A national report card gave Hawaii an F grade for disaster preparedness and access to emergency care, ranking the state among the bottom 10 in the nation.

The report card, released Thursday by the American College of Emergency Physicians, said the closure of the Hawaii Medical Centers in Liliha and Ewa in 2011 hampered access to emergency care.

"A severe gap in hospital capacity impedes the state’s ability to respond to both everyday emergency care needs and potential disasters or mass casualty events," according to the 2014 report, "America’s Emergency Care Environment."

"The state has a sufficient number of emergency physicians but few emergency departments and hospitals are nearly at capacity," the report said. "Patients wait on average more than five hours in the emergency department. The problems with access to care hamper Hawaii’s ability to respond to disasters, which is troubling in a state surrounded by water."

However, access to emergency services should improve this year. Queen’s Health Systems is spending more than $70 million to reopen the shuttered Ewa hospital — and West Oahu’s only emergency room — this spring, expanding emergency and operating rooms.

The state ranked second in the nation, scoring an A grade, for its commitment to public health and injury prevention, with both low rates of chronic disease and fatal injuries. It also received a B-minus grade for quality and patient safety environment but scored a D-plus for its medical liability environment due to the lack of protections for the state’s health care workforce.

"The admirable commitment that Hawaii’s state government shows to public health needs to be shown in other areas that affect emergency patients," Dr. Jay Ishida, president of the Hawaii Chapter of ACEP, said in a news release. "Hawaii’s gaps in hospital and treatment facility capacity lead to overcrowding, long wait times and an inability to respond to disasters. The best medical care in the world won’t help you if you can’t get to it in a timely manner."

Toby Clairmont, director of emergency services for the Healthcare Association of Hawaii, said the state has taken steps to compensate for the loss of the two hospitals.

"When HMC shut down it generated an immediate crisis in ER availability," Clairmont said. "We’ve compensated for it a little bit. Hospitals have put on additional space. Private ambulance companies are being used to augment the city. EMS added a new ambulance station out in the Ewa Beach area. All of us have put more resources in trying to deal with the loss of two hospitals."