Summary Aim of the study To study the epidemiology of death in the emergency unit, clinical practices and access to care for the dying person. Method We conducted a retrospective study of deaths among patients seen at the Emergency Department (ED) in Metz over a 3-year period. Epidemiology data, patient arrival, their period of stay, their place of death and therapeutic practices are analyzed. Results Two hundred and twenty-seven patients who died in the ED were included in the study, accounting for 0.20% of the clinical activity of the unit. Average age was 72 years. Death before the age of 20 years was exceptional. Etiologies varied. End-of-life situations and other serious pathologies accounted for 55% of the deaths. Male mortality prevailed before 60 years of age, mainly due to trauma. The average duration of the stay in the ED was greater than 11 hours. 73% of the subjects were referred by the Mobile Emergency Unit, 18% by a general practitioner. 47% of the patients arrived via a medicalized means of transportation. 49% of the patients died in the ED, 41% in the observation unit. 67% of the deceased persons in the observation unit were admitted for palliative care. Therapeutic abstentions and compassionate care concerned 55% and 21% of the patients respectively. Conclusion Incidence of death in the ED is low. Proper care of end-of-life patients can be difficult in the specific setting of emergency care. Because of the insufficiency capacity of referring units and the difficulties of subsequent orientation after discharge, dying people are frequently referral to the ED. The observation unit is often used for palliative care.