The state got an overall ranking of a C, better than the national grade of D+. And the emergency system got top ranking for the category focused on quality and patient safety.
That was largely based on protocols established by the state's unique management system, Maryland Institute for Emergency Medical Services Systems, for how emergency and trauma care is triaged and where patients are taken.
Other categories included access to emergency care, the medical liability, public health and injury prevention and disaster preparedness.
Washington, D.C. had the highest ranked overall system, followed by Massachusetts and Maine. The worst performers were Wyoming, Arkansas and New Mexico.
The group does the rankings to draw attention to the need for emergency services. In 2010, there were 130 million emergency department visits across the country, up more than a third from 1995.