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System · SAMU 192

Mobile Emergency Care Service (SAMU 192)

Problem
Mobile pre-hospital emergency care. In 2001, an ordinance of the Ministry of Health recorded low coverage and insufficient supply, with services mostly non-medicalized and unregulated, aimed only at trauma and concentrated in capitals and large cities; the 2002 regulation already provided for 192 as the national medical emergency number.
Who it serves
People in emergency situations; the Ministry of Health lists, among them, cardiorespiratory problems, accidents with victims, and suspected heart attack or stroke. Federal transfers go to qualified health departments that take responsibility for the management and administration of SAMU.
How it works
Implemented by Ordinance GM/MS No. 1,864/2003 as the mobile pre-hospital component of the National Emergency Care Policy and established in municipalities and regions by Decree No. 5,055/2004, which established national access through the single telephone number 192, made available by Anatel exclusively to the medical regulation centers linked to SAMU. According to the Ministry of Health, the service operates 24 hours a day, and the regulating physician provides guidance and dispatches ambulances when necessary. Funding is tripartite: 50% by the Union, transferred fund to fund by the National Health Fund, and the remainder covered by states and municipalities as agreed in each Bipartite Intermanagerial Commission.

Health

Relation to the Lula governments

Created under Lula · First term (2003 to 2006) · since September 2003

Ordinance GM/MS No. 1,864 of September 29, 2003, signed by Minister of Health Humberto Costa, established the mobile pre-hospital component of the National Emergency Care Policy through the implementation of SAMU-192, as the first stage of that policy.[1]

Ordinance 1,864/2003 established federal investment and operating funding for SAMU 192: resources for 650 basic support units, 150 advanced support units, up to 152 SAMU-192 Centers, and 27 teaching laboratories; tripartite operating funding with 50% borne by the Union, transferred fund to fund by the National Health Fund (R$12,500 per basic support team, R$27,500 per advanced team, and R$19,000 per center team, per month).[2]

Merged earlier initiatives · First term (2003 to 2006) · since September 2003

Ordinance 1,864/2003 provided that municipalities and states that met the criteria of the ordinance and already had mobile pre-hospital care services, operating in accordance with the legislation in force, could request supplementation of physical and financial resources, and that health departments with pre-hospital care services and a SAMU-192 Center already in operation would be immediately entitled to operating funds upon submitting to the Ministry of Health projects that included, among other items, a brief history of the service with its inauguration date.[3]

Shared implementation · First term (2003 to 2006) · since September 2003

Under Ordinance 1,864/2003, the remainder of the teams' operating costs is covered by states and municipalities as agreed in each Bipartite Intermanagerial Commission; the funds may not finance private providers, and transfers are limited to qualified health departments that take responsibility for the management and administration of SAMU.[4]

Origin and precursors

Origin milestone: founding legal act, First term (2003 to 2006).

Ordinance GM/MS No. 1,864 of September 29, 2003, signed by Minister of Health Humberto Costa, established the mobile pre-hospital component of the National Emergency Care Policy through the implementation of SAMU-192, as the first stage of that policy.[1]

