Emergency Mayhem is set in Crisis City, a metropolis where the player takes control of emergency services. The player must rescue people, put out fires, defuse bombs, and remove foreign objects from bodies as a paramedic using a magnet. The gameplay involves driving around the city with the Wii remote and using it to pump up tires by raising or lowering it, and putting out fires by waggling the remote side to side.
The game features challenge mode and career mode, where the player can choose to pick a certain event or drive around the city looking for emergencies. With 30 different missions available, the game also supports up to four players in party mode.