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Textbook knowledge of sonography is not immediately applicable in emergencies where the favourable prerequisites characterizing the standard case are often lacking. The question therefore arises of what textbook knowledge is also viable in the average emergency unit, under what circumstances and for which clinical questions. The answer to this differentiated question is a graded concept with "primary emergency sonography", "extended" and "standard sonography". The indications and advantages of "primary emergency sonography" in contrast to standard procedure are discussed in detail. The key to success depends on meticulous introduction and training, strict compliance with indications and principle, and rigorous surveillance by an experienced ultrasonic specialist. In addition further scientific examination of the concept is necessary.