Precursors

  • Ordinance 814/2001 (medical regulation) replaced Ordinance GM/MS No. 814 of June 1, 2001, signed by Minister José Serra, established the principles of medical regulation of emergencies and the standardization of the existing mobile pre-hospital emergency care services and of those that might be created; it revoked Ordinance GM/MS 824/1999. In the recitals, it records low coverage and insufficient supply, with services mostly non-medicalized and unregulated, aimed only at trauma and concentrated in capitals and large cities.[5]
  • Technical Regulation of State Emergency Systems (Ordinance 2,048/2002) earlier technical basis Ordinance GM/MS No. 2,048 of November 5, 2002, signed by Minister Barjas Negri, approved a regulation establishing the principles and guidelines of the State Urgency and Emergency Systems, covering pre-hospital care, and revoked Ordinance 814/2001. The regulation already provided for a regulation center easily accessible to the public by telephone, in a free system, with 192 as the national medical emergency number, or another number exclusive to health if 192 is not technically possible.[6]
  • Mobile prehospital care services already in existence absorbed Ordinance 1,864/2003 provided that municipalities and states that met the criteria of the ordinance and already had mobile pre-hospital care services, operating in accordance with the legislation in force, could request supplementation of physical and financial resources, and that health departments with pre-hospital care services and a SAMU-192 Center already in operation would be immediately entitled to operating funds upon submitting to the Ministry of Health projects that included, among other items, a brief history of the service with its inauguration date.[3]
  • Financing by procedure (Trauma I/II) replaced Ordinance 1,864/2003 established that receiving SAMU operating funds implies the interruption and revision of the financing mechanisms then existing for mobile emergency care; SAMU units would not be authorized to bill the Trauma I and Trauma II procedures through the SIA-SUS table.[7]

Precursor investigation: new structure established (October 13, 2026).

Scope: Rules and statements of reasons at the Planalto, publications of the ministries and oversight bodies, searches recorded in the dossier (research of October 13, 2026). Earlier municipal SAMUs (Campinas, Porto Alegre) not verified; Ordinance 824/1999 was not opened.

Responsibilities

  • States and municipalities (funding agreed in the bipartite commission) municipal implementation

    Under Ordinance 1,864/2003, the remainder of the teams' operating costs is covered by states and municipalities as agreed in each Bipartite Intermanagerial Commission; the funds may not finance private providers, and transfers are limited to qualified health departments that take responsibility for the management and administration of SAMU.[4]

  • Ministry of Health (requirements for transfers) federal management

    Ordinance 1,864/2003 made the obtaining of federal funds conditional, among other prerequisites, on the submission of Municipal or Regional Comprehensive Emergency Care Plans approved by the respective health councils and by the Bipartite Intermanagerial Commission and of a project to implement SAMU with its respective SAMU-192 Center, with free access through the national emergency number (192), in line with the Technical Emergency Regulation (MS Ordinance No. 2048, of November 2002).[8]

  • National Health Council and tripartite commission social participation

    In its recitals, Ordinance 1,864/2003 records resolutions of the National Health Council (131st meeting, June 2003) and contributions from CONASS and CONASEMS approved in a plenary session of the Tripartite Intermanagerial Commission on August 13, 2003.[9]

Timeline

Timeline of Mobile Emergency Care Service (SAMU 192)
DatePhaseWhat happened
September 29, 2003Legal actOrdinance GM/MS 1,864 establishes the mobile pre-hospital component.[1]
April 27, 2004Legal actDecree 5,055 establishes SAMU in municipalities and regions.[10]

What was established

Ordinance 1,864/2003 is based on Ordinance GM/MS No. 1,863 of September 29, 2003, which established the National Emergency Care Policy.[11]

Decree 5,055/2004 established, for SAMU care, national access through the single telephone number 192, made available by Anatel exclusively to the medical regulation centers linked to SAMU; municipalities or regions wishing to join would apply to the Ministries of Health and Communications, which would jointly decide on an agreement.[12]

How it works

According to the Ministry of Health, SAMU 192 is reached by dialing 192, operates 24 hours a day, 7 days a week, provides guidance and sends vehicles staffed by a trained team, dispatched by an Emergency Regulation Center; calls are forwarded to the Regulating Physician, who provides guidance and dispatches ambulances when necessary.[13]

Ordinance GM/MS 1,864/2003 provided for the purchase of ambulances at a ratio of one basic support vehicle for every group of 100,000 to 150,000 inhabitants and one advanced support vehicle for every 400,000 to 450,000 inhabitants.[14]

Who it serves

The Ministry of Health lists among the situations for calling SAMU 192 cardiorespiratory problems, poisoning, severe burns, labor with risk of death, suicide attempts, accidents with victims, and suspected heart attack or stroke, and lists among those that do not justify a call prolonged fever, chronic pain, and taking patients to appointments or tests.[15]

Budget and spending

Figures are nominal unless stated otherwise. Announced, authorized, committed, liquidated and paid amounts are different things and appear with the type indicated. In SIOP lines, "paid" means paid within the same fiscal year (arrears settled later are not counted), and one budget action can fund more than one program: the text says when the action is only part of a program.

