North Dakota Press Release


Embargoed For Release at 11 am (ET)
January 16, 2014

Media Contact:
Mike Baldyga, 202-370-9288 
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WASHINGTON — North Dakota is near the top of the national list when it comes to support for emergency care. The state received an overall C+ grade according to the American College of Emergency Physicians’ (ACEP) state-by-state report card on the emergency care environment (“Report Card”). The nation’s overall grade fell to a D+, since the last report card was released in 2009. North Dakota is currently ranked 8th in the nation. The report card forecasts the expanding role of emergency departments under Obamacare and deleterious effects wrought by the competing pressures of shrinking resources and increasing demand.

“Our state has made solid progress with regard to disaster preparedness and medical liability reforms,” said Dr. Christopher Boe, president of the North Dakota Chapter of ACEP. “However, North Dakota has to take action now to improve the public health and safety of our residents.”

The state received a near failing D- in Public Health and Injury Prevention. Nearly a quarter of adults in North Dakota binge-drink (23.8 percent) and 45 percent of traffic fatalities are alcohol-related. North Dakota also has the third highest rate of fatal occupational injuries and the 10th highest fall-related deaths (12.3 per 1 million people) in the nation. In addition, the state has only secondary enforcement of adult seatbelt laws applying to front seat occupants.

North Dakota earned a C in Access to Emergency Care. The state ranks among the top 10 with regard to health insurance for adults and children and has the lowest proportion of underinsured adults. The state fares well with hospital capacity with 514 staffed inpatient beds per 100,000 people and 37 emergency departments per 1 million people. ER wait times are third best in the nation, average 180 minutes from arrival to departure for admitted patients.

North Dakota continues to be very strong in the area of Disaster Preparedness, receiving an A. The state has a budget line item for disaster preparedness funding specific to health care surge. They are one of only 11 states to have it. The state also has systems in place to address behavioral health concerns during a disaster.

A few factors contributed to North Dakota’s poor grade in regard to Quality and Patient Safety Environment. The state received a D+ in this area partially because it lacks funding for both an emergency medical services (EMS) director and quality improvement of the EMS system. North Dakota’s hospitals are also among the least likely to collect data on patients’ race and ethnicity

The Report Card’s recommendations for improvement included:
  • North Dakota should consider legislation aimed at reducing traffic fatalities, which are much higher than the national average. This should include requiring helmets for all motorcycle riders, strengthening adult seatbelt laws through primary enforcement and requiring that seatbelts be used in all seats. 
  • Additional health promotion efforts should be aimed at reducing smoking and binge drinking. 
  • North Dakota could also help to improve quality and patient safety by funding an EMS medical director and encouraging hospitals to collect data on race, ethnicity and primary language. 
“America’s Emergency Care Environment: A State-by-State Report Card – 2014” evaluates conditions under which emergency care is being delivered, not the quality of care provided by hospitals and emergency providers. It has 136 measures in five categories: access to emergency care (30 percent of the grade), quality and patient safety (20 percent), medical liability environment (20 percent), public health and injury prevention (15 percent) and disaster preparedness (15 percent). While America earned an overall mediocre grade of C- on the Report Card issued in 2009, this year the country received a near-failing grade of D+.

People can see their state’s grades in America’s Emergency Care Environment: A State-by-State Report Card at

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.


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