Louisiana dropped six spots to No. 42 in the American College of Emergency Physicians’ 2014 report on emergency care systems nationwide.

The report ranks the states and the District of Columbia in five major categories: access to emergency care, disaster preparedness, quality and patient safety, public health and injury prevention; and medical liability environment.

Louisiana ranked No. 3 in Disaster Preparedness, with strong plans and protocols to make sure medically fragile patients remain safe and well-above-average rates of nurses who received emergency training.

The state ranked No. 26 in the medical liability environment, with the lowest average malpractice award payments in the country at $75,882, down 75 percent since the 2009 report. However, the number of payments had increased.

Louisiana ranked No. 34 in access to emergency care as a result of high rates of uninsured adults and children, 23.9 percent and 11.6 percent; and “a desperate need for primary care and mental health care providers.”

The state ranked No. 49 quality and patient safety, although steps are being taken to improve those areas.

Louisiana also ranked poorly in public health and injury prevention at No. 45. The lowlights include the second-highest rate of pedestrian deaths in the nation, 12 per 100,000 pedestrians; high rates of motor vehicle occupant deaths, 13.7 per 100,000 people; and “dire health risks” – 25.7 percent of adults smoke and 33.4 percent of adults and 21.1 percent of children are obese.

The report recommends that Louisiana hire a state Emergency Medical Services medical director and push to reduce the rates of smoking and obesity. Louisiana should also commit to improving traffic safety for motorists, bicyclists and pedestrians.

The top states were the District of Columbia, Massachusetts, Maine, Nebraska and Colorado. The lowest-ranked states were Wyoming, Arkansas, New Mexico, Montana and Kentucky.