Emergency care has been neglected in many resource-constrained countries and yet 50% of paediatric admissions die in the 1st 24 hours of admission. Carers may know how to manage clinical problems but there might not be a system in place to provide timely and appropriate care. This article reviews the needs--staffing, materials and physical layout--of a receiving hospital unit and describes how to set up a system of patient flow and care that prioritises and provides timely care, so that when a patient arrives in hospital the system does not fail them.