South Carolina tied for first place in a nationwide ranking of state health emergency preparedness that gave the federal government a D+ overall.

The Palmetto State scored eight out of 10 points in key indicators of readiness, such as labs able to test for anthrax or plague and plans to care for patients outside of hospitals in the event of a widespread outbreak.

Only Delaware and Virginia scored as high in the report entitled "Ready or Not" from The Trust for America's Health.

"South Carolina is one of the leaders in the country," said Shelley A. Hearne, executive director of the Trust. "And that's good news for its citizens."

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The Trust, a nonprofit, nonpartisan group dedicated to improving public health, began the annual analysis after 9-11 and the anthrax attacks to gauge the country's preparedness for a public health emergency because there is no national standard to measure what has been done with taxpayer money, she said.

"After 9-11 and the anthrax attacks, it was clear that our public health systems were not prepared for a major bioterrorism event," Hearne said. "And SARS and Katrina, and now the potential of an avian flu pandemic, have made it even clearer that those frontline defenses are even more critical."

Those events brought public health to the forefront after decades of neglect, prompting investment in the system, said Dr. Bill Kelly, an infectious disease specialist with Greenville Hospital System.

"A lot of people around the state have worked very hard in the last four years and done things that really mattered," he said. "We've done something right."

South Carolina hit the mark because it made public health a priority, by stocking and staffing labs, modernizing disease tracking systems, and beefing up hospital preparedness, Hearne said.

In only two states, she said, do the majority of hospitals have provisions to ensure that workers show up in the event of a major outbreak.

"We need to encourage this by taking care of the families and health of front-line workers," she said.

"It's nice to feel we're making progress and that it's recognized," said Dr. Max Learner, director of public health preparedness for the state Department of Health and Environmental Control. "But we can always be better prepared."

Over the past few years, he said, the state has used federal grants to train and equip public health and hospitals to respond to all kinds of disasters, and partners have worked together to improve their emergency plans. For instance, Learner said, DHEC has improved its labs to better respond to outbreaks and potential epidemics, such as pandemic flu.

The Trust also asked 20 top public health emergency experts to rate the federal government's preparedness, and they gave it a grade of D+, Hearne said. They cited a lack of leadership and coordination between programs such as Homeland Security and the U.S. Centers for Disease Control and Prevention, she said.

"There's no clear game plan in place to direct states on preparedness," she said. "We've got a lot of different moving pieces, and we need to strengthen and clarify the leadership in this country."

Hearne added that the country has invested nearly $4 billion for in the past few years for public health, but at the same time states are cutting budgets and asking public health officials to do more with less.

While the Palmetto State's showing was impressive, Hearne said, it's not the end of the story.