The coordinators of 42 Medical Emergency and Resuscitation Vehicles (VMER) and the Rapid Intervention Medical Team (EMIR) from Madeira have issued a warning about the potential dismantling of Portugal’s Integrated Medical Emergency System (SIEM). They stress that this system has ensured quality, safety, and equity in pre-hospital response.
The statement from VMER follows reports of the replacement of INEM President Sérgio Janeiro by Luís Cabral, which has drawn criticism due to Cabral’s healthcare system implementation in the Azores.
The signatories emphasize that medical emergencies should not be treated as makeshift exercises or ideological experiments but must be rooted in rigor, science, and public responsibility.
“The Portuguese medical emergency model, which relies on integrated and supervised doctor-nurse teams, is the best for patients and ensures quality, safety, and equity,” they asserted.
According to the VMER coordinators, research indicates that medicalized rescue saves more lives and reduces sequelae. It shows higher survival rates after cardiac arrest (35.6% compared to 9-12%), better pain control, and more rapid hemodynamic and respiratory stabilization.
The coordinators warned that replacing this mature and specialized model with undifferentiated alternatives would be a grave error, potentially costing lives.
They expressed “unequivocal support” for a joint proposal from the Order of Doctors and the Order of Nurses, dated October 14, 2025, which includes strengthening the three existing support levels, enhancing urgent patient orientation centers (CODU), and investing in accredited and continuous training.
“The SIEM is a collective achievement—a model combining speed with competence, decision-making with humanity. It’s a technical and moral heritage that must be preserved and strengthened. Dismantling it would be a historical setback. We must invest in training, value teams, consolidate the role of INEM, and preserve the doctor-nurse matrix that distinguishes it,” they concluded.
On Friday, a Health Ministry source confirmed the replacement of INEM President Sérgio Janeiro as part of a recruitment process initiated in January. However, the successor’s identity was not disclosed.
Reports have named Luís Cabral as the likely replacement. The Pre-Hospital Emergency Technicians Union (STEPH) has expressed concerns about Cabral’s appointment, urging reconsideration.
The union claims that Cabral’s public positions and work in the Azores contradict the best scientific evidence and involve a system six times more expensive than that used on the mainland.
The Health Ministry and the President of the Republic stated that the replacement followed criteria from the Public Administration Recruitment and Selection Committee (CReSAP).
