Fewer Nurses on Portuguese Ambulances Raise Response-Time Fears

The next time you dial 112 for an ambulance, understand that Portugal’s emergency lifeline is running on fewer nurses than it says it needs. Union leaders, government officials and the country’s emergency service – INEM – are locked in a blame game that expats should follow closely because it affects response times everywhere from Lisbon’s historic center to the far-flung Algarve villages.

A nervous pulse beneath Portugal’s white-and-yellow sirens

Portugal’s National Institute for Medical Emergencies, better known as INEM, oversees every blue-flashing ambulance and coordinates the critical CODU call centers that dispatch them. In theory, the system guarantees a nurse on board each Suporte Imediato de Vida (SIV) ambulance, while doctors staff the VMER advanced life-support cars. In practice, 34 authorised nursing posts remain empty, forcing existing staff to clock unsustainable overtime and leaving vehicles stranded. From Porto’s riverfront to the Alentejo plains, the shortage is now visible in longer waits and, in a handful of tragic cases, fatal delays.

A reform that promised more muscle – and delivered more friction

The crisis did not erupt overnight. When Ana Paula Martins took over as Health Minister in late 2024 she announced a sweeping “refundação” – effectively turning INEM into an Autoridade Nacional de Emergência Médica. Centralisation of decision-making shifted hiring powers from the INEM board to the minister’s own office, something unions describe as “paralysing”. At the same time, a high-profile technical commission was told to rethink the agency’s structure, finances and legal footing. While the commission drafts its white paper, vacant nursing stations accumulate and regional directors complain privately that budget sign-offs have slowed.

Empty seats in the back of the ambulance

Up close the numbers feel less abstract. Estremoz, Évora – an hour from Spain’s border – saw its SIV crew grounded for half a day in June because no qualified nurse could be found to take the shift. Seven to eight small hospital urgent-care units have reported similar stand-downs since spring. Every time that happens, the nearest operational ambulance must cover a wider radius, raising the average drive-to-patient interval well beyond the 20-minute guideline set by the Directorate-General of Health. A leaked inspection into a July fatality in Bragança, where a man waited 80 minutes despite living 2 km from a VMER base, called the delay “unacceptable”.

Government and unions trade accusations while overtime piles up

The Sindicato dos Enfermeiros Portugueses (SEP) says the ministry’s hiring freeze “creates instability, fuels burnout and delays overtime pay that is already three months in arrears”. Officials at the ministry counter that budget discipline is necessary and point to a new salary-tier agreement for emergency medical technicians as proof they are investing. Yet overtime hours for INEM nurses have jumped nearly 40 % since January, according to data the SEP shared with reporters. The union has filed repeated demands for an urgent meeting; so far, both sides only agree the situation is “grave”.

Part of a wider nursing drain on the public system

The ambulance shortage mirrors a broader exodus from Portugal’s public health service (SNS). Across hospitals and community clinics, more than 1 500 nursing vacancies are officially recorded, with the Algarve reporting the sharpest ratio of unfilled posts to population. Better-paid contracts in France, Spain and the U.K. draw many Portuguese nurses abroad within two years of graduation. Meanwhile, a new national pay floor introduced this year has yet to narrow the gap between state and private salaries, let alone those on offer overseas.

Why foreign residents should pay attention – and how to prepare

For most emergencies the system still works, but expats should recognise that response times in rural Portugal can be longer than in Northern Europe or North America. Keep GPS coordinates ready, state your exact location clearly, and if you live outside a major city consider sharing gate codes or landmark details with neighbours who can alert responders. International insurance plans that include private ambulance partnerships may reduce wait times for non-life-threatening transfers, though they do not replace 112 for serious incidents. Portugal’s fire-brigade volunteer ambulances remain an essential back-up; storing the contact number of the nearest bombeiros can be prudent.

The road ahead: commission findings due, but hiring remains the litmus test

The independent commission studying INEM’s overhaul is expected to deliver recommendations by autumn. Ideas on the table include fast-track visas for foreign nurses, regional hiring autonomy and a bonus for night-shift ambulance crews. None will matter, unions insist, unless the government releases the funds to fill those 34 posts immediately. Until then, Portugal’s emblems of swift medical aid – the white vans with yellow chevrons – may continue to run with one critical seat empty.