Category Grades
38D+ 42D
Access to Emergency Care:
28C- 38F
Quality/Patient Safety:
45D- 46F
Medical Liability:
8B 9B
Public Health/ Injury Prevention:
39D- 44F
Disaster Preparedness:
49F 18C

Alaska has made great strides in improving its Disaster Preparedness, implementing policies and procedures that allow the state to respond to natural disasters and protect its citizens. Improvements, however, are still needed in the areas of Public Health and Injury Prevention, Access to Emergency Care, and Quality and Patient Safety Environment.

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Alaska has made great improvements in its Disaster Preparedness, moving from 49th to 18th in this category since the 2009 Report Card. It ranks fourth in number of nurses registered in the Emergency System for Advanced Registration of Volunteer Health Professionals (ESARVHP; 853.1 per 1 million people) and 20th in number of physicians registered (31.4 per 1 million). Alaska RESPOND, the medical strike team, is also part of the national ESAR-VHP system, further enhancing medical response. Alaska plans to exercise the Patient Forward Movement in a statewide Alaska Shield 2014 Full-Scale Exercise to test additional medical teams, including out-of-state physicians. In addition, it has developed a statewide medical communication system with redundancy, and the state is in the process of procuring communications trailers and backpacks to provide additional layers of redundancy.

Alaska continues to have a strong Medical Liability Environment. Despite a relatively high average malpractice award payment ($405,000), Alaska has enacted such protections as mandatory pretrial screening panels, joint and several liability reform, and a $400,000 medical liability cap on non-economic damages. It also has the 16th lowest average medical liability insurance premiums for both primary care physicians ($9,203) and specialists ($39,853), as well as the second highest rate of insurers writing medial liability policies (31.8 per 1,000 physicians).

While Alaska fared poorly overall with regard to the Quality and Patient Safety Environment, the state has made some noteworthy improvements. It ranks among the best in the nation for the proportion of hospitals adopting electronic medical records and computerized practitioner order entry and has improved the proportion of patients with acute myocardial infarction who are given percutaneous coronary intervention within 90 minutes of arrival. Alaska has also allocated funding for quality improvement of the EMS system.


Alaska is a large, rural state with a very low population density compared to other states, and it faces unique challenges, particularly in the area of Access to Emergency Care. Although it has high numbers of board-certified emergency physicians (14.8 per 100,000 people) and emergency physicians (16.1 per 100,000), the state faces workforce shortages in several professions, including neurosurgeons (1.2 per 100,000), plastic surgeons (1.4 per 100,000), and registered nurses (754.3 per 100,000). Since about half the state's population lives in the Anchorage area, home to the state's only Level II trauma center, only 57.9% of Alaska's population is within 60 minutes of Level I or II trauma center care. The state also has low rates of adequate health insurance coverage, with 20.9% of its adults and 10.7% of its children having no health insurance at all.

Furthermore, Alaska ranks poorly in Public Health and Injury Prevention. It has the lowest rate of adults aged 65 and older who received an influenza vaccination in the past 12 months (51.8%) and has lower-than-average immunization rates among children aged 19ñ35 months (73.2%). Alaska has the highest rate of fatal occupational injuries in the nation (103.4 per 1 million workers) and among the highest rates of homicides and suicides and unintentional poisoning-related deaths, which includes drug overdoses. It also has relatively high proportions of adults who binge-drink (20.8%) and smoke (22.9%).


Alaska's high rates of preventable deaths and low vaccination rates point to the need for a stronger public health system. The state needs to fund and support activities related to vaccination and injury prevention in order to improve the well-being of its citizens. Alaska should consider funding injury prevention efforts to address its highest-in-the-nation rate of fatal occupational injuries. The state should also consider efforts to reduce binge drinking and drug use, which likely contribute to disproportionately high rates of homicide and suicide and poisoningrelated deaths.

The state also needs to continue to improve the Quality and Patient Safety Environment by implementing triage and destination policies for stroke and ST-elevation myocardial infarction patients and a uniform system for providing pre-arrival instructions, which provide a critical opportunity to provide life-saving care while waiting for first responders to arrive. Alaska's Quality and Patient Safety Environment will also be improved greatly when it incorporates the Centers for Disease Control and Prevention's Guidelines for Field Triage into its State Trauma System Plan, which ultimately will improve the care received by the state's emergency patients.

