Public Health Exercise Doubles as Real-Life Service Event
By Julie Anderson
The sarcastic among us view the term “emergency preparedness” as an oxymoron; after all, can you really be prepared for an emergency? Travel on down the spectrum, and the “believers” among us, the proponents of emergency preparedness, are no doubt familiar with wise and worthy sayings such as, “To fail to plan is to plan to fail,” (attributable to Benjamin Franklin and Winston Churchill).
Texas counties have no choice but to be believers. Every county is required by law to maintain an emergency management program or participate in an inter-jurisdictional emergency management program, as stated in Section 418.102 of the Texas Government Code. Accordingly, counties across the Lone Star State conduct regular drills and tabletop exercises in an effort to train and be as prepared as possible while working continually to improve specific areas, such as communications during disaster response.
In early August, four South Texas counties – Cameron, Hidalgo, Starr and Webb – participated in a public health training endeavor designed to not only educate and prepare local partners and responders, but simultaneously provide healthcare services to thousands: Operation Lone Star.
Launched in 1999, Operation Lone Star (OLS) is an annual joint military and civilian full-scale emergency response exercise that takes place along the Texas-Mexico border.
The purpose of this collaborative effort is to practice emergency response roles while simultaneously providing free medical services to residents across South Texas, as described by John Villarreal, bilingual information specialist with the Department of State Health Services (DSHS) and public information officer for OLS.
On Aug. 4-8, five sites, known as Medical Points of Dispensing, opened their doors to provide free healthcare services.
“Approximately 300 military staff members, 200-plus state and county employees, and countless volunteers gave of their time and talents to make OLS 2014 a reality,” Villarreal reported.
The public health services, including screenings and general medical evaluations, were open to everyone, he emphasized. The only exceptions applied to certain offerings designed for children, such as vaccines or age-specific preventive dental care. No identification was required.
“Just like disasters don’t discriminate, we do not discriminate,” Villarreal declared. “During disasters, it’s all about saving lives, and that’s what we practice.”
From the Beginning
In 1997, on the heels of a rabies outbreak, clinics were set up to provide free medical services to people in Starr County. The clinics were deemed a success, and in 1998 DSHS partnered with the Catholic Church and repeated the operation in Laredo. In 1999, the project was brought to Hidalgo and Starr counties and given a name, and the 16-year journey with Operation Lone Star began.
In the summer of 1999, the Texas Department of Health (now the Department of State Health Services) partnered with the U.S. Navy, providing them an opportunity to exercise their Navy and Marine Reserve personnel to provide healthcare services in an underserved area of the state. Working with the DSHS Office of Border Health, they set up temporary clinics in local schools and designed a patient flow system. The Navy supplied medical providers and equipment. From the beginning, as it is today, health services were provided to anyone who came to the clinic sites, without concern for nationality or immigration status. In 1999, OLS operated for two weeks at three sites, and served about 3,000 clients. With additional sites established in Hidalgo and Cameron counties, the number of clients served rose to 8,000 by 2004.
In organizing the initial OLS, a key decision was made to use public schools for the clinic sites. This created strong ties between the state and military providers and the local communities. As Navy and Marine Reserve forces were deployed overseas following 9/11, they were replaced with Texas military forces, first the Army and Air National Guard and then the Texas State Guard. To expand coverage, the decision was made in 2007 to move from sites in the lower Rio Grande Valley to sites in the Laredo area between the first and second weeks of OLS.
The exercise is funded by the state and federal government and by donations of participating agencies, such as the Remote Area Medical Volunteer Corps (RAM); for example, other humanitarian groups donate surplus medical supplies to RAM, who in turn donates them to support endeavors such as OLS. There is no cost to the participating counties, taxpayers, or the patients served.
Fast Forward: Operation Lone Star 2014
The OLS 2014 partnership team included the DSHS, Cameron County Department of Health and Human Services, Hidalgo County Health and Human Services Department, the city of Laredo Health Department, the Texas Army National Guard, the Texas Air National Guard, and the Texas State Guard, along with volunteers from local agencies and support from local government and school officials, with public health as the lead. In 2012, the decision was made to conduct OLS at a number of sites concurrently during a one-week operation, thus OLS returned to a one-week format.
The 2014 sites were located in in Brownsville, Laredo, Mission (Palmview), Rio Grande City, and San Juan. Health services included diabetic screening, blood pressure screening, hearing and vision screening, and general medical evaluations for clients of all ages. Special services for children included immunizations and school/sports physicals. Dental services for adults and children were available at the Brownsville and Mission (Palmview) sites, while Rio Grande City provided preventive dental services for children, only.
