The Portugal Health Inspectorate (IGAS) has closed an investigation into an emergency response delay in Évora without determining responsibility, after the Portugal National Emergency Medical Institute (INEM) destroyed the telephone recordings central to the case. The destruction, carried out under a data protection rule limiting call retention to 90 days, has sparked alarm over accountability in a healthcare system already under severe strain.
Why This Matters
• No accountability: A 25-30 minute delay in dispatching an ambulance near Évora hospital in February 2025 cannot be explained because INEM erased the recordings before investigators requested them.
• Systemic pattern: The Évora case is one of dozens of recent emergency delays reported across Portugal, with ambulances stranded in repair shops and staff shortages leaving critical calls unanswered.
• Legal fallout: The Public Prosecutor has opened a criminal investigation into whether the destruction of evidence constitutes an offense.
The Évora Case: A Man Left Waiting Outside a Hospital
On 18 February 2025, a patient collapsed near the Hospital de Évora and called for help. Despite being meters from a medical facility, he waited up to 30 minutes for an ambulance. The IGAS inquiry, archived and released in May 2026, confirmed the delay was "excessive" and could have caused serious harm had the patient's condition been more complex.
The inspectorate acknowledged that the in-hospital emergency team at Évora is mandated only for incidents inside the building, meaning the man had to rely on the 112 system and the INEM dispatch center (CODU) even though he was within sight of the hospital entrance.
But when IGAS requested the phone recordings to reconstruct what happened at the CODU, the file had already been deleted. INEM cited a ruling by the National Data Protection Commission (CNPD) that requires call recordings to be destroyed after 90 days. The formal request came on 29 September 2025, by which point the audio was long gone.
Without the recordings, IGAS could not interview the emergency call operators or assess whether protocols were followed. The inquiry was closed without assigning responsibility.
A Widening Crisis: Fleet Failures and Staff Shortages
The Évora incident is part of a broader unraveling. On the same day in late May 2026, a 63-year-old man in Palmela died after waiting over an hour for a medical response. The call to CODU came at 14h45; the Advanced Life Support Vehicle (VMER) arrived at 15h52. INEM confirmed that response units from Setúbal, Barreiro, Almada, and Montijo were all engaged in other emergencies.
Health Minister Ana Paula Martins acknowledged on 31 May that the system is hampered by a chronic shortage of personnel. "Vehicles that are inoperative are so — most of the time — due to a lack of human resources," she told reporters. The government has been recruiting for two and a half years, she said, but the pipeline has not kept pace with attrition and rising demand.
The Union of Pre-Hospital Emergency Technicians (STEPH) has logged multiple delays in recent weeks, including two priority-1 cases in late May where no VMER was immediately available. In one, a woman in Santo António da Charneca with breathing difficulties and an allergic reaction waited nearly 30 minutes for the Red Cross to be dispatched. In another, a woman with chest pain in Quinta do Anjo waited 20 minutes for a motorcycle unit from Setúbal.
Dozens of Ambulances Sidelined by Breakdowns
Union president Rui Lázaro told Lusa that around 40 INEM vehicles are currently in repair shops. Normally, each regional delegation maintains reserve units, but as of late May, neither the North delegation nor the Lisbon and Tagus Valley region has a single spare ambulance.
"In recent days, several ambulances have been grounded for hours because there are no vehicles to swap in," Lázaro said. On 29 May, one of two INEM ambulances in Setúbal broke down between 13h30 and 18h00. A replacement was summoned from Pombal — which then also broke down. The following day, an ambulance in Seixal was out of service for over an hour with no backup available.
The logistics bottleneck has real-world consequences: even when personnel are on shift, they cannot respond if the vehicle is in the garage.
What the Government Is Doing — And When
In January 2026, the Cabinet approved the purchase of 275 new vehicles — 163 ambulances, 34 VHERs, and 78 support vehicles — for €16.8M. The tender was awarded on 7 January, and the vehicles are expected to be operational "close to summer" 2026, once retrofitting is complete.
A previous order under the prior government had envisaged 312 vehicles for €19M, with deliveries starting in 2024. That plan was scaled back and delayed by the current administration.
On 7 May 2026, the government approved a new legal framework for INEM, granting it the status of a Public Institute of Special Regime. The change is intended to allow more competitive salaries, more flexible hiring, and a clinical governance structure that includes a medical director and a nursing director on the board — a feature absent until now.
INEM also opened recruitment drives in early 2026: 30 doctors in January and 83 nurses in April, with the nursing deadline extended to 30 April. In March, 28 senior technician positions were advertised across legal, procurement, and engineering roles.
Impact on Residents
For anyone living in Portugal, the message is clear: calling 112 does not guarantee a rapid response. Even in urban corridors like Setúbal, Palmela, and Seixal — areas within 30 minutes of Lisbon — ambulances may be tied up, broken down, or simply unavailable.
If you or a family member requires emergency care, be prepared to:
• Call early and stay on the line. Operators may need to search multiple dispatch zones for an available unit.
• Know your nearest hospital emergency department. For non-life-threatening but urgent situations, consider whether private transport to the nearest emergency department is feasible. Never move someone with suspected spinal injuries, stroke symptoms, or heart attack. When in doubt, call 112 and wait for professional help.
• Report service failures. The STEPH union has set up channels for the public to flag delays, which feed into oversight and union advocacy.
The destruction of the Évora recordings also raises a troubling question: How many other incidents have been erased before investigators could review them? The 90-day retention policy, designed to protect privacy, may be shielding systemic dysfunction from scrutiny.
Lessons From Neighboring Systems
According to European emergency medicine research and healthcare system analyses, France, Spain, and Italy — all of which use variations of the Franco-German emergency model with strong physician involvement — manage reserve capacity differently. France's SAMU system triages calls through doctors, dispatching ambulances in only 65% of cases and relying on fire brigades for basic life support. Spain divides response into Advanced and Basic Life Support tiers, with regional autonomy and private contractors filling gaps. Italy leans heavily on volunteer organizations for Basic Life Support, backed by physician-led rapid response units.
Portugal could apply several lessons:
• Strengthen medical triage at dispatch centers to avoid sending advanced units to non-critical calls.
• Create a unified platform showing real-time availability across INEM, fire services, Red Cross, and private operators, allowing dispatchers to mobilize the nearest appropriate resource regardless of agency.
• Expand rapid response units with a doctor or advanced nurse who can stabilize patients on-site while the transport ambulance is en route.
• Formalize and equip volunteer and municipal responders — especially fire brigades — as integral, standardized components of the national network.
What Happens Next
The Public Prosecutor's investigation into the Évora recording destruction is ongoing. If charges are filed, it would be the first criminal case tied to INEM's data retention practices.
Meanwhile, the government's timeline called for operational changes to take effect by the end of the first quarter of 2026 — a deadline that has already passed. The new ambulances are expected in the coming weeks, but staffing them remains an open question. As of late May 2026, response times remain uncertain until the new fleet and staff are fully operational.
For residents across Portugal, the situation underscores an urgent need for systemic reform to ensure that emergency care remains truly accessible when minutes matter most.