In SIOP, nominal values: in 2008, action 8761 (Mobile Emergency Care Service - Samu 192) had an authorized appropriation (law plus credits) of R$375,029,450, commitment of R$299,294,296, liquidation of R$299,294,296, and payment in the fiscal year of R$278,297,831; and in 2010, action 8761 had an authorized appropriation (law plus credits) of R$575,929,490, commitment of R$522,151,218, liquidation of R$522,151,218, and payment in the fiscal year of R$453,818,103.[16]

Deliverables

Announcement, contracting, completion and operation are different phases.

In a presentation to the Chamber of Deputies (file dated June 7, 2021), the Ministry of Health reports that SAMU 192 currently provides coverage to 85.45% of the Brazilian population and that since 2004, 10,433 mobile units have been donated for implementation, enlargement, expansion, and renewal of the fleet.[17]

According to a presentation by the General Coordinator of Emergency Care of the Ministry of Health to the Chamber of Deputies (file dated September 12, 2023), the ministry reported SAMU 192 coverage of 86.6% of the population, in 3,917 municipalities.[18]

Audits

In Report No. 61 on the Evaluation of the Execution of a Government Program (August 2016), with inspections in the fiscal years 2013 to 2015, the CGU attested to the uninterrupted operation of the 27 Emergency Regulation Centers evaluated, but identified deficiencies in minimum structure in 8 and a shortage of professionals in 14 (51%) of them; of the 806 ground mobile units qualified in the municipalities evaluated, 151 (18.73%) were out of service at the time of the inspections.[19]

In Ruling 1147/2026-Plenary (monitoring of the patient journey for acute myocardial infarction in the SUS in Belo Horizonte, Brasília, and Fortaleza), the TCU found that SAMU's total transport time (from the call to 192 until delivery at the hospital) systematically exceeds the operational limit of 60 minutes in the capitals analyzed: in Fortaleza, only 12.8% of patients reached the reference hospital within 60 minutes, with the average transport time at 127.6 minutes, and in Belo Horizonte the average was 67.9 minutes. According to the report, the technical director of SAMU Fortaleza acknowledged that the time records in the system do not accurately reflect the real dynamics of the incidents.[20]

Limitations

According to the study by O'Dwyer et al. (Cadernos de Saúde Pública, 2017), based on document analysis, interviews with state emergency coordinators, and an expert panel, the implementation of SAMU was uneven across states and regions, with structural difficulties in retaining physicians, poorly equipped regulation centers, and a shortage of ambulances, especially in the North and Northeast; the performance of the service was affected by the limited participation of primary care in the emergency network and mainly by the lack of hospital beds.[21]

According to the census-based descriptive study by Malvestio and Sousa (Ciência & Saúde Coletiva, 2024), with data from the Outpatient Information System on SAMU 192 between 2015 and 2019, the 116.8 million procedures analyzed result from a 28.5% increase over the period, while the population covered and the mobile resources grew by 9.7% and 14.4%; the production of procedures exceeded the growth in population covered, but national productivity proved lower than international productivity.[22]

Precursors

In its recitals, Ordinance 1,864/2003 cites Ordinance No. 2048/GM of November 5, 2002, which establishes the Technical Regulation of the State Urgency and Emergency Systems.[23]

Sources and evidence

Excerpts are quoted in the original language of the source.

