Overall Results: C- The results of the 2009 Report Card present a picture of an emergency care system fraught with significant challenges and under more stress than ever before. The overall grade for the nation across all five categories is a C-. This low grade is particularly reflective of the poor score in Access to Emergency Care (D-). Because of its direct impact on emergency services and capacity for patient care, this category of indicators accounts for 30 percent of the Report Card grade, so the poor score is especially relevant. This category also incorporates many of the issues that states have identified as their top areas of concern.24 These include:
- Boarding of patients in emergency departments and hospital crowding
- Lack of adequate access to on-call specialists
- Limited access to primary care services
- Shortages of emergency physicians and nurses
- Ambulance diversion
- Inadequate reimbursement from public and private insurers
- High rates of uninsured individuals
The grades for the other categories are slightly better, but not strong enough to pull up the full national average. Both Disaster Preparedness and Quality and Patient Safety Environmentreceive a C+, Public Health and Injury Prevention receives a grade of C, and the Medical Liability Environment receives a grade of C-.
| Top ranked states|
(highest to lowest)
| Bottom ranked states|
(lowest to highest)
| 1. Massachusetts|
2. District of Columbia
2. Rhode Island
10. North Dakota
| 51. Arkansas|
49. New Mexico
The overwhelming effects of Hurricane Katrina on the medical infrastructure and emergency medical response capacity of an entire region highlighted our nation’s vulnerability to major disasters. However, federal funding in this area has been lacking. For example, only 4 percent of funding from the Department of Homeland Security goes to emergency medical system preparedness.37,38,15 As a result, although numerous states have made considerable investments in infrastructures and systems to respond to the health and emergency medical needs that may arise as a result of a natural or manmade catastrophe, the overall grade in this category is a C+.
The top ranked performers in this category include the District of Columbia, Maryland, Louisiana, Pennsylvania, and North Dakota. All of these states share some commonalities in this area, including having received relatively high rates of federal funding per capita to support disaster preparedness compared to other states. They have written all-hazards medical response or ESF-8 plans, which are shared in most cases with EMS and essential hospital personnel. Some have high bed surge capacity and written plans to address special needs populations and supply medications for chronic conditions in the event of a disaster. They have relatively high rates of nurses and physicians registered in a state-based Emergency System for Advanced Registration of Volunteer Health Professionals. In addition, these states have instituted communications and notification systems, and have held drills and trainings for medical staff, emergency personnel, and essential hospital personnel. The lowest ranked states for Disaster Preparedness include Tennessee, Idaho, Alaska, Arkansas, and Nevada."