Hawai'i is moving ahead of the flock in terms of preparing for a pandemic, but the state's geography makes it susceptible to unique problems if bird flu or another virulent, rapidly-spreading illness strikes here, experts said yesterday at the Hawai'i Pandemic Influenza Readiness Conference.

Vice Admiral Richard Carmona, U.S. surgeon general, spoke at the conference and stressed that awareness and preparation — not only by government and medical officials but also among business people and citizens in general — are essential.

The conference was held at the Sheraton Moana Surfrider hotel.

To prepare for a pandemic —as well as terrorism, hurricanes and other threats — Carmona called for the return of an attitude prevalent during the early stages of the Cold War.

"Each and every citizen needs to understand that they have a role in preventing and responding to and mitigating any and all challenges," he said. "A civil defense mentality needs to return, only much more complex today, much more complex in its threats and its responses."

Carmona and other top health officials have been traveling across the country, working with state and local officials to coordinate nationwide plans to combat flu pandemics.

Gov. Linda Lingle, who talked about how Hawai'i's plan has been lauded by national media for being at the forefront of national pandemic preparation, said she was pleased to have Carmona in Hawai'i as state legislators are considering a $15 million appropriation for stockpiling enough of the antiviral medications Tamiflu and Relenza to help mitigate flu symptoms in 25 percent of the state's population.

Carmona said that although each state must address its specific concerns, the ability to coordinate and assist other states is important.

Dr. John Murray, chief of Emergency Medicine at Kaiser and the physician representative for the emergency preparedness committee of the Health Care Association of Hawai'i, said that concept is problematic for Hawai'i, because the wait for assistance from the Mainland would be too long.

At least in the beginning, he said, Hawai'i will have to take care of its own, a tricky proposition since hospitals in the state generally operate at 80 percent to 90 percent capacity on any given day, leaving far too few beds available for those who become ill as a result of the pandemic.

To further complicate the issue, fewer doctors and nurses are likely to be available to tend to the patients because hospitals are expected to be hit at the same rate as the general population, with 25 percent to 30 percent of the staff incapacitated by the illness.

State health providers are compensating by stockpiling equipment — to the point where storage space has become dear, he said, and by creating a registry of retired doctors and nurses.

Civilian versions of MASH units are being formed to set up emergency tent hospitals, he said, and hotels are being considered for emergency hospital space.

Reach Karen Blakeman at kblakeman@honoluluadvertiser.com.