Background In the last decade, the specialty of Emergency Medicine has gained tremendous interest in low and middle income countries, with a demand for new training programs, pre-hospital systems, emergency department expansions and policy change. Yet, little is known about the actual distribution of medical emergencies in these settings. Aim Project EMcounter proposes the implementation of this much needed, uniform, multi-center epidemiologic survey of emergencies in India to provide sound scientific data upon which new training programs, infrastructural expansions, and legislative change can be built. Methodology A standardized, web-based, user-friendly data entry tool, EMcounter, forms the backbone of this project. The tool is currently piloted at a tertiary center in Chennai, India. The project is aimed at capturing the geographic and temporal variations in over 20 participating centers across the private and public sector in rural and urban India. The uniform use of the web-based tool ensures standardization in data collection across the centers. Our pilot project logs patient demographics, pre-hospital transportation, chief complaints, vitals, interventions, disposition and diagnoses. The volume of data thus collected is large and is currently saved in a spread sheet format. Observations The first quarter has already begun to highlight the epidemiologic differences between a local hospital in Chennai and national averages in the US. The pilot phase has been critical in gauging the robustness of the tool before its expansion to multiple centers and has proved to be invaluable in identifying potential flaws. Conclusion The early pilot phase has demonstrated that combining the multiple parameters available through the EMcounter database will allow the study of demographics and existing practice algorithms. Expansion of the project to multiple centers will shed objective light on the gaps in health-care provision at various levels and help design triage and transfer guidelines based on these data. This epidemiologic knowledge can potentially have significant influence in shaping the inventories and designs of emergency departments, and identifying staff needs and skill requirements. The project aims to seek and analyze data that will make the development of emergency medicine in India locally relevant.