The Casualty Department of the University Hospital of the West Indies (UHWI) has evolved in an ad hoc manner over the last decade, and questions regarding its appropriateness and effectiveness as an Emergency Department persist. This study of 100 systematically-selected patients attempts to assess time utilization during transit, as dictated by the present system of patient management. Time to first contact averaged 2 hr 38 min (158 min). The mean total time was 3 hr 46 min (226 min) and mean total waiting time was 3 hr 10 min (190 min), versus a mean total utilized time of 19 min. Actual contact time with casualty officers averaged only 8.3 min. Referrals to specialist services constituted 11% of the sample, and overall mean waiting time for specialists was 2 hr 16 min (136 min) with a mean contact time of 48 min. Given that the mean total time of 3 hr 46 min is not inordinately long in a public health system such as ours, the recommendation is being made for a modified coding and triage system to reduce time to first contact for more urgent cases.