BACKGROUND: Since demographic changes have contributed to the growth of emergency medicine, a highly populous nation such as India needs to give physicians associated due credit and recognition. The management of knowledge source must also be conducted with due care as the work environment is completely different from that of any other clinicians. METHODS:The data were collected by direct interaction with residents of the department. Additional information was gathered by observation. The data were verifi ed for validity. RESULTS:This study was to bring out the benefi ts of proactive decisions that could further enhance the emergency department. But such decisions did not always result in positive responses and improved morale. When such decisions were retracted as it causes misalignment with the existing system. An academic emergency department was expected and physicians should enrich their knowledge about emergency medicine.CONCLUSIONS: The problems faced by emergency department might be similar but the way in which one tackles the situation would be different. Decision making in this hospital may not be the best but it would've been the optimum one given the conditions available.