The National Institute of Medical Emergency (INEM) of Portugal revealed in its 2024 activity report that patients, despite being classified with the highest priority, were not attended by the most specialized teams.
The report explained that the clinical evolution of victims and proximity to a hospital often determined the use of less specialized ambulances.
In 2023, INEM registered 148,251 priority 1 (P1) incidents, representing severe situations requiring immediate advanced life support, with deployment of differentiated resources like Immediate Life Support ambulances (SIV), Emergency and Resuscitation Medical Vehicles (VMER), or helicopters.
These teams consist of doctors and nurses, while SIV ambulances are staffed by nurses and pre-hospital emergency technicians.
According to the annual management activity report, not all priority 1 incidents received the immediate or advanced life support deemed necessary.
In 2024, SIV ambulances were dispatched for 36,885 incidents, VMERs responded to 89,408 cases, and helicopters were deployed 997 times. Therefore, out of 148,251 priority incidents, there were 127,290 deployments of the most specialized resources, leaving 20,961 situations without the most specialized intervention, as reported.
“They likely received a response from medical emergency ambulances, INEM or firefighter teams staffed by technicians with less training and competencies,” it was noted.
The report also highlighted an annual discrepancy between critical incident numbers and VMER, SIV, or helicopter deployments, a gap that has widened since 2022. Nearly 17,500 critically triaged patients did not receive appropriate care in 2022, about 19,000 in 2023, and nearly 21,000 in 2024.
The activity report underscored significant human resources shortages within INEM: the staff has 1,304 occupied positions, 709 short of the intended 2,013.
The shortage of emergency technicians is particularly acute, with 501 vacancies, and difficulties in retaining doctors are evident with 26 out of 49 positions unfilled.
In terms of financials, the report revealed that expenses escalated and the year ended in deficit for the first time since 2020.
Revenues have not matched rising expenditures on firefighters and staff, prompting previous appeals by the institute’s president for an increased insurance beneficiary fee to ensure sustainability.
