Hybrid emergency room system (HERS): a system-based approach to CT-integrated resuscitation for trauma and non-trauma emergencies

Abstract Background The hybrid emergency room system (HERS) integrates resuscitation, whole-body computed tomography (CT), surgery, and interventional radiology (IR) in a single space, eliminating intrahospital transport during early care. Over the past decade, HERS has evolved from a hardware-based innovation into a system-based model combining CT-integrated resuscitation workflows with a dedicated command hierarchy and standardized protocols. However, clinical evidence remains fragmented, and system-level implications have not been comprehensively reviewed. Main body This narrative review summarizes the concept, workflows, cognitive pitfalls, and clinical outcomes associated with HERS, integrating published evidence with the authors’ institutional experience. We define HERS and its time–space advantages relative to conventional trauma bay and hybrid operating room configurations, and describe major hardware models, including catheter-table–based and operating-table-based systems, as well as dual-room configurations sharing a CT gantry. We outline team organization and the role of the HERS commander, emphasizing clear command hierarchy, closed-loop communication, and HERS-specific communication tools such as SBAR for trauma. The ABC–CT–DE approach represents a HERS-specific adaptation of the primary survey, integrating whole-body CT into the evaluation of circulation (“C”). To manage CT data volume, we describe the modified Focused Assessment with Computed Tomography for Trauma (mFACT), a CT-based summarizing tool prioritizing injuries with high risk of imminent physiological deterioration. We review evidence on trauma outcomes, including mortality, functional outcomes, transfusion requirements, and cost-effectiveness, and summarize emerging non-trauma applications in ruptured aortic disease, cardiogenic shock with extracorporeal cardiopulmonary resuscitation, acute ischemic stroke, and complex abdominal or obstetric emergencies. Finally, we discuss cognitive traps associated with CT-integrated resuscitation within HERS and propose a multilevel future research agenda for HERS implementation and evaluation. Conclusion HERS provides time–space advantages and a system-based framework for CT-integrated, procedure-ready emergency care. Available evidence suggests that HERS is associated with improved process measures and resource utilization, with potential outcome benefits in selected high-risk populations, while introducing cognitive challenges. Future research should clarify where, for whom, and under what conditions HERS provides greatest value within regional trauma and emergency care systems.