Note: Since this article was written for our print edition, the government has announced emergency solutions to the chaotic state of Portugal’s emergency medical services. Read about them here
Portugal’s emergency medical services are in “chaos”. At the start of the week, INEM (the national institute for medical emergencies) had 47 ambulances, from north to south of the country, ‘out of action’ due to a lack of paramedics – and this lack, combined with a syndicate work to rule over ‘extra hours’, has seen a dramatic fall in the number of people available to answer 112 calls.
As a result, on any given day recently, there have been reports of “up to 100 calls waiting to be answered”.
On Monday, that total reached between 130 to 140, all of them representing people, gripping their phones in anxiety, praying that their request for medical assistance would be answered quickly.
This inability by authorities to respond to emergencies in real time has seen reports of at least two deaths in the last week.
It has also seen INEM ‘instruct’ fire stations to ‘effect services’ before they are contacted in the normal fashion – and only update CODU (the centres for orientation of urgent patients) afterwards.
A closer analogy of chaos would be hard to find.
Monday also saw ANTEM – the national association of emergency medical technicians – announce that it is filing a complaint with the EU Court of Justice and the European Court of Human Rights because, as far as it can see, Portugal is no longer guaranteeing the right to health laid down in the Constitution.
In a statement, ANTEM accuses the governments of recent years of inertia – saying the system in this country “profoundly contradicts the most basic practices and ways of managing any effective, patient-focused Emergency Medical Service”.
ANTEM goes as far as suggesting that the “distorted system” is much more based on “corporatist interests” than those of any patients, who, the association claims, will pay for failings by having to endure “long term hospitalisations, morbidity and death” – when more prompt response to their emergencies could have seen much more favourable results.
As to STEPH’s claims of two deaths over the last few days, the government has said it “regrets” them and is investigating the circumstances in which they occurred.
The government has also ordered an ‘internal audit’ of INEM, which is not expected to be completed before the end of the month. That point will get the country to the pre-Christmas period, and the colder weather, which traditionally sees large numbers of people, not to mention seasonal visitors, getting ill, and requiring medical assistance.
In other words, an internal audit won’t change anything quickly (enough).
Rui Lázaro, president of STEPH, puts the picture into an easy to understand ‘nutshell’: of the 1480 technicians needed to man 112 lines in the various CODUs, there are currently only 700 available – and those 700 are on a work-to-rule over ‘excess hours’ following years of unresolved issues with the country’s governments.
Meantime, at least two families have had to organise funerals which they believe would not have been necessary had their 112 calls been answered on time.
The first death cited by STEPH took place last Thursday (October 31) – another day when there were more than 100 simultaneous calls on hold, according to Rui Lazaro.
The victim – a man aged 75 – was in cardiorespiratory arrest. His wife, making the call, had to wait over an hour for someone to answer her, by which time “nothing could be done to save him”, wrote Correio da Manhã.
On the same day in Vinhais, a 64-year-old man suffered an accident, and had to be transported to A&E in Bragança, where he is now an inpatient, by his daughter “because she could not get her call to 112 answered”, added STEPH in a communiqué.
The second death came over the weekend in Molelos, Tondela: A 94-year-old woman in cardiorespiratory arrest waited more than 40 minutes to see the call made by family members attended by the CODU. She died on the way to hospital.
As STEPH insists, ‘constraints’ caused by a shortage of pre-hospital emergency technicians are already well documented: they go back years. The dilemma has seen “more and more staff abandoning the only profession that operates exclusively in medical emergencies”, while successive governments appear to have done little more than shuffle papers.
This current government – hanging on to power without any kind of majority – likes to say “We have only been in office for six months…” as if this explains the mounting problems across multiple fronts (not to mention the societal unrest in inner city boroughs). But many don’t believe that it does: the last summer saw ‘increased chaos’ in maternity services; large numbers of births taking place in ambulances instead of in hospitals – and now even these births are compromised because there are no longer the number of ambulances in service that should be.
For a country that is ‘desperate’ to increase its birth rate, this is not a good look. Peek a little further and you come up against the news that 12,000 three-year-olds are ‘waiting for a place’ at a pre-school kindergarten.
The chaos in the country’s medical emergency response is just part of a much larger picture which is not coming to the end of another year with very much to recommend it.
