“It is my intention to include everyone who wants to be part of the new National Institute of Medical Emergency (INEM). However, it is also my obligation to ensure a swift reformation process, so those who decide to remain inactive or resist change without justification will remain with the old INEM,” wrote Luís Mendes Cabral in a message sent today to employees.
About a month after taking over from Sérgio Janeiro, the president of INEM emphasized that “all who genuinely wish to improve emergency response for the population and restore the institution’s external image” will be included.
Luís Mendes Cabral further stated that the restructuring plan for the institute was built on recommendations from various inspections, audits, and evaluations conducted by entities outside INEM, which is why “they should not be a surprise to the employees.”
“The time for diagnostics, opinions, and discussions is over. The moment has arrived to implement the necessary changes so that INEM can meet the expectations of the Portuguese,” asserted the specialist in urgent and emergency medicine.
In his address, Luís Mendes Cabral highlighted that the reformation inevitably involves a new organizational structure, arguing that the country needs an agile, modern INEM with a focus on its clinical activities.
“The institute should move away from the institutional and territorial organization model of 1981 to meet the demands of a 21st-century healthcare providing institution,” noted its president, stating that the management of the Integrated Medical Emergency System (SIEM) is the core mission, around which “everything else revolves.”
“It is by this that Portuguese people assess us, mainly our ability to promptly respond to their rescue requests and dispatch an ambulance within the time defined by the triage. These two parameters will be our priority, even if it means relinquishing some services we currently offer,” Luís Mendes Cabral emphasized.
He also remarked that it is not comprehensible for emergency response to be heterogeneous and asymmetric, differentiating Portuguese citizens. For this reason, SIEM requires a pyramidal structure with three levels of response – Basic Life Support (BLS), Immediate Life Support (ILS), and Advanced Life Support (ALS).
In this context, he stated that the BLS level, with teams in ambulances, will be the foundation of the entire system and will define initial response times to the incident location, while the ILS and ALS levels will provide more specialized support, each at its own level of technical differentiation, with their respective teams in light vehicles.
Additionally, Luís Mendes Cabral stressed the importance of ensuring continuous training for operatives, asserting it is not possible for a professional to remain operational in various INEM capacities without any recertification for 20 years.
The president of the institute also mentioned that the events of November 4, 2024, a day marked by simultaneous strikes in public administration and pre-hospital emergency technicians during overtime hours, exposed the “existing fragilities and highlighted the importance” of advancing with the changes.
“From that date, it became a national objective to reform INEM. Where many saw misfortune, I saw the opportunity to fulfill the changes the institute has been asking for years,” remarked Luís Mendes Cabral, warning that “any cosmetic operation that fails to correct fundamental issues will be poorly received by the Portuguese and will perpetuate past mistakes.”
In response to this communication, the president of the Pre-Hospital Emergency Technicians Union expressed concern over the INEM president’s mention of “significant changes without the independent technical committee’s report being known,” created to propose alterations for the institute.
Rui Lázaro noted that Luís Mendes Cabral shows a “blatant ignorance by overlooking” that since 2016, there have been healthcare professionals in the special career of pre-hospital emergency technician who “provide differentiated medical emergency care and save lives with clinical operation protocols and medical validation well above the basic life support level.”
“The discourse used in the message, particularly stating that those not aligned with him will be left behind, reveals an attempt at leadership through fear, which we repudiate, and we invite to retract,” the union leader further mentioned.
