Children with hematologic malignancies and other cancers are highly vulnerable to serious, rapidly progressive complications—including fever and neutropenia, bloodstream infection, bleeding, and metabolic disturbances—due to immunosuppression from the underlying disease or chemotherapy. The emergency department (ED) is often the first point of care for these children. Consequently, the quality of triage, timeliness of treatment initiation, medication and blood product safety, management of central venous catheters, and effective communication with the oncology team can decisively influence patient outcomes. In Iran, despite therapeutic advances, important challenges persist, including disparities in access to and quality of services across centers, delays in referral, and weaknesses in adverse event reporting systems. Establishing a dedicated triage pathway, ensuring timely administration of antibiotics for febrile neutropenia, implementing safe medication management, providing targeted staff training, strengthening error-reporting culture, and enabling rapid communication between EDs and referral centers can reduce preventable complications and improve the quality of care.