Taking it to the streets

It's a Monday morning and at the back of Caesars Palace, where chugging semis dock and unload their cargo, workers are making their way back and forth to an employee entrance, some just starting their day, others right in the midst of it. They wear everything from fresh, white waitress aprons to blue, button-down maintenance shirts already powdered with the day's work dust.

As they make their way between a parking structure and the back entrance, the stream of workers passes a tiny 10-by-24-foot trailer with an A-frame sign out front advertising teeth cleanings for walk-in dental patients.

Inside, two office workers for a local company called On-Site Dental sit face-to-face at a small desk and work off portable computers; four chairs lining the paneled walls just feet away could easily compete for the title of world's smallest waiting room.

At one point, an employee steps inside and is immediately whisked out the door to another, much larger trailer, and within minutes she is sitting in a dental chair. No long waits, no fighting traffic, and barely a ripple in terms of the work she will miss on this Monday.

Welcome to the world of mobile and on-site health care.

While a visit to the doctor can mean a long commute from home or work, not to mention an unpredictable amount of time in the waiting room, some businesses and nonprofits in the Las Vegas Valley are taking the show on the road, so to speak.

Mobile units and on-site clinics in the greater Las Vegas area are offering medical services that include dental checkups, hearing tests, immunizations and mammograms. In some cases it can be a government-subsidized clinic set up in, perhaps, a community center or local church, and in other cases in can mean giant semitrailers retrofitted with some of the latest in transportable, high-tech medical equipment.

On-Site Dental provides dental care in a 53-foot semitrailer with five exam rooms, a sterilization room and an area set aside for digital panoramic X-rays. The sleek, white interior looks like something out of a futuristic movie with smoke-colored plexiglass sliding doors; rows of small, recessed ceiling lights; and flat-screen TVs above the patients' chairs.

The dental equipment is what you would find in a modern free-standing dental office and patients can receive most of the same services including cleanings, fillings, crowns and fittings for dentures, according to Aaron Gubler, the dentist who runs the mobile clinic along with a staff of hygienists.

The semitrailer is equipped with water tanks and is powered by hooking up to on-site power.

Most of On-Site Dental's clients are casinos including Caesars, the Rio, Bally's, Mandalay Bay and the Mirage, and about 100 patients are seen each week. Gubler notes that his patients appreciate the convenience of the clinic, and since coming on in October he has seen an increase in patient numbers.

And once they get used to the idea that the clinic is sitting in a parking lot but "is actually safe, beautiful and clean," they are very receptive, notes Carleen Sadewasser, owner of Health Management Solutions, the company that manages the mobile clinic.

Another company offering mobile health services in the Las Vegas area is Concentra, which is based out of Texas. The company has been serving the Las Vegas Valley since 2006, mostly through medical screenings related to occupational safety requirements.

The company serves 16 clients in the greater Las Vegas area. Many of them are casinos that are required to regularly test their employees' hearing due to working around noisy slots or the machines used in casino count rooms, according to Sam Tishler, assistant vice president of operations for Concentra mobile services.

Even entertainers hired by the casinos may fall under the requirements. Tishler notes that members of the Blue Man Group have been clients.

Concentra has a total of eight mobile units and two of them are used to serve businesses locally. One is about the size of a U-Haul and outfitted with audio booths to test hearing. The other is a 53-foot semitrailer set up like a medical clinic including exam rooms and equipment that allows workers to receive screenings such as pulmonary function tests, X-rays and EKG's, Tishler said.

The semitrailer also has multiperson audio booths that allow the testing of as many as 300 employees in one day, while about 32 physicals can be performed at the clinic on a typical day, he said. Because of the 24-hour nature of Las Vegas, Concentra offers health services during both daytime and nighttime shifts, Tishler added.

The clinics are staffed with physicians, medical assistants and trained emergency medical technicians depending on the services needed on any given day; even the driver is required to have a medical background.

