The US emergency care system is failing us badly, according to the National Report Card on the State of Emergency Medicine compiled by the American College of Emergency Physicians.

By Marian Benjamin

The US emergency care system is failing us badly, according to the National Report Card on the State of Emergency Medicine compiled by the American College of Emergency Physicians (ACEP).1

The report card rates five categories of emergency care:

Emergency Care SectorACEP Grade
Access to emergency careD-
Quality and patient safety environmentC+
Medical liability environmentC-
Public health and injury preventionC
Disaster preparednessC+

The results might not be a surprise to those of you working in emergency venues, but they sure were to me: The overall state of emergency care earned a C-, with 90% of states earning “mediocre or near-failing grades.”

The report card does not fault—or even measure—the quality of care provided by individual hospitals or emergency providers; it considers only the legislative and regulatory environment, the existing infrastructure, and the available workforce comprising an emergency care system.

The reasons for these poor grades are many, among them: The failing economy is resulting in people losing their jobs and being unable to pay for private insurance. Rising costs are forcing hospitals to close emergency departments just when demand for their services is growing: The report found that emergency department visits had grown by 32% in the last decade; the number of emergency departments had fallen by 7%.1

Interestingly, in the midst of this crisis, John Goodman, a Dallas health economist, commented on a story about the number of uninsured in Texas in the August 27 Dallas Morning News.2 He said that since hospital emergency departments are open to all, everyone has insurance, and “The next president of the United States should sign an executive order requiring the Census Bureau to cease and desist from describing any American—even illegal aliens—as uninsured.”

Former President Bush said much the same thing during a July 2007 speech in Cleveland, when he commented, “I mean, people have access to health care in America. After all, you just go to an emergency room.”

The confluence of increasing demand and shrinking resources has put our emergency service system at risk. Already. emergency departments are so overtaxed that patients are boarded and experience life-threatening delays of treatment,3 and ambulances are diverted because emergency departments simply cannot take any more patients (in 2003, an estimated 501,000 ambulances were diverted, ie, one ambulance diversion per minute).4

In a January 19 statement,5 Nicholas Jouriles, MD, president of the ACEP, said, “President Obama said recently, ‘Reforming our health care system will be a top priority of my administration and key to putting our economy back on track.’ Emergency physicians look forward to working with him to follow through on the top recommendations of ACEP’s Report Card, beginning with passage of the Access to Emergency Medical Services Act, which will be reintroduced in Congress next month. Health care reform will not be complete until the severe problems in our emergency medical care system are solved, and passage of this legislation is a critical first step in the right direction.”

Emergency care professionals know what’s sick in the system, and they can be the instruments of healing; but they need the support of the new administration to begin this process.


Marian Benjamin is the editor of RT magazine. For more info, contact [email protected].


  1. American College of Emergency Physicians. The National Report Card on the State of Emergency Medicine. Available at: Accessed January 29, 2009.
  2. John Goodman’s influence felt in GOP policies. Available at: Accessed January 30, 2009.
  3. Meeting the challenge of emergency department overcrowding/boarding. Report from a roundtable discussion. Available at: Accessed January 30, 2009.
  4. Burt CW, McCaig LF, Valverde RH. Analysis of ambulance transports and diversions among US emergency departments. Ann Emerg Med. 2006;47:317-26. Epub 2006 Feb 17.
  5. American College of Emergency Physicians. January 19 press release. Available at: Accessed February 11, 2009.