America gets a barely-passing grade on overall emergency care, according to a report card issued the American College of Emergency Physicians (ACEP), which is pretty terrifying for those of us who live here and don't want to die in an emergency.

The overall score is a weighted average of the country's grades in five categories:

  • Access to Emergency Care (30% towards the total): D-
  • Quality & Patient Safety Environment (20% towards the total): C
  • Medical Liability Environment (20% towards the total): C - 
  • Public Health & Injury Prevention (15% towards the total): C 
  • Disaster Preparedness (15% towards the total): C - 

According to ACEP, the categories are "based on 136 objective measures that reflect the most current data available from reliable public sources." ACEP adds that these measures "represent factors vital to life-saving emergency care and meet the key criteria of relevance, reliability, validity, reproducibility, and consistency across all states," which means the U.S. scored a C at best on every meaningful aspect of life-saving emergency care. For context, the D+ score is actually lower than the C- the U.S. scored overall in 2009, the last time the report card was issued. 

Though the news overall is somber, some states did see individual improvements. This year, Washington D.C. beat Massachusetts for the top spot overall, and Colorado and Ohio made it into the top ten for the first time. But a number of states also took an unprecedented plunge to the bottom fifth, including Alabama, Montana, Illinois, Alaska and Louisiana. At least those states aren't Wyoming, which got a flat-out F.

In addition to D.C. and Massachusetts, Maine, Nebraska, Colorado, Pennsylvania, Ohio, North Dakota, Utah and Maryland are among the top ten states in emergency care overall. But the gap between best and worst states has increased

In 2014, the highest grade received is a B- and the lowest grade is an F. Comparatively, 2009 grades ranged from a B to a D-, reflecting a declining trend in overall state grades and contributing to the overall worsening national grade. While four states received grades falling in the range of a B in both Report Cards, the number of states with a C grade has dropped dramatically. That gap is accounted for by the increase in states receiving D’s.

CNN notes that more people are seeking emergency care while the supply of emergency care-givers has fallen:

The report also highlighted that there were 130 million emergency department visits, or 247 visits per minute, in 2010, and there were 37.9 million visits related to injury, according to the CDC's National Hospital Ambulatory Medical Care Survey: 2010 Emergency Department Summary. From 1995 to 2010, there was a 34% increase in emergency department visits, according to CDC's data. During this same time period, the supply of emergency departments went down by 11%. 

And that the number of people seeking care is only going to grow

The number of patients visiting emergency departments is likely to increase as baby boomers age and develop more medical problems. And the report projects that with the Affordable Care Act going into effect, millions of people who can't find physicians who accept their insurance, and who were added to Medicaid, will also seek emergency care. A recent study in Science suggested that Medicaid increases the use of emergency departments.

The ACEP authors have issued a number of recommendations designed to alleviate the situation, including protecting access to emergency care, supporting programs that focus on its importance, and allocating federal funds to disaster preparedness. Now the question is, is our government prepared to invest in change?