[imgbelt img=emergency_room_3.jpg]One in four Americans live more than an hour away from a hospital with an emergency room equipped to handle a life-threatening situation. A University of Pennsylvania School of Medicine study shows that 71 percent of Americans have access to an emergency department of some kind within 30 minutes, and 98 percent can reach one within an hour. But on a state-by-state basis, the findings suggest that many of those nearby facilities may not be able to provide care for the most emergent conditions. Most of those living far from the best emergency care reside in rural areas. In South Dakota, for instance, just 13 percent of the population has access within 60 minutes to an emergency department that sees three or more patients per hour; in Montana, only 8 percent do. In Vermont and Main, only half the residents can reach high-volume emergency rooms. Among possibilities for boosting care quality in rural or other underserved areas, the authors suggest subsidizing rural hospitals or offering incentives for physicians to practice at those facilities, improving interhospital referral networks and identifying hospitals that can specialize in treatment of certain emergent illnesses.