  1. 1. Ordinance GM/MS No. 1,864 of September 29, 2003, signed by Minister of Health Humberto Costa, established the mobile pre-hospital component of the National Emergency Care Policy through the implementation of SAMU-192, as the first stage of that policy.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 1. Accessed October 13, 2026.
      “Art. 1º Instituir o componente pré-hospitalar móvel previsto na Política Nacional de Atenção às Urgências, por meio da implantação de Serviços de Atendimento Móvel de Urgência - SAMU-192, suas Centrais de Regulação (Central SAMU-192) e seus Núcleos de Educação em Urgência”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 1 (end) and signature. Accessed October 13, 2026.
      “em municípios e regiões de todo o território brasileiro, como primeira etapa da implantação da Política Nacional de Atenção às Urgências [...] Esta Portaria entra em vigor na data da sua publicação, revogadas as disposições em contrário. HUMBERTO COSTA”

  2. 2. Ordinance 1,864/2003 established federal investment and operating funding for SAMU 192: resources for 650 basic support units, 150 advanced support units, up to 152 SAMU-192 Centers, and 27 teaching laboratories; tripartite operating funding with 50% borne by the Union, transferred fund to fund by the National Health Fund (R$12,500 per basic support team, R$27,500 per advanced team, and R$19,000 per center team, per month).

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 3, caput. Accessed October 13, 2026.
      “Art. 3º Estabelecer que, para a organização da primeira etapa de implantação dos SAMU, serão destinados recursos para a aquisição de 650 unidades de suporte básico de vida e 150 unidades de suporte avançado de vida, equipamentos, construção, reforma e/ou ampliação de até 152 Centrais SAMU-192 e estruturação de 27 Laboratórios de Ensino em Procedimentos de Saúde para os Núcleos de Educação em Urgência.”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 4, caput and § 1. Accessed October 13, 2026.
      “Art. 4º Definir que as despesas de custeio deste componente serão de responsabilidade compartilhada, de forma tripartite, entre a União, Estados e Municípios, correspondendo à União 50% do valor estimado para estes custos.”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 4, § 1, subitems a to c. Accessed October 13, 2026.
      “a) por Equipe de Suporte Básico: R$ 12.500,00 por mês; b) por Equipe de Suporte Avançado: R$ 27.500,00 por mês; c) por Equipe da Central SAMU-192: R$ 19.000,00 por mês.”

  3. 3. Ordinance 1,864/2003 provided that municipalities and states that met the criteria of the ordinance and already had mobile pre-hospital care services, operating in accordance with the legislation in force, could request supplementation of physical and financial resources, and that health departments with pre-hospital care services and a SAMU-192 Center already in operation would be immediately entitled to operating funds upon submitting to the Ministry of Health projects that included, among other items, a brief history of the service with its inauguration date.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 6, subitem q. Accessed October 13, 2026.
      “q) Os Municípios e Estados que atendam os critérios aqui estabelecidos e que já possuam serviços de atendimento pré-hospitalar móvel, operativos nos moldes da legislação vigente, poderão solicitar complementação dos recursos físicos e financeiros, fazendo jus, após aprovação do pleito, ao montante global dos recursos de custeio, incluída a parte já existente do serviço.”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 7, main provision. Accessed October 13, 2026.
      “Art. 7º As secretarias municipais e estaduais de saúde com serviços de atenção pré-hospitalar e Central SAMU – 192 já em funcionamento nos moldes da legislação referida farão jus imediato dos recursos de custeio mediante apresentação ao Ministério da Saúde de projetos que contemplem:”

