The National Report Card on the State of Emergency Medicine assesses the support that each state and the District of Columbia provides for their emergency care systems. The results of the 2009 Report Card present a picture of an emergency care system fraught with significant challenges and under more stress than ever before. The overall grade for the nation across all five categories is a C-. This low grade is particularly reflective of the poor score in Access to Emergency Care (D-). Because of its direct impact on emergency services and capacity for patient care, this category of indicators accounts for 30 percent of the Report Card grade, so the poor score is especially relevant. For more information and to download state-by-state results, go to http://www.emreportcard.org/overview.aspx?id=388 .