WASHINGTON — The nation's emergency care system itself is ailing, warns a new health care analysis, which gives Utah, Idaho and Arkansas the lowest rankings for access.

"The emergency health care system's in serious condition. We have a safety net for health care that is frayed," said Dr. Stephen Epstein, an emergency care physician at Beth Israel Deaconess Medical Center in Boston.

Epstein was a member of the American College of Emergency Physicians task force that studied the nation's emergency care. Their report was released today.

The panel found a system that is overcrowded, with access to emergency care declining and with poor capacity to deal with public health or terrorist disasters.

"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 Utah Medical Association cautioned that the report's rankings are not a measure of the quality of care provided in emergency rooms but of the population's general access to emergency room care.

"It's not a reflection of the physicians in those departments, or of the quality of care offered in those departments," said Mark Fotheringham, spokesman for the Utah Medical Association.

Dr. Craig Marsden, an emergency room doctor and Utah spokesman for ACEP, said the study shows Utah lags behind other states in general support for emergency medicine. Utah residents, he said, are less likely to have easy access to emergency rooms and specialists trained in emergency care, and they are more apt to face a long wait when they go to an emergency room.

Compared with other states, Utah's emergency rooms also have less capacity to handle major events, including flu outbreaks and disasters, Marsden said. Among the reasons are that Utah's emergency room capacity and emergency physician training programs have not kept pace with population growth. The state's rural character also leaves many residents farther away from emergency care than residents in other states.

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.

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 compact District of Columbia, which includes several emergency care centers, ranked first for access to emergency care, along with Connecticut, Maine, Massachusetts, Ohio, Pennsylvania and Rhode Island. No state received a failing mark for access.