Abstract: Emergency Treatment Unit which is the entry point for patients to the hospital, is responsible for initial accident and emergency care for patients. The need of prompt action in emergency care was explained by Dr. Cowley of Maryland University as the “Golden hour in emergency medicine”, as patient’s survival or death may decide on how the patient is cared within the first hour of onset of the emergency. A & E policy in Sri Lanka defines the optimum level of care in each level of health care institutions. The article describes the strategies and ways and means of establishing a new ETU at Base Hospital, Elpitiya, Sri Lanka to address the basic objectives of accident and emergency care. With the establishment of the new ETU, number of minor surgical procedures and thrombolysis of acute MI patients at ETU were markedly improved indicating reduction of door to needle time.