Precision medicine has the potential to transform acute care and emergency surgery by integrating molecular, genomic, and digital insights into real-time clinical decision-making. This chapter explores the current status of advances in multi-omics profiling, biomarker discovery, and artificial intelligence for acute surgery and how they are enabling personalised diagnostics, targeted therapies, and predictive analytics for patients. By linking deep molecular profiling and bioinformatics with surgical workflows, clinicians can now stratify patients by risk, tailor interventions, and improve recovery trajectories. The chapter highlights translational exemplars, from biomarker-guided sepsis management to precision coagulation and trauma genomics, showcasing how data-driven, patient-specific strategies can enhance safety and outcomes in time-critical scenarios. Critically, the potential transformational impact of precision medicine on emergency surgery is highlighted facilitating a shift from reactive care to proactive health optimisation.