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In 2008 Uranues published the results of a questionnaire sent to experts across 27 European countries on the assessment of attitudes toward acute care surgery and he concluded that no unified system of acute care surgery in Europe was yet developed due to different approaches to the surgical critical patient and that, with exception of some dedicated centres, the intra-hospital resources were not dedicated to acute care surgery patients with consequent negative impact on ideal treatment both in the elective and acute patients (1). The problem in most of European countries is still the same: who is the best surgeon to deal with these patients with an acute surgical condition? The era of the "omnipotent general surgeon" is to an end and in order to improve quality in specific areas many institutions dedicate most of their economic resources to highly specialized surgical units; nowadays young committed surgeons are therefore attracted by the so-called "organ specific surgery" and take care of emergency surgery and trauma cases just because of a contractual obligation. The lack of subspecialty in trauma and acute care and the lack of interest in the treatment of such complex surgical and trauma cases did not give impetus to the development of clinical standards or professional accreditations guidelines causing a perfect storm with consequent provided care that is less than optimal.

Acute Care Surgery: A Necessity Across Europe. Are We Ready to Take the Lead?