AIM:To determine whether patients presenting to the emergency department (ED) with possible benign paroxysmal positional vertigo (BPPV) are managed in accordance with best practice guidelines, and whether physiotherapists are involved in their care. DESIGN:Retrospective observational study. PARTICIPANTS:Ninety-six consecutive patients presenting to one of three EDs with vertigo, dizziness or imbalance symptoms documented at triage. Individuals with a clear non-vestibular cause of symptoms were excluded. OUTCOME MEASURES:Proportional adherence to clinical practice guidelines by medical and physiotherapy clinicians, primary diagnosis, incidence of falls, admission to hospital, and referral to a physiotherapy service. RESULTS:Adherence to clinical practice guidelines by both professions was low, with only 25 (26%, 95% CI: 18-36%) and 3 (14%, 95% CI: 4-36%) patients assessed by a medical clinician or physiotherapist, respectively, receiving the gold-standard Dix-Hallpike test. Sixty-four (67%) individuals were given a diagnosis of undifferentiated dizziness. Of the 26 (27%) patients with a primary BPPV diagnosis, only three (12%) were treated with a canalith-repositioning technique, and four (15%) reviewed by a physiotherapist. CONCLUSION:Adherence to best-practice guidelines for the management of BPPV in individuals presenting to the ED is low, and physiotherapists are seldom involved in their management.