Background: Emergency departments frequently serve as the first point of contact for victims and perpetrators of crimes. Proper documentation and preservation of medico-legal evidence at this stage are crucial for both patient care and the administration of justice. However, deficiencies in knowledge, time constraints, and lack of standardized protocols often compromise evidence integrity. Aim: To assess the practices of documentation and preservation of medico-legal evidence in emergency settings and identify gaps affecting the medico-legal outcome. Materials and Methods: A retrospective observational study was conducted in the Department of Forensic Medicine in collaboration with the Emergency Department at the School of Medical Sciences and Research, Sharda University. Medico-legal case records registered between November 2010 and August 2012 were reviewed. Parameters analyzed included completeness of documentation, type of injuries recorded, evidence preservation methods, chain of custody, and compliance with medico-legal protocols. Results: A total of 412 medico-legal cases were analyzed. Incomplete documentation was observed in 28.6% of cases, with missing injury descriptions and inadequate history being the most common deficiencies. Proper preservation of physical evidence was noted in 61.4% of cases, while chain-of-custody documentation was complete in only 54.9%. Assault-related cases showed better documentation compared to road traffic accidents and poisoning cases. Conclusion: Significant gaps exist in the documentation and preservation of medico-legal evidence in emergency settings. Regular training, standardized protocols, and closer collaboration between emergency physicians and forensic experts are essential to improve medico-legal outcomes.