Portugal’s Emergency Medical Service Faces Shake-Up After Grim Audit

Portugal’s ambulances have been taking longer to arrive, lifesaving helicopters have spent days grounded and call-centre desks often stand empty. Confronted with those hard numbers, Health Minister Ana Paula Martins is now promising a remodelling of INEM that she says will demand “political bravery” in equal measure to money. The plan touches everything from career ladders to fleet age, but critics argue that courage alone will not cure structural shortages built up over a decade.

A System Under Strain

Even before the pandemic, emergency response in Portugal was faltering; by 2024 the cracks were impossible to miss. The latest audit found 21 000 critically ill patients last year who were handled by crews with lower clinical training than guidelines recommend. At the same time, VMER cars – the gold-standard vehicles staffed with a doctor and a nurse – posted an inoperability rate of 1.95 %, the worst in ten years. Staffing gaps are equally glaring. INEM’s official roster lists 2 013 posts, yet 709 remain vacant, including 501 emergency technicians and 26 physicians. A shortage of call-takers means some 112 lines ring unanswered, even as total calls rise. These figures explain why President Marcelo Rebelo de Sousa warned publicly that “things are not going well”.

The Blueprint for a Turnaround

The cabinet’s response is a multi-layer package that starts with a new organic law designed to give INEM financial autonomy, allowing it to retain part of the fees it already bills private insurers. A freshly appointed three-member board would replace the current duo to tighten oversight. Parallel to the legal rewrite runs a Strategic Plan 2024-2026—revised this year—to modernise dispatch software, expand coverage in the interior regions and push tele-medicine pilots. Most visible to the public is a €60 M fleet revamp that obliges every ambulance partner to operate vehicles under six years old and introduces motorcycle first-responders in congested urban areas.

Money, People and Technology

Human resources sit at the core of the reform. A landmark deal with the Técnicos de Emergência Pré-Hospitalar union enshrines a three-tier pay scale, recognising seniority beyond 16 years of service and phasing in raises from January. An extra 200 technicians have already been authorised this summer, and a second cohort of 180 trainees is midway through coursework in Coimbra. Funding-wise, the ministry earmarked €110 M for 2025, up 17 % on the previous year, with a protected line for cloud-based CAD software aimed at reducing dispatch errors. A new triage algorithm—co-developed with Instituto Superior Técnico—promises to cut false high-priority calls by 12 %, easing pressure on scarce intensive care crews.

Voices From the Front Line

Reactions diverge sharply. The Emergency Technicians’ Union applauds what it calls the first “written commitment” by any minister to overhaul working conditions. Fire chiefs, newly covered by an updated subsidy agreement, are optimistic that shared protocols will end turf wars over who gets dispatched first. By contrast, the National Doctors’ Federation questions whether adding technicians without matching numbers of doctors and nurses will simply shift bottlenecks from the street to the hospital door. Health-policy scholars also warn that political turnover could dilute reforms once headlines fade; the independent review panel chaired by retired justice Leonor Furtado has until December to file binding recommendations, but ministers are under no legal obligation to adopt them.

What Comes Next?

Deadlines arrive quickly. The commission’s draft report is due in November, the new career statute is meant to enter into force on New Year’s Day and the first batch of modernised ambulances should be patrolling by spring. Success will be measured in raw minutes: officials have promised to bring the average urban response time back under 11 minutes and rural times under 17 minutes by the end of 2026. For residents from Bragança to Faro, that metric—rather than speeches about courage—will reveal whether Portugal’s emergency lifeline is finally back on its feet.