What began in 1948 as a "Casualty and Outpatient Service" at the Singapore General Hospital grew into the first 24-hour emergency unit in 1964 and has since expanded to the current emergency departments of the 6 public hospitals providing acute 24-hour accident and emergency services with an annual patient load of up to 540,000. In 1984, emergency medicine was recognized as a distinct medical specialty by the Ministry of Health. Five years later, structured academic postgraduate training programs were introduced. In 1990, a specialist training committee for emergency medicine was appointed to oversee the development of advanced training in emergency medicine locally. Seven areas of subspecialization have since been identified and are in various stages of development: emergency cardiac care, emergency trauma care, emergency toxicology, prehospital emergency care, pediatric emergency medicine, disaster medicine, and observation medicine. The achievements in emergency medicine in Singapore can help to provide a model for the future development of emergency medicine in other similar environments.