Bullfighting surgery in the XXI century

With regard to the article by Dr. Ríos¹ in which he rightly reflects on the problems of bullfighting surgery, we would like to add other topics for concern that should be considered.

If this surgery is "always urgent" and "with a high volume of activity", and the primary objective pursued is to "save life" in situ, it is easy to understand that poor outcomes² are invariably the result, given the lack of experience and equipment.

The quality of care that is required must encompass the clinical safety it needs, although promotion of research in this particular scenario is lacking: it is necessary to measure in order to visualize. As drugs are studied, so too must we be aware of the efficacy and safety of the "bullring infirmaries", which are so unequal in infrastructures for dealing with the same task, and indeed we consider them the Achilles' heel of bullfighting.

Quality of care is based on cycles of continuous improvement underpinned by three basic pillars: 1) structure: resources needed to meet material, human, financial and organisational objectives; 2) process: a series of interrelated tasks that together achieve the objectives; and 3) outcome: any change in health attributable to the process, and changes need to be measured by indicators based on scientific evidence³.

The current Bullfighting Regulations lack guarantees when they state that for bullfighting events that are not first or second class, "an anaesthesiologist is not required", ignoring the high incidence of injuries in the rest (third class bullrings and popular festivals), regardless of the seriousness of the injuries⁴.

Finally, we would like to leave a few questions unanswered because they are ambiguous: How is the inspection and enforcement function exercised? Which scientific societies have been involved in advising the responsible organisers? Who is responsible for the maintenance of the anaesthesia equipment? What are the quality and safety standards for performance and who monitors them?

There are many gaps to be filled and we must not look the other way. If we want to survive, we must get down to work.