'Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly that isn't the case,' said Dr. Frederick C. Blum, president of the physicians group.

The American College of Emergency Physicians task force studied the United States' emergency care system, giving each state grades on a scale of A to F -- A being the best, F the worst -- in different categories of emergency care.

Overall, the report gave the US a C- for emergency care.

"This report is a serious wake-up call to the nation," Dr. Angela Gardner, chair of the task force that produced the report, said in a statement. "If the emergency medical system gets a C- on an average day, how can it ever be expected to provide expert, efficient care during a natural disaster or terrorist attack?"

Access Is Declining

The panel found a system that is overcrowded, with access to emergency care declining.

"Americans assume they will receive lifesaving emergency care when and where they need it, but increasingly that isn't the case," said Dr. Frederick C. Blum, president of the physicians group.

Overall, California, Massachusetts, Connecticut and the District of Columbia were rated best in emergency care, while the lowest grades went to Utah, Idaho and Arkansas.

The number of emergency departments has declined by 14 percent since 1993 despite an increasing number of people coming to them for treatment, the report said.

Need for Surge Capacity

Hurricane Katrina showed the critical need for surge capacity in emergency medical care when a disaster occurs, the report noted. In addition, every year people suffering from flu crowd emergency rooms.

The reported noted that even if care can be provided in an emergency room, a patient needing specialist might be hard-pressed to receive it.

Emergency patients tend to be sicker and more unstable than others, causing some specialists to be reluctant to see them because of the higher liability and higher malpractice insurance rates, said Dr. Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston.

The result is that some specialists, like neurosurgeons, leave certain states or refuse to provide emergency care.