The genesis of this project is a direct result of the fact that there is no substantive textbook that addresses the full-spectrum of surgical emergencies. Even in a ?eld in which there is a plethora of excellent textbooks on a variety of surgical topics (including trauma), there is no one reference book with a dedicated emphasis on both traumatic and nontraumatic conditions potentially necessitating surgical int- vention in the acute setting.This project became even more unique when its st- wise development paralleled the evolution of a new specialty–acute care surgery. This was far from a serendipitous link.On the contrary,my editorial colleagues and I, along with many of the contributors, have recently been part of a major effort to build the foundation for this new specialty.As with any proposed new specialty, there have been a few rough interfaces with some of the other surgical specialties regarding the scope of practice of the acute care surgeon. Fortunately, the key to this con?ict resolution will revolve around what is best for the patient. However, irrespective of these dynamics,there is a worsening crisis in acute care in this nation.