A recent assessment of public health emergency readiness among states finds Hawai'i has made significant strides in protecting its population, but a nursing shortage and the availability of hospital beds remain concerns.

The Trust for America's Health last month released a 2006 report card on disaster readiness showing Hawai'i does well in seven of 10 categories.

Hawai'i and 10 other states are in the middle of the pack nationally when it comes to disaster, disease and bioterrorism readiness.

The state earned credit for year-round monitoring of influenza and other diseases, having enough available lab scientists, and maintaining funding for public health programs and services. The state also was lauded for its high level of vaccinated residents older than 65.

However, the report criticized Hawai'i for having too few hospital beds and nurses, and for an inability to quickly distribute vaccines, antidotes and medical supplies.

"Hawai'i had a better score this year because of improvement in our state laboratory's ability to test for biological and chemical threats," said Janice Okubo, spokeswoman for the Department of Health. "The Department of Health is constantly improving its ability to respond to a health crisis, by working closely with our partners in the private and public sectors.

"As for the nursing shortage, that is a challenge being faced nationwide. Emergency preparedness is an evolving and ongoing process, and while we may not be perfect, Hawai'i is in a better position to respond to a crisis because of good working relationships with our healthcare and emergency response communities."

Hawai'i should have received a higher score, Okubo said.

The report says Hawai'i received a Strategic National Stockpile amber rating from the U.S. Centers for Disease Control and Prevention, but she said the state actually received a green rating at the last evaluation. Another point should have been awarded to the state, bringing its score to eight, she said.

The trust identifies itself as a "nonprofit, nonpartisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority."

A representative from the trust could not be reached for comment about the disputed point.

RECRUITING EFFORT

The state has been working with the University of Hawai'i to better recruit and train nursing candidates, said Okubo, and is collaborating with the Hospital Association of Hawai'i on recruiting and building a Medical Reserve Corps of volunteer clinicians that could assist during a crisis. The corps consists of practicing, nonpracticing and retired healthcare professionals, she said.

The hospital association also has the ability to set up mobile clinics to add bed capacity and is working with the state on that issue as well. After October's earthquakes, a mobile "hospital" was set up on the Big Island to handle possible situations.

At The Queen's Medical Center, there is an average of 25 to 50 beds available on any given day.

Queen's works with the state and other hospitals to prepare for a crisis in which more hospital beds are needed, said Gary Dias, the hospital's director of security, who also heads its emergency preparedness efforts.

The hospital routinely reviews its practices to determine who could be discharged or moved out of beds in a crisis.

"We feel very strongly that we're prepared here at Queen's for disasters in general, including hurricanes and an influenza outbreak," Dias said. "Our emergency disaster plan covers everything from hurricanes to bioterrorism, and as far as biological terrorism or influenza, we look at it from the standpoint of how many people can we accommodate at the hospital.

"We have a report every day on actual bed availability. Our disaster plan provides for the ability to add to those numbers."

FATAL SCENARIOS

Aside from a hurricane or tsunami, the public health disaster most worrisome to first responders is an influenza or disease outbreak.

According to the report, Ha-wai'i's hospital beds would be at 72 percent capacity within two weeks of a "mild pandemic" flu like the one that swept the nation in 1968. A "moderate" pandemic would put the state at 143 percent capacity, well over what would be needed, the report states.

A bioterrorism attack, such as the malicious distribution of disease- or illness-causing agents, could be difficult to detect, say first responders responsible for handling such a situation.

"We recognize, especially since 9/11, that we lacked field detection ability when it comes to bioterrorism and radiological threats," said Honolulu Fire Department Capt. Carter Davis of the hazardous materials unit. "What we've done in the last six years is improve the training of our personnel by attending national courses around the country related to terrorism and public health disasters."

Practicing disaster response, like an exercise in August at Aloha Stadium, is the only way to keep vigilant, said Davis.

"The more we get together and play the game before the game actually happens, the better off we will be."

Reach Peter Boylan at pboylan@honoluluadvertiser.com.