didn’t have major illnesses or injuries and the so-called “worried well,’’ Chatman and Jui said.
So when coronavirus broke out in Oregon with the first case Feb. 28 and Gov. Kate Brown last month declared a state of emergency, Chatman called Jui from his third-floor office at Portland Fire Station One off Southwest Ash Street to brainstorm.
“What message can we get out to the public that’s going to make a difference,” Chatman said he asked Jui.
They agreed that hospitals would need to focus on only the sickest of the patients.
Chatman reached out to Diggles, a tech-savvy friend of his from Portland, to see how a message could be widely shared with the public.
Diggles initially considered a text-messaging platform, but then found online triage tools, including the one designed by Vital and Emory University doctors.
The global c19check.com site went online March 20 and has had 500,000 users.
The easy-to-use system helps people understand their risks of contracting the disease and guides them on what they should do, based on information from the World Health Organization and the U.S. Centers for Disease Control and Prevention.
Diggles worked with Vital Software to customize it for emergency workers managing the outbreak. Each county’s monthly fees will be paid to Vital Software.
“This gives emergency response people a little bit of foresight,’’ said Nate Fletcher, operations director at Vital Software.
With a few clicks on the website, people enter their age, ZIP code, symptoms and if they have any pre-existing health conditions. The tool will tell them if they are at low risk (green), medium risk (yellow) or high risk (red) for the coronavirus.
If emergency workers spot a growing number of users in a particular area reporting symptoms that place them in the red, or high-risk, category, they can warn area hospitals and doctors. They’ll also be able to recommend to users which hospitals have space or steer those with more moderate symptoms to an urgent care center instead.
Emergency workers will be able to view all the site’s emerging data.
“That’ll tell us how many people may be coming to the hospital,’’ Chatman said. “It’ll give us a data point that we never have.’’
The site is available to users in 15 different languages so underrepresented populations have access. It is also accessible by smartphone, which may be more feasible for use by the homeless population.
Chatman, two other Portland Fire staff members and a member of Portland Fire Commissioner JoAnn Hardesty’s office will be able to monitor the data from the site for the three metro counties.
While the state site now directs users to county website pages for resources and other information, Chatman and his staff plan to update it soon with more details on specific urgent care centers, their hours of operation based on ZIP codes and additional phone resources. The Portland staff will receive email notifications every time a user is identified as high-risk or critical.
Relieve 9-1-1 dispatch and hospitals
Oregon’s hospitals aren’t filled to capacity now. The governor’s stay-at-home order and social distancing has helped, Jui and Chatman said.
According to the latest model, the state is expected to reach its peak of cases around April 24 or 25, Jui said.
Currently, emergency medical and public health staff can find out the number of COVID-19 patients admitted into each hospital and the number of people who have tested positive for the disease through a state tracking tool.
But the website tool will provide additional geographical information and help match a patient’s needs to the right resources so they can get the help they need without overwhelming the medical care system, Chatman and Jui said. To participate, people must sign onto the site and enter their symptoms.
“You’ll actually see the communities impacted by COVID-19, by the total number and acuity,” Jui said. “It gives you a 100,000-foot view of the impact and the severity of the epidemic on the community.”
Multnomah County Health Director Dr. Jennifer Vines is working to convince other counties to participate. Chatman said he and others will consider how the information gathered can be shared with the public and media at some point.
“We realize it’s useful and important to people what’s happening in our communities,’’ he said.
Diggles, a co-founder of a cybersecurity data company called Constellation who has volunteered his work on this tool’s development, said he’s obtained claims to all other potential C19(state name) internet domains as he envisions offering state-tailored sites similar to Oregon’s around the country.
This will create a filter to relieve 911 call centers and hospitals, Diggles said, but also create a fast lane for those in immediate medical emergencies to get expedited help.
“We’re kind of writing the script on this,” Chatman said.