This study examines the individual and sociocultural factors related to severity of injury among emergency department (ED) patients across six countries (United States, Canada, Mexico, Australia, Spain, and Italy). Secondary analysis of existing data using 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 multilevel hierarchical linear models. Patients drinking greater quantities of alcohol before the injury were more likely to have arrived to the ED by ambulance or admitted 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 is merited.