This study examines the individual and socio-cultural factors related to severity of injury among emergency department (ED) patients across six countries (United States, Canada, Mexico, Australia, Spain, and Italy). Probability samples of injured patients from 15 studies (N=9,599) were analyzed for severity of injury as measured by arrival by ambulance and admission to the hospital, using logistic regression models and multi-level hierarchical linear models. A dose-response relationship was found between patients drinking prior to the injury and arriving to the ED by ambulance and admission to the hospital after the injury event. Country level detrimental drinking pattern explained some of the study variation for patients arriving by ambulance but not for patients admitted to the ED. Findings support a relationship between acute alcohol consumption to injury severity however, further examination of the clinical implications related to triage, patient evaluation, and intervention for alcohol-related problems are merited.