The report from the Health Activities Inspectorate General (IGAS), accessed by Lusa today, suggests that the death of a patient from an acute myocardial infarction on November 4, 2024, during a strike at the National Institute of Medical Emergencies (INEM), could have been prevented if assistance had been provided within a minimal and reasonable timeframe, allowing the victim to be transported via a Coronary Green Path to one of the nearest hospitals for a coronary angioplasty.
Experts consulted by IGAS explained that such a procedure must be performed within a maximum of 120 minutes from the first symptom, indicating that the arrival time of the first specialist medical unit exceeded this critical window.
The IGAS report criticizes the behavior of the pre-hospital emergency technician at the Coimbra Urgent Patient Guidance Center (CODU), stating that “the diligence and care required by the case were not applied”. The report emphasizes the case’s extreme seriousness and the medical emergency best practices mandating utmost urgency in sorting and dispatching assistance, which the inspection concludes did not occur.
If the first specialized unit—Pombal’s Immediate Life Support (SIV) ambulance—arrived an hour and 26 minutes after the initial 112 call, which took 10 minutes to be answered, the second dispatched unit (Leiria’s Medical Emergency and Resuscitation Vehicle, VMER) reached the scene one hour and 50 minutes later.
Alongside the pre-hospital emergency technician, IGAS also blames the on-duty physician at CODU Coimbra, who, despite being aware of the victim’s situation, “did not expedite the deployment of a more specialized emergency unit, namely the VMER, given the seriousness of the clinical situation”, describing this as an “omission” and “legally and disciplinarily reprehensible”.
“This professional behavior demonstrates, above all, a lack of understanding of the dynamics of Medical Emergency,” states IGAS.
The report further notes: “The most evident aspect of this behavioral framework is the complete disregard, perhaps indifference, to the functional duties of a regulatory physician. This is reprehensible on all counts.”
It also argues that, since the physician is accredited and authorized by the Medical Association to practice clinical activities in primary health care, hospital environments, and within INEM, he should have had the adequate knowledge that the victim, if promptly assisted, could be referred to the region’s Coronary Green Path at hospitals.
IGAS adds that the delays in service from the 112 call to the dispatch of the Pombal SIV Ambulance and Leiria’s VMER are “indicative of inefficiencies” and “legally reprehensible”, suggesting disciplinary accountability for both the CODU Coimbra pre-hospital emergency technician and the regulatory doctor due to “deviant behavior.”
“Both acted with a lack of diligence, care, and attention, not adhering to best medical emergency practices prescribed by the INEM Organic Law,” it notes.
Following IGAS’s conclusions, INEM confirmed on Wednesday that disciplinary action will be initiated against the pre-hospital emergency technician to “clarify the situation and take appropriate measures”.
IGAS confirmed at least one death during the National Institute of Medical Emergency strike at the end of 2024. The victim was a 53-year-old man from the Pombal municipality.
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This incident dates back to November 4, 2024, a day marked by simultaneous strikes by pre-hospital emergency technicians over overtime and public administration staff.
IGAS initiated several inquiries to determine the potential link between 12 deaths and alleged delays in CODU INEM’s response. In two cases, the process was dismissed, while in this case, the correlation between the victim’s death and the delay in assistance was established.
