Hawaii health officials preparing for the worst

Hawaii is well prepared for most disasters but likely is ill prepared for a catastrophic global disaster, says Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii.

He said the state would "do OK" in an influenza pandemic, "but not what we feel we need to do. We just don't have resources. The money is shrinking every year, but expectations of us are growing every year."

Hospitals received $1.7 million out of $2.2 million allocated in federal money this year through the state Health Department for Hawaii's hospital preparedness program, Clairmont said. No state or county money is provided for the emergency management program, he added.

The Health Department kept some money for alternate care sites, recruitment and materials for Medical Reserve Corps volunteers, said Dr. Paul Effler, state epidemiologist. "The goal is having it all integrated with HAH."

Clairmont said emergency equipment, supplies, portable hospital systems and disaster training have been expanded. "We've managed to capitalize on federal money, and the hospitals did $1.5 million in in-kind contributions to train people.

"We expect to double hospital capacity in a pandemic," he said. "It would be astronomical, unprecedented in recent history."

He said protective equipment, such as masks, booties, gloves and gowns, has been stocked for 50,000 health care workers because of a lesson learned during the 2003 SARS (severe acute respiratory syndrome) epidemic.

"Folks from Asia bought out all the supplies on this island and shipped them to Hong Kong," he said. "We made a decision that we have to ensure the safety of health care workers. If they don't come to work, we're in a lot of trouble."

Hawaii ranked among the top states in preparedness to respond to public health emergencies in a recent study by the research group Trust for America's Health.

Supplies and equipment have been accumulated gradually and stored in hospitals, in caches throughout the state and in the program's operations center on Oahu, Clairmont said.

Six response trailer systems with portable hospitals have been located across the islands.

The oct. 15, 2006 earthquake showed "even the most reliable communication systems didn't function," so satellite communication systems are being installed in the hospitals, Clairmont said.

Effler said the state has stockpiled enough antiviral medicine to treat one-fourth of the population.

The school vaccination program to protect children from seasonal flu has ben run as an "incident command setting" to practice giving massive vaccinations as if they were being done in shelters for influenza, he said.

Community-based mitigation efforts also are planned, Effler said, noting reports about the 1918 Spanish flu pandemic that showed cities that acted sooner and aggressively tended to have lower infection rates.

"What we need to work toward is, shy of a statewide emergency, being able to have interventions followed by private and public groups across the state, schools and businesses."

For instance, Effler said, the Health Department wants a liberal policy on work leave so people can stay home if a family member is ill.

The department also is working on a plan to determine how to screen passengers when they arrive from overseas, what resources are needed and how effective or disruptive screening would be, he said.

Passengers can transmit influenza before they arrive from abroad, Effler said. "We don't look at screening as a wall to keep it out, but more of a way to pick up early cases for appropriate isolation while we buy time in a pandemic to get vaccinations out and antiviral dispersals."

Clairmont also is developing multilateral disaster exchanges with other countries. He visited Indonesia, Malaysia and China with the Pacific Command during the past year.