Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the time of the initial A&E consultation documenting patient demographics, presenting complaints, investigations ordered, procedures done, initial diagnosis and outcome of A&E consultation. Results: Data on 1887 patient presentations were described with adults (≥13 years) accounting for the majority (70%) of patients. There were two peak age groups, 0-9 and 20–30 years accounting for 27% and 25% of the patients respectively. Respiratory and trauma presentations each accounted for 21% of presentations with a widespread of other presentations. Over half (58%) of the patients were investigated in the department and an equal number (56%) were treated and discharged from the A&E. Only one in three patients admitted or transferred to specialist units received any immediate therapy. Conclusions: Public accident and emergency departments in Kenya provide care to a widespread undifferentiated patient population yet most of the immediate therapy is provided only to patients with minor conditions who are subsequently discharged from the A&Es. Sicker patients have to await transfer to the wards or specialist units to start receiving treatment.