On the analysis of the results of a survey on trauma systems in Spain.

We have read with interest the recent article by Costa Navarro about trauma systems in Spain that analyzed several hospitals specialized in trauma care. We would like to congratulate the authors for their review of more than 100 centers in their study and for the conclusions to which they arrived, with which we agree completely. However, we would like to make some comments based on what we have recently observed in prehospital emergency care. In its ATLS guidelines, the American College of Surgeons established the need for continuous training for prehospital services and trauma units. These guidelines include emergency departments, which in Spain, due to the presence of physicians at the prehospital care level, are omitted on many occasions. Continuity in healthcare is basic in many aspects, but even more so in trauma situations, as demonstrated in several studies. The quality of the information transmitted from prehospital services is far from adequate, and protocols should be established for patient transfers. Lastly, the departments involved in trauma patient care have been clamoring for trauma patient databases for a long time now. These databases are being implemented in several Spanish autonomous communities, but it is also necessary for them to include prehospital care aspects in order to be properly constructed.