INEM President Condemns 2024 Strike as Ethical Failure During Inquiry

Luís Cabral, the president of Portugal's National Institute of Medical Emergency (INEM), told a parliamentary commission of inquiry on March 31, 2026 that the 2024 strike by pre-hospital emergency technicians constituted a "serious ethical failure," while simultaneously announcing a sweeping modernization drive that includes tripling the number of emergency ambulances in Lisbon and equipping the entire fleet with geolocation tablets. Cabral, who took up the INEM presidency in November 2025, made the remarks during nearly five hours of testimony before the CPI established to examine INEM's conduct during the late-2024 strike and its relationship with government oversight since 2019. The hearing took place on the same day that a new indefinite strike by the same technician workforce began, targeting administrative work. Cabral described that new action as "unjust and unreasonable," setting the stage for a confrontation between INEM's leadership and the union representing the professionals who make up two-thirds of the institute's workforce.

Three deaths linked to 2024 strike delays, Cabral testifies Cabral told deputies that during the October 30 to November 4, 2024 strike, INEM "pure and simple stopped answering calls," and that the institute "failed by not being able to answer calls and activate means." According to conclusions by the General Inspectorate of Health Activities (IGAS), 12 deaths were recorded during the strike period, three of which were associated with delays in assistance. Cabral was careful to note that his condemnation of the technicians reflected his personal reading as a doctor and manager at the time — he was based in the Azores during the strike — and not the current institutional position of INEM. „On that day, those lines were crossed, with a clear lack of ethics” — Luís Cabral via Observador He argued that health professionals carry a particular obligation regardless of the legitimacy of their labor demands. „Professions in the health area know that regardless of the justice of their claims, there are limits that must not be crossed under penalty of harming those who need them, and who have no alternative” — Luís Cabral via Observador Cabral added that if an identical strike occurred now, "it would not have the same consequences," citing the minimum services determination he ordered as soon as the current strike notice was filed.

Key events in the INEM crisis: — ; — ; — ; —

Lisbon ambulance capacity to triple, tablets to track every vehicle On the same day as his testimony, INEM announced that it was activating 12 new Medical Emergency Posts (PEM) in Lisbon from midnight, with a planned expansion to 18 posts by the end of April 2026, up from the previous six — a tripling of capacity. Cabral told the commission that Lisbon had been operating with as few as four ambulances at certain points, against a target of 14, due to a shortage of human resources, and that he had decided not to wait for technician recruitment to fill the gap, contracting directly with firefighters instead. Cabral announced the purchase of 1,600 tablets to be distributed across all ambulance resources, with a software tender closing the following Friday and the first geolocated vehicles expected by the end of April 2026. He acknowledged that INEM currently has no active, continuous geolocation system across its fleet, with vehicle location only possible through the SIRESP emergency network and all operational recording dependent on manual operator input. The institute also stated that the CODU dispatch centers, after staffing adjustments that placed more technicians there, had seen average wait times fall from two minutes to 14 seconds. The Central Administration of the Health System transferred 10 million euros to INEM in 2026, funds that have already been forwarded to fire departments providing pre-hospital emergency resources, though Cabral warned the institute continues to face a "chronic deficit."

Lisbon emergency ambulance capacity: Medical Emergency Posts (PEM) active (before: 6 posts (prior to March 31, 2026), after: 18 posts planned by end of April 2026); CODU average wait time (before: 2 minutes, after: 14 seconds)

New strike begins as recruitment competition falls far short The new indefinite strike launched by the Union of Pre-Hospital Emergency Technicians (STEPH) on March 31, 2026 targets administrative work and recorded near-total participation, according to union president Rui Lázaro. Lázaro told the Lusa news agency that the action was designed to cause organizational disruption to INEM management — preventing the collection of statistical data, for example — without affecting emergency assistance to citizens. The union's grievances center on the non-implementation of three pharmacological action protocols covering pain, poisoning, and cardiorespiratory arrests, as well as what it describes as a withdrawal of competencies from technicians. Lázaro said that Minister of Health Ana Paula Martins had contacted STEPH after the strike notice was filed, indicating that Cabral would reach out to the union, but that three weeks passed without any contact from the INEM president. „Three weeks have passed and we still have not received any contact from the Mr. President of INEM, which leads us to foresee that we will have to move on to other protest actions” — Rui Lázaro via Correio da Manhã Compounding the staffing pressure, a recruitment competition for 200 new technicians for the Lisbon and Tagus Valley and Alentejo delegation had only 68 candidates remaining as of March 31, with some of those still at risk of failing the training under way during the experimental period. Cabral said he would not wait for that process to conclude before crewing Lisbon's expanded ambulance network, relying instead on firefighter partnerships to fill the operational gap.

Portugal's pre-hospital emergency medical services were created in 1964. The modern system covering continental Portugal operates under SIEM, the Integrated Medical Emergency System, managed by INEM in partnership with firefighters and the Portuguese Red Cross. The parliamentary commission of inquiry into INEM was approved in July 2025, following a proposal from the liberal IL party, and is composed of 24 deputies tasked with determining political, technical, and financial responsibilities related to the institute's current situation, with a specific focus on the 2024 strike and INEM's relationship with government oversight since 2019.