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Emergency medical services in Portugal are organized in three separate systems, one each covering Continental Portugal, the Azores and Madeira. The largest system is the SIEM, which covers the territory of Continental Portugal.
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The modern Portuguese emergency medical services were created in 1964, initially being provided only in the major cities (Lisbon and then Porto, Coimbra, Aveiro, Setúbal and Faro) by PSP Police ambulances and staff. These services were activated through a telephone call to the national emergency number 115. In 1971, the National Ambulance Service (SNA) was created, theis being latter absorbed by the INEM when this was created 10 years later. The SIEM was created in 1980. In the 1990s, the national emergency number 115 was replaced by the European common emergency number 112.
Emergency medical services providers
In Portugal, there are three major emergency medical services providers, these being the National Institute of Medical Emergency (INEM), the fire departments and the Portuguese Red Cross.
The INEM is the agency of the Portuguese Ministry of Health, which is responsible to coordinate the Integrated Medical Emergency System of Continental Portugal and to directly provide some of its emergency medical services. Of the services provided by the INEM, some of them are operated by their own staff (e.g. guidance centers and ambulances in major cities), while the operation of others is delegated in the staff of the local fire departments and of the Portuguese Red Cross but using INEM's equipment (e.g. ambulances in small towns).
The fire departments - the great majority of them being voluntary fire departments - are traditionally the major local providers of emergency medical services, both in Continental Portugal and in the islands.. Virtually all of the more than 400 fire departments include an emergency medical services unit. Outside of the main cities, the local fire departments are the primary responsible to provide this services in their respective areas of responsibility, which usually coincide with the territory of a municipality. The services are provided through the use of the departments' own means or - by delegation of the INEM - using equipment provided by this agency. In the main cities, the emergency medical services units of the fire departments act merely as backups or reinforcements of the INEM.
The Portuguese Red Cross - through its Corps of Rescue Units (CORUS) - is another major provider of medical emergency services. It usually acts as backup or reinforcement of both the INEM and the fire departments.
The SIEM
The Integrated Medical Emergency System (Portuguese: Sistema Integrado de Emergência Médica) or SIEM is centrally managed by the National Institute of Medical Emergency (INEM). It covers Continental Portugal and operates like other SAMU/IEMS networks of Europe or Brazil.
In Portugal, the free of charge emergency telephone number for emergency medical service is the 112. When someone calls 1-1-2, the call is directed to a PSP Police dispatch center. Accordingly, to the type of emergency, the PSP dispatch center redirects the call to the appropriate emergency services. In Continental Portugal, medical emergency calls are directed to one of the INEM's urgent patients guidance centers (Portuguese: centro de orientação de doentes urgentes) or CODU. There are four regional CODU (Lisbon, Oporto, Coimbra and Faro). Additionally, there is the CODU-Mar that responds to medical emergencies at the sea.
Besides the CODU, the SIEM also includes the INEM's Anti-Poison Information Center (CIAV) - that provides 24/7 toxicological medical information at national level (including in Azores and Madeira) - and the Pediatric Inter-Hospital Transport (TIP) subsystem - providing emergency transportation of high risk newborns to specialized hospital units.
Under the coordination of the CODU, a number of specialized mobile resources operate, including ambulances, fly cars, air ambulances and motorcycle ambulances. The ambulances are either directly operated by the INEM from its regional delegations or are operated from the medical emergency and reserve posts installed in the local fire departments or local delegations of the Portuguese Red Cross.
Services in the Portuguese Atlantic islands
As part of their developed power, the Portuguese autonomous regions of Azores and Madeira have their own separate emergency medical services, under the control of the respective regional secretaries of Health. These services are smaller but share many common features with the SIEM.
In Madeira, the emergency medical services are coordinated by the Regional Medical Emergency Service (SEMER), mirroring in the region the role of the INEM in Continental Portugal. The SEMER includes the Rapid Intervention Medical Team (EMIR) prepared to provide medical rescue in any part of the region, including rescue in maritime and air environment if needed.
In the Azores, the emergency medical services are centrally managed by the Regional Civil Protection and Fire Service.
Unlike Continental Portugal, where the air ambulance service is mainly provided directly by the INEM through its own helicopters, in the Atlantic islands, the Portuguese Air Force is in charge of the emergency patient evacuations between islands and from ships, using rotary and/or fixed wing aircraft (usually EADS CASA C-295 aircraft operated by the 502 Squadron and EH-101 helicopters operated by the 751 Squadron), in combination if needed.