OLS serves multiple purposes, Villarreal said. First and foremost, it is a massive public health emergency preparedness exercise, one of the largest in the country involving over 1,300 working participants. Emergency response techniques are practiced at all levels, and the Rio Grande Valley is prepared if and when a disaster strikes the area.
“Texas military forces, DSHS, county and city health departments, and local government officials who partner for OLS have developed networks that enable them to function effectively together,” Villarreal maintained. “That relationship is especially important should they have to respond to a natural disaster or other crisis situation.”
The Texas State Guard (especially the Medical Brigade) and the state and county health agencies have proven experience moving into a community, setting up healthcare facilities in public spaces, delivering health on a mass scale, and demobilizing and moving out—skills that have an application in a number of critical circumstances, Villarreal continued.
Second, OLS provides an opportunity for people to receive healthcare who would otherwise not have access. Last year, OLS provided 45,520 medical services to 9,829 people; throughout the past 16 years, OLS has provided health services to more than 125,000 clients.
“Finally, OLS has a significant impact on the communities it serves,” Villarreal emphasized. “Because these communities are also partners in the process, they, too, have developed skills in addressing crisis situations.”
In 2012, while looking back at OLS and how it had evolved in the past years, Dr. Brian Smith, of DSHS, identified the partnerships that OLS creates as the major accomplishment: “Most remarkable was the ability of OLS to integrate the many different organizations, people, and personalities who come together, and to focus them on the mission and implement our vision of what can be done to help the people we serve.”
Operation Lone Star: The County Connection
Cameron County, primarily through the Department of Health and Human Services Public Health Preparedness Program, took the lead in coordinating OLS services, reported Cameron County Judge Carlos H. Cascos.
“OLS is a preparedness endeavor that relies primarily on volunteer partnerships and relationships to provide the much-needed medical, dental, vision, mental health and other healthcare-type services,” Cascos shared. Cameron County maintains an interlocal agreement with Brownsville Independent School District for the provision of facilities, utilities and equipment.
“OLS provides a means to establish and maintain multi-agency and multi-jurisdictional communications while helping all people, young and old, to have access to medical care,” Cascos summarized.
Along with providing a tremendous service to the community, the preparedness exercise provides the participating partners with a mechanism to operate under the incident command structure, Cascos added.
“The knowledge gained from an OLS experience is invaluable,” he concluded.
Hidalgo County also maintains interlocal agreements with area schools that participate in the program.
When it comes to emergency preparedness, OLS has a significant impact on Hidalgo County, stated Eddie Olivarez, chief administrative officer, Hidalgo County Health and Human Services Department. For example, the exercise:
- helps staff understand the military system and organizational structure as participants work hand-in-hand with local and state representatives;
- builds the effectiveness of the working relationship with the county’s larger school districts, empowering their staff to be able to assist during a large-scale event and giving them the confidence to deal with emergency situations;
- allows the county’s local university, community college, and vocational schools an opportunity to take part in such a large-scale operation, and use this as an education and training tool from a volunteer perspective; some 800 Hidalgo County volunteers assisted during OLS; and
- facilitates training with available technology, such as regional radio communication, internet/digital communication, and satellite uplink communication.
“We learn from Operation Lone Star, and we grow from it,” Villarreal affirmed. Each year builds on the next as participants glean from both the successes and challenges of a real-time operation. In fact, the 2008 Operation Lone Star exercise continues to stand out as an example of the value of such training.
Hurricane Dolly was a tropical cyclone that made landfall in extreme southern Texas in July 2008, just a few days before the initiation of that year’s OLS.
“Texas military forces were already on the ground because OLS was about to commence,” Villarreal recalled. Half of the military stayed for OLS, and the other half participated in Operation Dolly Rescue.
“We made due with half of the staff, with the other half assisting those whose homes had become islands,” Villarreal remembered. This real-life scenario taught responders how to manage with fewer volunteers than planned.
The uniqueness of Operation Lone Star is its dual focus – an emergency preparedness exercise and a real-time public service event, Villarreal maintained.
To Commissioners Courts, the added value of an immediate benefit such as healthcare access is especially appreciated; after all, Commissioners Courts are continually striving to fulfill mandatory duties, such as emergency management, while simultaneously offering discretionary services that improve the quality of life.
“One of the biggest benefits is helping the thousands and thousands of people who will walk through our doors to obtain healthcare services at no cost to them,” Olivarez remarked. “This act benefits the community and generations to come.”
Cascos echoed this sentiment, noting that Operation Lone Star may be the only time underserved residents in Cameron County ever have access to a doctor.
At press time, Operation Lone Star was entering its fifth day of service. Preliminary numbers from the first four days are as follows: 9,269 patients seen across all sites; 41,634 total services delivered.