U.S. states fail the grade when it comes to dealing with a major emergency

Jan 10 2006

According to a report by the American College of Emergency Physicians, the United States is ill prepared to tackle any kind of major emergency.

A team of emergency medical experts have given virtually every state in the country a low grade when it comes to being prepared to tackle an emergency.

The panel of medical experts took an objective look at emergency care across the country and have produced the first-ever National Report Card facilities and the results are not encouraging.

They declare the system is characterised by overcrowding, with declining access to care, soaring liability costs and a poor capacity to deal with public health or terrorist disasters.

The best they could award the nation's emergency medical care system was a grade of C-, which is indicative of the average of grades for all 50 states and the District of Columbia.

The experts looked at a range of available data to develop 50 measures for grading each state on a scale of A through F for its support in four areas:

• Access to Emergency Care,

• Quality and Patient Safety,

• Public Health and Injury Prevention, and

• Medical Liability Environment.

According to Frederick C.Blum, MD, FACEP, president of ACEP the assumption by most Americans that they will receive lifesaving emergency care when and where they need it, is wrong.

He says support for emergency medical care is mediocre or possibly worse.

Blum says the majority of Americans expect the highest quality medical care and would not accept mediocre treatment or mediocre medicines; they also should not be expected to accept mediocre support of an emergency medical system.

He says for a nation that prides itself on providing the highest-quality medical care in the world, anything less than an A grade is unacceptable.

It seems that though no state received an overall A grade, California ranked first in the nation, followed by Massachusetts, Connecticut, and the District of Columbia, all earning the highest overall B grades.

The report found that as many as half of all the states were providing below-average support for their emergency medical systems, earning poor or near-failing grades.

Arkansas, Idaho and Utah had the weakest support, receiving the worst overall grade of D.

The experts analyzed data from the American Medical Association, the American Nurses Association, the Henry J. Kaiser Family Foundation and the U.S. Department of Health and Human Services, and others.

A task force of emergency physicians applied the grades by considering 50 measurements that were common to all states. A "curved" grading system was used, applying grades by comparing each state with the highest ranked state in each category.

Angela Gardner, MD, FACEP, a practicing emergency physician in Texas and chair of ACEP's Report Card Task Force, says this is a 'serious wake-up call to the nation'.

According to Gardner, if the best emergency medical systems can achieve on an average day is a C minus, they cannot be expected to provide expert, efficient care during a natural disaster or terrorist attack.

It appears that though the Report Card found a correlation between the wealth of a state and better grades, it also found that some of the country's historically poorest states achieved better than average grades; South Carolina (B plus) and West Virginia (C plus), which demonstrates their commitment to high-quality emergency care.

They also discovered that states with lower population densities generally faced greater deficits in emergency care.

On a more optimistic note Dr. Blum says it is important to remember that in virtually every category at least one state is doing an excellent job which provides an excellent model for others to analyze, adapt and improve their own emergency care systems.

ACEP officials say they will continue to measure state efforts and improvements in emergency care over time, using this report as an initial benchmark.

For complete report card and state ranking comparisons, visit http://www.acep.org.