HMN 2025: How Gaps in emergency health knowledge could be costing lives worldwide

In a medical emergency, every second counts—but around the world, many people still hesitate or make the wrong decision when faced with an urgent health crisis. Our new multi-country study sheds light on this issue, finding that public understanding of when and how to seek emergency medical help remains limited, even in regions with advanced health care systems. The work is published in the journal Medicine.

When seconds matter, knowledge can save lives

The study, which surveyed nearly 5,000 participants across many countries, found that only about one in five people demonstrated a strong level of Emergency Health Literacy (EHL)—the ability to recognize a medical emergency and know how to respond appropriately.

EHL also refers to how well individuals understand what qualifies as a medical emergency, which services to contact, and how to use them efficiently. It goes beyond first-aid skills—EHL is about judgment, awareness, and trust in health systems.

High EHL helps people act quickly, use services appropriately, and avoid preventable deaths. Low EHL, on the other hand, leads to confusion, delays, and unnecessary pressure on emergency departments worldwide.

Recognizing emergencies isn’t always easy

While most respondents (over 80%) knew where to find an emergency facility nearby, less than half could correctly identify local rescue or ambulance services. The biggest challenge, however, wasn’t access—it was decision-making. Nearly 40% of people said they found it difficult to judge whether a situation required emergency care.

Unnecessary emergency visits strain health care systems, while delays in true emergencies can be fatal. Knowing when to call for help can be just as important as knowing where to go.

Our research revealed several patterns consistent across countries. Men, health care professionals, and people with higher education or income levels tended to have better emergency health literacy. Younger adults (ages 24–30) and older adults (over 60) also scored higher—perhaps because these groups are either more digitally connected or more experienced with health care systems.

However, the majority—about 75% of participants—were found to have “problematic” emergency health literacy, meaning they might struggle in real-life crises to evaluate symptoms or decide when to seek urgent medical help.

A global challenge for health systems

Low health literacy doesn’t just affect individuals—it creates ripple effects throughout health systems. Unnecessary emergency visits, misuse of ambulance services, and delays in treatment all add financial and human costs. Similar challenges have been reported in Europe, North America, and Asia, suggesting that the issue is far from regional.

Countries with robust public education programs in first aid and emergency response, such as Norway and Switzerland, show that these gaps can be closed. For example, nearly nine in 10 Norwegian middle-school students receive life support training, and in Switzerland, emergency education is mandatory for all residents.

Simple steps to strengthen emergency awareness

Start early: Integrate first-aid and emergency response lessons into school curricula.

Communicate clearly: Governments and hospitals should publicize local emergency numbers and guidance on urgent symptoms.

Empower digitally: Use mobile apps and online tools to teach the public how to recognize and respond to emergencies.

Target high-risk groups: Focus outreach on those with lower education, lower income, or limited health-system experience.

Train communities: Community-based programs can transform bystanders into first responders.

The role of the built environment in emergency preparedness

The study also highlights that public readiness for medical emergencies depends not only on knowledge, but also on the spaces people live in. The built environment—including hospital accessibility, road networks, and the distribution of emergency facilities—plays a critical role in shaping how quickly and effectively people can respond when emergencies occur.

In many urban centers, heavy traffic congestion, distant hospitals, or poorly marked emergency access routes can delay care and significantly worsen patient outcomes.

Conversely, communities with well-planned infrastructure, clear emergency signage, and equitable distribution of health care facilities tend to experience faster response times and higher survival rates. This connection between urban planning and emergency health outcomes is especially important as cities grow more crowded and complex.

Improving the built environment goes hand-in-hand with public education campaigns. Expanding ambulance coverage, integrating smart navigation systems, and ensuring hospitals are reachable by all neighborhoods can enhance the public’s confidence in using emergency services. In short, a well-designed environment supports not just mobility—but preparedness.

By aligning urban design with health literacy efforts, governments can create safer, more responsive cities where people and systems work together to save lives.

Building a more prepared public

Creating a more prepared global public requires collaboration across governments, health care institutions, educators, and communities. Emergency literacy cannot be treated as an optional skill—it is as essential as knowing how to read or drive. When individuals understand how to act in the first moments of crisis, they become an active part of the emergency care chain rather than passive victims of circumstance.

This study highlights that emergency preparedness is not solely about resources or technology, but about empowerment. People must feel confident in their ability to recognize danger, reach the right service, and provide basic assistance until professionals arrive. To achieve this, nations need sustained public education campaigns, accessible online resources, and inclusion of emergency health topics in schools, workplaces, and media.

Global cooperation can also help. Sharing successful national models—like community first-aid training programs in Scandinavia or digital emergency platforms in Asia—could guide countries still developing their public awareness systems. By treating emergency health literacy as a universal public health goal, societies can reduce avoidable deaths, improve emergency system efficiency, and foster a stronger sense of shared responsibility. In a world where health crises can strike anyone, anywhere, preparation is everyone’s business.

This story is part of Science X Dialog, where researchers can report findings from their published research articles. Visit this page for information about Science X Dialog and how to participate.

Amer Abukhalaf is an assistant professor at the Nieri Department of Construction and Real Estate Development, Clemson University. Abukhalaf is also a faculty scholar at the Clemson University School of Health Research. He researches risk management and safety design with a focus on natural hazards, built environment, crisis management, and emergency planning. Abukhalaf is also a civil engineer and a structural designer by practice and has a master’s in executive management from Ashland University in Ohio, and a Ph.D. from the University of Florida. He is a member of the Hazard Mitigation and Disaster Recovery Planning Division at the American Psychological Association.

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