Emergency Medicine in Papua New Guinea is a unique and challenging project. A poster presentation of the system currently in use with analysis of areas for improvement, initial goals for review and refining the system is included. AUSaid project starts January 2002 in association with the MONAHP (medical officer nursing and allied health training project) The rural/ urban interface is huge; overwhelming demands on a system with few tertiary centers in a large rural setting with ongoing tribal warfare. Issues of prehospital care and training, triage, and emergency transport system challenge local providers. Finding a level of care, which the health care system is able to afford and sustain, is a major issue. Defining the arena of Emergency Medicine in PNG, assisting in training and programs to suit the unique environment and the smooth transfer of the project to a local medical director are the goals of the project.