António Carapeto, Inspector General of Health Activities (IGAS), has confirmed to press that an inquiry has been opened into the death of a 78-year-old man in Seixal on Tuesday, 6 January. The elderly man reportedly fell, called the National Institute of Medical Emergency (INEM) for help, and was forced to wait around three hours for emergency services to arrive.
According to the inspector general, IGAS intends to assess “the quality of the service in terms of responsiveness, particularly on the part of INEM”.
The case was first reported today, Wednesday, 7 January, by news agency Lusa and has since sparked controversy, coming just days after a new INEM triage system came into force. According to statements by the president of the Union of Pre-Hospital Emergency Technicians, the incident may “be related to the new triage system that has been in operation since the beginning of the year”.
However, that interpretation has been firmly rejected by INEM’s president, Luís Mendes Cabral, who attributed the delay to a lack of ambulances. “There were no ambulances available on the south bank of the Tejo river to respond,” he told journalists.
Facing scrutiny, the INEM chief insisted that “the response was delivered within the required timeframe”, stressing that “INEM did its job, carried out the triage correctly, and requested an ambulance after 15 minutes”. He nevertheless reiterated that “due to a lack of resources, it was not possible to provide that response”, adding that “there is a very significant shortage of ambulances on the south bank”. For reference, the ‘south bank’ refers to the area across the Tejo River from Lisbon.
Rui Lázaro, president of the Union of Pre-Hospital Emergency Technicians (STEPH), defended that the explanation may not be so straightforward. Speaking to press, he argued that the new triage system, which came into force last Friday, 2 January, and is also used in hospital emergency departments, may result in “the allocation of a priority level that allows a response time of up to 60 minutes, which can delay the active call for resources immediately after the case is opened, something that did not happen under the previous system”.
Lázaro went further, warning that similar situations have already occurred since the new system was introduced just days ago. He claimed that the union has been receiving daily reports of cases in which the maximum response times defined for each priority level are exceeded without any ambulance being dispatched, even when resources are available on the ground.
It should be recalled that INEM and its ongoing restructuring have been among the issues most frequently brought up in Parliament in debates with Minister of Health, Ana Paula Martins, who has repeatedly been called upon to explain incidents involving the institution.
The failure to allocate an ambulance to this individual has already drawn criticism from the opposition, particularly the Socialist Party (PS). PS MP Mariana Vieira da Silva has said that the health minister “limits herself to acknowledging the difficulties that exist and offers no response to those difficulties”, adding that her “presence is of little impact”. According to the MP, “when someone calls INEM today, they are hoping for luck, when they should just be able to expect a response”.
According to information published on INEM’s own website, the changes to the triage priority system were introduced to better “respond according to the severity” of each situation, while remaining aligned “with international best practices in emergency management, with the aim of making responses faster, fairer and more appropriate to the seriousness of each case”.
The new system came into force on 2 January and “establishes five priority levels, similar to the system used in hospital triage”. As explained on the website, each classification “always results from a clinical assessment carried out by professionals, based on the information gathered during the call to the European emergency number, 112”.
Each priority level is now associated with defined response times, “allowing for more rigorous management of emergency resources”.
The priority levels are as follows:
P1 – Emergency: situations involving imminent risk to life, requiring an immediate response, with the deployment of Basic Life Support units coordinated with Immediate or Advanced Life Support.
P2 – Very urgent: situations with high clinical risk, with the first resource expected to arrive on scene within 18 minutes.
P3 – Urgent: situations with a risk of clinical deterioration, requiring arrival within 60 minutes, with the deployment of a Basic Life Support unit.
P4 – Less urgent: situations associated with low clinical risk, with a Basic Life Support unit expected to arrive within 120 minutes.
P5 – Non-urgent: situations that do not require the deployment of emergency resources; calls are immediately transferred to the SNS 24 health line, where appropriate advice and referral are provided.
At the end of the call, the caller is allegedly “informed of the priority level assigned, the estimated response time and the defined referral pathway, as part of a clear commitment to transparency and to managing the expectations of those who call 112”. Callers are also asked to contact 112 again should the victim’s symptoms change or new symptoms emerge.
Source: DN / INEM
