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.

Even so, emergency care is one thing, and getting a specialist in an emergency may be something else, Epstein noted.

He recalled an incident in which a Massachusetts 8-year-old was hurt in a sledding accident. The emergency physician concluded that the child needed a neurosurgeon, but none was available in that part of the state that day.

The child had to be transported, during a snowstorm, to a Connecticut hospital for treatment.

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, Epstein said.

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

In addition to access to emergency care the report also looked at quality of care, efforts to prevent injuries and improve public health so emergency care wouldn't be needed and the medical liability climate in states, such as caps on non-economic damage awards and protection for physicians who provide emergency care.