A typical visit by an employee to the clinic will usually take about 20 minutes, a far cry from having to drive to a free-standing clinic that may serve 150 to 200 workers a day for a range of issues, Tishler noted.

Of course, the on-site convenience also benefits the employers who don't have to pay for lost work hours.

"So when you pull four people off that line ... they don't have very far to travel because we're right in the parking lot," Tishler said.

A nonprofit mobile clinic called the Mammovan has been providing a convenient way for local women to receive mammograms since 2000. The Nevada Health Centers project is funded by donations from organizations such as Susan G. Komen for the Cure of Southern Nevada, Food 4 Less grocery stores, the National Breast Cancer Foundation and the David and Linda Shaheen Foundation, according to Blanca Ayala, community outreach coordinator for the Mammovan.

The project has partnered with Caesars Entertainment Corp., MGM Resorts International and also serves the Palms, Stations Casinos Inc. and International Gaming Technology. It also reaches women throughout the community by setting up in the parking lots of churches, senior centers, grocery stores and community centers, Ayala said.

The statewide program provides mammograms for about 3,500 women a year and since 2000 has diagnosed 95 cases of breast cancer, Ayala said.

"Early detection is the best prevention in any kind of disease, so we're hoping we can diagnose at the early stages so women can get treatment ... It's to save women and to save lives," Ayala said.

The Mammovan, which is actually a semitrailer outfitted with one mammography machine, is serving about 30 percent more women than a few years ago because of the recession, she added. Many of the women she has talked to have lost their jobs so in some cases it is the only affordable way to get a mammogram.

The service used to be free, but now clients are required to pay a sliding-scale fee that can range from $40 to about $200. Someone living below the poverty level at a certain percentage, however, does not have to pay. That would include, for example, a family of five with an income of less than $39,000 a year, Ayala said.

On a typical day, the Mammovan will serve about 25 women and the test usually takes only 15 minutes, she said.

If it wasn't for the six mobile units that allow United Blood Services of Las Vegas to conduct its community blood drives, the valley would be seriously underserved, according to United Blood Services, Las Vegas, spokesman Darren Hankel.

The nonprofit community blood center works with 1,600 sponsor groups -- including high schools, colleges, hospitals, churches, and businesses -- to conduct about 120 blood drives a month throughout the valley, he said. The amount of blood units collected at the drives ranges from about 15 to 200.

In many cases, United Blood Services will set up its drives inside a host site such as a business. But if there is no room available, the mobile units come into play.

The six Bluebird busses include donor beds, interview booths where donors are asked questions about their medical history, a recovery area and small canteen.

Whether set up inside a building or in a bus, the nonprofit will sometimes begin a blood drive as early as 6 a.m. and end as late as 9 p.m. in order to accommodate nighttime work shifts, according to Jim Tueller, United Blood Services, Las Vegas, human resources director.

A blood drive, he added, will be staffed with anywhere from three to 40 employees depending on the size of the event.

As part of the process to determine if someone can give blood, there is a mini health screening that includes a blood pressure check and cholesterol screenings, the results of which can be checked online two days later, Hankel noted.

Another nonprofit that reaches out to the community with mobile clinics, although only occasionally, is the Southern Nevada Health District. While most of its outreach immunization clinics are held inside host sites, such as child care centers and area middle schools, a few times a year the district uses vans from the local Office of Public Health Preparedness to host clinics at places such as Lorenzi Park, according to Veronica Morata-Nichols, Southern Nevada Health District's Immunization Department manager.

But whether a clinic is inside a van or a building, taking the services to the community is vital, Morata-Nichols said. In 2007, Nevada was ranked last in the nation for its immunization rate. Part of the reason was that the state was doing a poor job of keeping a registry of immunized children, which has since been addressed.

The district also has been expanding its outreach services, providing free immunizations to 90 to 100 child care centers a year, for example, that have low immunization rates. And last year it reached about 30 percent of the total population of middle school students.

"One vaccine-preventable disease is one too many. It should never happen at all," Morata-Nichols said.