Domestic violence (DV) and Sexual assault (SA) are serious, but preventable public health problems. There are a number of negative and often long-term mental and physical health consequences of different forms of DV. Women experiencing DV and SA visit their health care professional more frequently than women not experiencing DV and SA. Health care professionals in any health care settings can play crucial roles in identifying, managing and preventing DV. In particular, those who work in emergency departments (EDs) are in a unique position to identify patients and initiate early interventions as they are often the first point of contact to access help. The role of social workers as a first point of referral is well acknowledged in the literature. The aim of this study is to identify DV and SA presentations to the ED of a large metropolitan tertiary referral hospital in NSW, for a period of one year. It provides a description of the main characteristics of the presentations, staff responses to the cases and the referral pathways. These findings highlight the critical role of the health system in reducing the harms caused by DV and SA. Finally, recommendations as to how EDs can better address DV and SA are provided.