Access to Emergency Care

Title 2009
Report Card
Report Card
Board-certified emergency physicians per 100,000 pop 13.0 14.8
Emergency physicians per 100,000 pop 14.0 161
Neurosurgeons per 100,000 pop 1.3 1.2
Orthopedists and hand surgeon specialists per 100,000 pop 12.0 11.5
Plastic surgeons per 100,000 pop 1.0 1.4
ENT specialists per 100,000 pop 4.5 4.2
Registered nurses per 100,000 pop 760.2 754.3
Percent of children able to see provider 94.0
Level I or II trauma centers per 1M pop 1.5 1.4
Percent of population within 60 minutes of Level I or II trauma center 55.2 57.9
Accredited chest pain centers per 1M pop 0.0 0.0
Percent of population with an unmet need for substance abuse treatment 8.2 9.4
Pediatric specialty centers per 1M pop 3.0 2.7
Medicaid fee levels for office visits as a percent of the national average 223.4 229.1
Percent change in Medicaid fees for office visits (2004-05 to 2007/2007 to 2012) NR 26.0
Percent of adults with no health insurance 18.9 20.9
Percent of adults underinsured 8.8
Percent of children with no health insurance 10.3 10.7
Percent of children underinsured 15.5
Percent of adults with Medicaid 7.6 8.0
Hospital closures in 2006/2011 0 0
Staffed inpatient beds per 100,000 pop 263.8 262.1
Hospital occupancy rate per 100 staffed beds 56.2 63.5
Psychiatric care beds per 100,000 pop 20.4 34.3
Median time from ED arrival to ED departure for admitted ED patients 274
State collects data on diversion NO NO

Disaster Preparedness

Title 2009
Report Card
Report Card
Per capita federal disaster preparedness funds 21.19 15.64
State budget line item health care surge NO
ESF-8 plan is shared with all EMS and essential hospital personnel YES YES
Emergency physician input into the state planning process YES, YES YES
Public health and emergency physician input during an ESF-8 response YES
Drills, exercises conducted involving hospital personnel, equipment, or facilities per hospital
Accredited by the Emergency Management Accreditation Program (EMAP) NO YES
Special needs patients included in medical response plan NO YES
Patients dependent on medication for chronic conditions in medical response plan NO YES
Medical response plan for supplying dialysis NO YES
Mental health patients included in medical response plan YES
Medical response plan for supplying psychotropic medications YES
Mutual aid agreements in place with behavioral health providers STATE LEVEL
State requires long-term care and nursing home facilities to have a written disaster plan YES
State able to report number of exercises involving long-term care facilities or nursing YES
Just-in-time training systems in place STATEWIDE STATEWIDE
Statewide medical communication system with one layer of redundancy NO YES
Statewide patient tracking system YES NO
Statewide real-time or near real-time syndromic surveillance system YES NR
Real-time surveillance system in place for common ED presentations NO NO
Bed surge capacity per 1M pop 219.5 1730.8
ICU beds per 1M pop 236.2 229.7
Burn unit beds per 1M pop 8.8 0.0
Verified burn centers per 1M pop 0.0 0.0
Physicians registered in ESAR-VHP per 1M pop 0.0 31.4
Nurses registered in ESAR-VHP per 1M pop 0.0 853.1
Behavioral health professionals registered in ESAR-VHP per 1M pop 12.3
Strike teams or medical assistance teams NO YES
Disaster training required for essential hospital/EMS personnel NO, NO YES
Percent of RNs that received emergency training 44.4 46.9

