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An annual report on emergency preparedness capabilities of the 50 states puts Montana in a category by itself: meeting fewer of the preparedness indicators the report examined than any other state.

“Ready or Not? Protecting the Public’s Health from Disease, Disaster and Bioterrorism,” presents a snapshot of state public health preparedness by examining 10 indicators of readiness. No state scored a perfect 10, but eight states including North Dakota scored 9; 35 states scored between 6 and 8 points, six states scored 5 points. Montana with 3 points was the only state to score fewer than 5.

The Trust for America’s Health in collaboration with Robert Wood Johnson Foundation created this annual emergency report card several years ago to call attention to the continuing challenges of protecting the U.S. population from “all hazards.” In Montana, that means being prepared to deal with the public health effects of floods, wildfires, explosions, contagious and foodborne illnesses as well as the possibility of terrorist attacks with chemicals or biological agents. A low score on the report doesn’t mean that Montana’s public health system is failing, but shows there’s room for improvement.

For example, Montana doesn’t have enough staff at the state public health lab to sustain 12-hour work days, five days a week for several weeks. In an extreme emergency— an influenza pandemic — the lab wouldn’t be able to keep up with testing. Thirty-seven other states can meet that standard.

However, Montana’s public health lab was able to meet the demand for extra tests during this fall’s epidemic of H1N1 influenza, said Jim Murphy, head of the state Communicable Disease Control and Prevention Bureau in Helena. Murphy acknowledged that the lab staffing isn’t “ideal”, but said it’s difficult to recruit qualified public health lab workers.

All states could get some help in that department if Congress passes health care reform legislation. Both the House and Senate bills propose measures for bolstering the public health work force.

Montana was counted among 27 states that decreased their public health preparedness funding between 2008 and 2009. Murphy said the 5 percent decrease last year followed a 47 percent increase the previous year. However, most of the money Montana spends on public health comes from the federal government, not from taxes the state collects. Federal funding for emergency preparedness also has been decreasing for the past few years to all states.

There is one indicator that Montana can improve on without spending more money: enacting liability protection for businesses and nonprofit organizations when they volunteer aid in a disaster. Earlier this year, a law enacted by the 2009 Legislature took effect to shield health care professionals from liability when they volunteer to assist disaster victims. But the law here just covers people, not entities, such as hospitals.

The health care volunteer liability law should help facilitate action on another state preparedness deficiency. Montana doesn’t have an organized medical corps to call upon in major emergencies, although 41 other states met the Trust for America’s Health medical reserve corps readiness criteria. Murphy said the medical reserve corps are organized on a local level in Montana with little state involvement.

Two other points in the readiness report are under study by Montana health officials, Murphy said.

• Requiring all licensed daycare facilities to have a multihazard, written evacuation and relocation plan.

• More extensive testing of foodborne illness outbreaks.

Public health is the first line of defense in an emergency that threatens the population of a neighborhood, city, state or the entire nation. Maintaining this defense requires a continuing commitment of government support and public scrutiny. Most of us don’t think about public health until there’s an emergency. “Ready or Not” is a timely reminder that government leaders and ordinary citizens must think about disaster before it strikes.