In recent years there has been major improvement in the management of patients with serious injuries. The initial imaging technique for multiple trauma patients is also undergoing change. In addition, other innovations including specialisation in training (casualty surgery), preclinical services (emergency medical care/ambulance system), optimisation of early clinical procedures (guidelines for action) and modification of clinical treatment strategies (conservative/operative/interventional) have altered the management of these patients. Conventional X-ray diagnosis, which has played a major role to date, is now increasingly giving way to modern cross-sectional imaging, in particular CT. This tendency has been seen in Germany particularly since the introduction of spiral CT. However, to minimise any risk to critically injured patients, standards must be defined with regard to physical structure, emergency room equipment and quality. The basic principles, the current situation and suggestions for improvement with regard to the emergency management of multiple trauma patients are put forward and discussed from the radiologic point of view.