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Emergency manuals (EMs) can help healthcare providers respond to crises more efficiently. Three anesthesia EMs have been translated into Chinese. These EMs have been made publicly available as a free document downloadable in China. A year after these Chinese versions of EMs were published, we conducted a multi-institutional survey in China to assess the progress of how well EM had been adapted and used in the setting of critical events.Our study used a multi-institutional, anonymous electronic survey. We included hospitals that had conducted group studies of EMs as well as simulation trainings. The survey consisted of the five-point Likert scale, yes or no boxes, and multiple-choice questions with five possible choices. Statistical analysis included Pearson correlation coefficient and χ2 test.Nine hospitals were included in the study. The overall response rate was 56.4%. More than 70% of all respondents reported using an EM during at least one critical event within the past 6 months in China. A total of 87.7% of all respondents self-reviewed or group studied EMs. A total of 69% participated in multidisciplinary simulation training. Emergency manual use during a critical event showed a positive correlation with multidisciplinary simulation training (R2 = 0.896) and self-review/group study (R2 = 0.5234). The average self-reported use of EMs during clinical critical events is twice per anesthesiologist.This study demonstrated the nascent success of EM implementation in multiple Chinese institutions. Simulation training enhances the implementation and clinical usage of EM. Simulation training in an operating room was sufficient to learn how to use EM.