Medical Liability Environment

Title 2009
Report Card
Report Card
Lawyers per 10,000 pop 14.8 13.5
Lawyers per physician 0.6 0.6
Lawyers per emergency physician 10.4 8.4
ATRA judicial hellholes (2009 range 0 to -7/2014 range 2 to -6) 0 0
Malpractice award payments per 100,000 pop 5.8 2.1
Average malpractice award payments $283,739 $405,000
National Practitioner Databank reports per 1,000 physicians 15.9 18.5
Apology laws: Apology is inadmissible as evidence in a court of law NO
State has implemented a patient compensation fund NO NO
Number of insurers writing medical liability policies per 1,000 physicians 22.8 31.8
Average medical liability insurance premiums for primary care physicians $10,834 $9,203
Average medical liability insurance premiums for specialists $49,163 $39,853
Presence of pretrial screening panels Mandatory Mandatory
Pretrial screening panel's findings admissible as evidence YES YES
Periodic payments are: required, granted upon request, at court's discretion At Judge's or Court's Discretion At Court's Descretion
Medical liability cap on non-economic damages $350,001-500,000 $350,001-500,000
Additional liability protection for EMTALA-mandated emergency care NO NO
Joint and several liability abolished YES YES
Collateral Source Rule/Provides for Awards to be Offset YES
State provides for case certification NO NO
Expert witness required to be of the same specialty as the defendant YES YES
Expert witness must be licensed to practice medicine in the state NO NO

Public Health & Injury Prevention

Title 2009
Report Card
Report Card
Bicyclist fatalities per 100,000 cyclists 2.7
Pedestrian fatalities per 100,000 pedestrians 1.5
Percent of traffic fatalities alcohol-related 31.0 33
Percent of front occupants using restraints 82.4 89.3
Child safety seat/seat belt legislation - score out of a possible 10 points 4 9
Helmet use required for all motorcylce riders NO NO
Distracted driving legislation score - out of a possible 4 points 2
Graduated drivers' licenses legislation score -out of a possible 5 points 1
Percentage of children aged 19-35 months who are immunized 73.3 73.2
Percentage of adults aged 65+ who rec’d an influenza vaccine in the last 12 mos 62.5 51.8
Percentage of adults aged 65+ who ever rec’d pneumococcal vaccine 59.9 66.2
Fatal occupational injuries per 1M workers 115.0 103.4
Homicides and suicides (non-motor vehicle)(per 100,000) 25.3 27.4
Unintentional fall-related fatal injuries (per 100,000) 3.0 4.5
Fire/burn related fatal injuries (per 100,000) 1.8 1.3
Rate of unintentional firearm-related fatal injuries (per 100,000) 0.3 0.3
Rate of unintentional poisoning-related deaths (per 100,000) 15.8
Total injury prevention funds per 1,000 persons $1,994.21 $1,069.72
Dedicated child injury prevention funding YES
Dedicate elderly injury prevention funding NO
Dedicated occupational injury prevention funding NO
Anti-smoking legislation score - score out of a possible 3 points 0
Infant mortality rate per 1,000 live births 5.9 3.8
Percentage of adults who binge drink 17.0 20.8
Percentage of adults who currently smoke 24.0 22.9
Percentage of adult population who are obese (BMI > 30.0) 26.2 27.4
Percentage of children who are obese 14.0
Cardiovascular disease disparity ratio 2.4
HIV diagnosis disparity ratio 7.5
Infant mortality disparity ratio 2.8

Quality & Patient Safety

Title 2009
Report Card
Report Card
Funding for quality improvement within the EMS system NO YES
Funded state EMS medical director YES YES
Emergency medicine residents per 1M pop 0.0 0.0
Adverse event reporting required NO NO
% of counties with Enhanced 911 capability 52.2 55.6
State has a uniform system for providing pre-arrival instructions NO NO
State uses CDC guidelines for state field triage protocols No Protocols
State has or is working on a stroke system of care YES NO
State has triage and destination policy in place for stroke patients NO
State has or is working on a PCI network or a STEMI system of care NR NO
State has triage and destination policy in place for STEMI patients NO
State maintains statewide trauma registry YES YES
State has triage and destination policy in place for trauma patients NO
Prescription drug monitoring program score (range 0-4) 3
% of hospitals with computerized practitioner order entry 25.0 94.1
% of hospitals with electronic medical records 53.3 100.0
% of patients with AMI given PCI within 90 minutes of arrival 82 90
Median time to transfer to another facility for acute coronary intervention 122
% of patients with AMI who received aspirin within 24 hours 100
% of hospitals collecting data on race/ethnicity and primary language 40.7
% of hospitals with or planning to develop a diversity strategy or plan 29.6

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