BACKGROUND: Emergency medicine was inaugurated, as an official specialty in China, only 25 years ago, and its growth in clinical practice and academic development since that time have been remarkable. METHODS: This paper is a critical and descriptive review on current situations in emergency medicine in China, based on the literature review, personal observations, interviews with many Chinese emergency medicine doctors and experts, and personal experience in both China and USA. RESULTS: The current practice of emergency medicine in China encompasses three areas: pre-hospital medicine, emergency medicine, and critical care medicine. Most tertiary emergency departments (EDs) are structurally and functionally divided into several clinical areas, allowing the ED itself to function as a small independent hospital. While Chinese emergency physicians receive specialty training through a number of pathways, national standards in training and certification have not yet been developed. As a result, the scope of practice for emergency physicians and the quality of clinical care vary greatly between individual hospitals. Physician recruitment, difficult working conditions, and academic promotion remain as major challenges in the development of emergency medicine in China. CONCLUSION: To further strengthen the specialty advancement, more government leadership is needed to standardize regional training curriculums, elucidate practice guidelines, provide funding opportunities for academic development in emergency medicine, and promote the development of a system approach to emergency care in China.