International EMS systems: Portugal E. Gomes a, , R. Araújo a , M. Soares-Oliveira b and N. Pereira b a UCIP—Unidade de Cuidados Intensivos Polivalente (General Intensive Care Unit), Department of Anaesthesiology Intensive Care and Emergency, Hospital Geral de Santo António, Largo Abel Salazar, Porto 4099-001, Portugal b INEM—Instituto Nacional de Emergência Médica (National Institute for Emergency Medicine), Portugal Resuscitation Volume 62, Issue 3, September 2004, Pages 257-260 doi:10.1016/j.resuscitation.2004.04.013 1. Introduction and objectives Pre-hospital Emergency Medical Services (EMS) are a relatively recent achievement in Portugal. Starting in Lisbon in the late 1980‘s, systems spread rapidly to most urban centres across the country. Pre-hospital EMS is now an established patient centred system that allows rapid access, stabilisation and transport of sick patients to the most appropriate hospital. This article provides an overview of the history of EMS in Portugal to date and outlines the objectives and aims for the future. EMS system configuration is not uniform all over the country. This is often due to variable medical involvement. We also provide an overview of the system design, funding, dispatch and team training. Hospital Emergency Departments are a critical link in the chain of care and are also discussed. As with pre-hospital EMS, there is some variability in the provision of emergency department care and the structure, organization, staffing and training is also discussed. The aims and future projects, both in the EMS and Emergency Department, are stressed. 2. Background Portugal has a resident population of just over ten million people distributed over a total area of 92.151 km 2 . The population distribution is not uniform with more than half of the population concentrated along the coast in the four main cities, Lisbon, Porto, Braga and Coimbra. The overall mortality rate in Portugal is 10.2 and the birth rate is 10.9 per 1000 inhabitants. The statistics for 2003 show a ratio of 3.2 doctors per 1000 people and 122 public hospitals [1] and [2].Health care in Portugal is mostly a public service funded mainly through taxation. Health sub systems and insurance companies are charged retrospectively for the medical service delivered [3]. 3. The pre-hospital EMS system 3.1. History The first emergency system started in Lisbon in 1965 and its aim was to transport patients to the nearest hospital. There was a specific emergency telephone number (115) and an ambulance staffed with an unpredictably trained crew (usually consisting of policemen), was dispatched. The National Ambulance Service was created in 1971 in an effort to spread the emergency system and the common access emergency number throughout the country. The concept of a national integrated emergency medical system was not implemented until 1980. The different elements of the system were brought together with the common simple aim of saving lives. This