The Massachucetts Institute of Technology study points to New York, Los Angeles and Honolulu as the three top airports as the most likely places to spread an infectious diseases in the early days of a pandemic.
"It can come out of nowhere, and can occur quickly and affect lots of people," said Toby Clairmont, Hawaii Healthcare Association Emergency Services Director
The first two airports on the list are the largest and busiest in the country.
Location, layover times, and connectivity push Hawaii up on the list.
The days of swine flu and SARS forced the world to take stock of how well we could respond to a deadly outbreak.
"SARS was a wake-up call. It was lethal. It killed people. It certainly got everyone's attention." said Clairmont.
Four years ago a joint drill with the Centers for Disease Control, state civil defense and Hawaii’s hospitals tested our response.
"We talked about an airline coming into Honolulu with an infected casualty. We set up a clinic down at the airport and transported some of the patients to the hospitals. I think we demonstrated in concept that everything works," said Clairmont.
Last year’s gathering of world leaders for an economic conference helped the state.
The recent military war games and disaster drills were good practice for the state's first responders and hospitals.
The Healthcare Association recently purchased a bio-contaiment chamber. It’s believed to be the only one in the Pacific.
It is a necessary tool to isolate and quarantine potential carriers of the next deadly outbreak.
The chamber was used once on a suspected swine flu case from Christmas Island, which turned out to be negative.
Clairmont said the state is due for another review of it’s emergency preparedness in September.
"We go through a scenario. So it’s time to refresh our plans to take a look and see if anything is changed,
Honolulu's number three ranking in this latest model doesn’t surprise Clairmont.
"I am not surprised. A lot of people transit through Hawaii. Do we dwell on that, or do we prepare? I think we should prepare," Clairmont said.