To evaluate the efficiency of the emergency care system in Düsseldorf 6314 medical records (dating from 1987) were analysed. The result shows a well-functioning system of ambulant emergency care. The success rates a better than average in West Germany, mainly due to the specific conditions in a large city. A detailed assessment of the quality of the medical care is impossible to achieve with the current documentation systems. In contrast to other cities the physicians of the medical department in Düsseldorf take an active part in the emergency care system. Prerequisites are a specialist training (e.g. surgery, anaesthesiology or internal medicine) and several years of clinical experience in intensive care. Consequently, the task of "Coordinating Emergency Physician" has been allocated to the Public Health Office. The combination of medical and administrative experience is of great benefit in solving the organisational problems of cooperation of several medical services. The organisation of the emergency care system should be accepted as an important challenge for the public health system. This engagement may contribute to a better understanding by hospitals, physicians and the general public, of the role and the importance of the Public Health Service.