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Editor, We thank Dr Petrino and co-workers for their letter1 in response to our recently published Editorial on CRitical Emergency Medicine (CREM).2 An open and clear discussion will help us to mutually understand our positions and to avoid misunderstandings. To further elucidate the facts and needs,2 we would like to condense our position into 10 basic principles, which also help clarify the relation between anaesthesiology and CREM. Optimal patient care – especially in life-threatening critical emergencies – should be the key concern for everyone taking care of critically ill or injured patients. It is a ‘patient's right’ to get the best and safest medical care. Medical care in emergencies covers a wide spectrum, from the new-born to the very old, from less severe to life-threatening illnesses, from a mild infection to sepsis, from minor injuries to severe trauma, cardiac arrest and cardiopulmonary resuscitation. The critically unwell are a small, but distinct group amongst all emergency patients; they require special attention. In countries that had poor access to medical services, implementation of emergency medicine as a specialty has improved medical care. In countries with highly developed and easily accessible medical services, the implementation of emergency medicine as an additional primary specialty has resulted in new inter-specialty ‘barriers’ and pathway disruption resulting in poor access to specialty care. Critical patients presenting with life-threating emergencies require coordinated, collaborative and continuous management, which includes vital function support, as well as diagnosis and treatment of the underlying disease. In life-threatening conditions, patients must have immediate access to doctors who have these competences and the corresponding interpersonal skills. Expertise in the support of vital functions with particular attention to airway management, vascular access and haemodynamic stabilisation represent the key competences of anaesthesiologists. Anaesthesiologists are exposed on a daily basis to vital function challenges in the unique environment of the operating room and in the ICU. It is this ceaseless exposure that has shaped the expertise needed in CREM. Only those who practise life-support skills on a daily base can safely and effectively apply them in emergency settings. It is our responsibility to provide critical or seriously injured patients with the best care in the safest way. The principles outlined above represent the cornerstones of patient safety in critical emergency medicine.2 Acknowledgements relating to this article Assistance with the reply: none. Financial support and sponsorship: none. Conflicts of interest: none.