We performed a nested convenience sample survey of harmful alcohol use among injured patients aged 18 years and older treated in the Komfo Anokye Teaching Hospital (Kumasi, Ghana) emergency department (ED). Data from the Alcohol Use Disorder Identification Test, alcohol breath or saliva tests, patient demographics and injury characteristics were collected from an administered survey and medical chart review. A total of 403 subjects were surveyed, and 107 (27%; 95% CI 22 to 31) reported harmful alcohol use. High rates of harmful alcohol use were found among males (35%), acutely alcohol-positive subjects (55%), drivers (32%), pedestrians (35%) and assault victims (43%). A substantial proportion of injured patients reported harmful alcohol use. The data obtained support routine screening of injured patients presenting to Ghanaian EDs for harmful alcohol use.