Emergency department personnel are frequently asked to give advice to members of the community who telephone for advice or information about a wide variety of medical problems. A study was designed to determine the consistency and accuracy of directions given to adults who call EDs seeking advice about a problem. Forty-six EDs were selected and telephoned for advice by a research assistant who presented a scenario that could have reasonably been interpreted as a patient experiencing myocardial ischemia. Nine percent of the calls were answered and managed only by ED unit secretaries. Fifty-six percent of the respondents failed to ask the caller any questions about the patient or the chief complaint. Only four ED respondents instructed the caller to call 911 and have the patient brought to the ED. The data suggest that telephone advice given by some EDs is nonstandardized and may be inadequate to the point of jeopardizing the welfare of the caller.