To the Editor:
The contribution (we take as such his letter of reply that refers to our editorial article on Chest Pain Units [CPU] published in this journal1) by Jiménez Murillo et al, representing the Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) (Spanish Society of Urgent and Emergency Medicine), is welcome and appreciated. It was a pleasure to accept, at the time, the task from the Ischemic Cardiopathy Section of the Spanish Cardiology Society (SCS) of coordinating the consensus document regarding CPUs,2 and to provide our comments in said editorial on the first favorable clinical results obtained in Spain with the use of the recommended methodology, as shown in the excellent article by Pastor et al,3 and with appreciation for the contribution of the SEMES. The principal aim of the previously mentioned directories2 (in the elaboration of which, of course, emergency medicine experts participated as well as cardiologists) was precisely what Jiménez et al mention in their letter: to make better use of resources, increase coordination of the personnel and units actually involved in the care of patients who present in an urgent clinical state (not emergency patients, please) and, thus, to increase to the maximum the quality of such care. It is precisely this enthusiasm for the integration of services that governed the SCS group who designed the above-mentioned document to not go provide excessive detail regarding the requirements, procedures, or responsibilities of CPUs, with the purpose of allowing each to be organized locally in response to the their particular version of the wide variety of situations that occur in our country. There is no doubt that the organizations Jiménez et al mention fit perfectly into the proposed structure: an excellent example of this is the Hospital de Valme group.3 The road, then, to rectify the deficiencies and difficulties that Jiménez et al correctly refer to in their letter is, precisely, the functional integration that we defend and celebrate. We are working together (virtually or physically), then, toward the same end, without in the same direction, without disparate demands or sterile posturing.
The substantial, courageous, and relevant contribution of García Cosío is no less welcome, and is replete with his known scientific rigor, intellectual depth, and enthusiasm for collaboration with the SCS. Actually, when reviewing his account of how cases of chest pain are treated on the cardiology service of Getafe University Hospital, it appears to be a description, more or less, of a virtual chest pain unit exactly as defended (or as at least we attempted to defend) in the editorial on which he comments.1
Once again, the purpose of the work document concerning CPUs2 was to create a framework for action that embraces the infinite number of particularities of our country, without hiding the defects but also without refusing to improve them where we can, without having to base them on the experiences of countries with very different situations. In the title of our editorial «Total Development is Urgent» (although because of an, in our judgment, inadequate stylistic correction on the part of the journal, the effect that the use of capital letters was intended to achieve was lost as was its free translation into English: mimicking the abbreviations CPU/CPU) we justly use the term «development,» which is farther-reaching than «creation,» to attempt to communicate the idea of autonomous function. The rapid appearance of results from 2 different groups3,4 is but a demonstration of the possibilities of focusing on the issue in this way.
We understand the comments of García Cosío to show that on his service they have considered various ways to efficiently care for patients with acute chest pain and have chosen those that are most in accordance with the resources available to them. This consideration is, surely, the principal consideration with regard to the success of CPUs, regardless of whether in the end they are organized physically or virtually, whether they are multi or single disciplinary, large or small, located in the emergency service or the cardiology service, or are called CPUs, another name, or no name at all.