  4. 4. Under Ordinance 1,864/2003, the remainder of the teams' operating costs is covered by states and municipalities as agreed in each Bipartite Intermanagerial Commission; the funds may not finance private providers, and transfers are limited to qualified health departments that take responsibility for the management and administration of SAMU.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 4, § 2. Accessed October 13, 2026.
      “§ 2º O restante dos recursos necessários para o custeio das equipes será coberto pelos Estados e Municípios, em conformidade com a pactuação estabelecida em cada Comissão Intergestores Bipartite”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 3, §§ 9 and 10. Accessed October 13, 2026.
      “§ 9° Os recursos a ser transferidos pelo Ministério da Saúde em decorrência do disposto nesta Portaria não poderão ser utilizados para o financiamento de prestadores da rede privada (filantrópica e lucrativa). § 10. Os recursos de investimento e custeio terão seus repasses limitados às secretarias de saúde qualificadas que se responsabilizarem pela gestão e gerência do SAMU e das Centrais SAMU - 192.”

  5. 5. Ordinance GM/MS No. 814 of June 1, 2001, signed by Minister José Serra, established the principles of medical regulation of emergencies and the standardization of the existing mobile pre-hospital emergency care services and of those that might be created; it revoked Ordinance GM/MS 824/1999. In the recitals, it records low coverage and insufficient supply, with services mostly non-medicalized and unregulated, aimed only at trauma and concentrated in capitals and large cities.

    • Portaria GM/MS nº 814, de 1º de junho de 2001 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: art. 2. Accessed October 13, 2026.
      “Art. 2° Estabelecer, na forma do Anexo II desta Portaria, a Normatização dos Serviços de Atendimento Pré-Hospitalar Móvel de Urgências já existentes, bem como dos que venham a ser criados no País.”
    • Portaria GM/MS nº 814, de 1º de junho de 2001 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando a baixa cobertura populacional e oferta insuficiente de atendimento pré-hospitalar móvel, constituída em sua maioria por serviços não medicalizados e não regulados, destinados apenas ao atendimento ao trauma e localizados, a maior parte, em capitais e grandes cidades;”
    • Portaria GM/MS nº 814, de 1º de junho de 2001 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: art. 5 and signature. Accessed October 13, 2026.
      “Art. 5º Esta Portaria entra em vigor na data de sua publicação, revogando a Portaria GM/MS n° 824, de 24 de junho de 1999. JOSÉ SERRA”

  6. 6. Ordinance GM/MS No. 2,048 of November 5, 2002, signed by Minister Barjas Negri, approved a regulation establishing the principles and guidelines of the State Urgency and Emergency Systems, covering pre-hospital care, and revoked Ordinance 814/2001. The regulation already provided for a regulation center easily accessible to the public by telephone, in a free system, with 192 as the national medical emergency number, or another number exclusive to health if 192 is not technically possible.

    • Portaria GM/MS nº 2.048, de 5 de novembro de 2002 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: art. 1, § 1. Accessed October 13, 2026.
      “§ 1º O Regulamento ora aprovado estabelece os princípios e diretrizes dos Sistemas Estaduais de Urgência e Emergência, as normas e critérios de funcionamento, classificação e cadastramento de serviços e envolve temas como a elaboração dos Planos Estaduais de Atendimento às Urgências e Emergências, Regulação Médica das Urgências e Emergências, atendimento pré-hospitalar, atendimento pré-hospitalar móvel”
    • Portaria GM/MS nº 2.048, de 5 de novembro de 2002 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: art. 6 and signature. Accessed October 13, 2026.
      “Art. 6º Esta Portaria entra em vigor na data de sua publicação, revogando a Portaria GM/MS nº 814, de 01 de junho de 2001. BARJAS NEGRI”
    • Portaria GM/MS nº 2.048, de 5 de novembro de 2002 · Ministry of Health (BVS Saúde Legis) Official legal act
      Where: Annex, Technical Regulation, medical regulation. Accessed October 13, 2026.
      “A central deve ser de fácil acesso ao público, por via telefônica, em sistema gratuito (192 como número nacional de urgências médicas ou outro número exclusivo da saúde, se o 192 não for tecnicamente possível)”

  7. 7. Ordinance 1,864/2003 established that receiving SAMU operating funds implies the interruption and revision of the financing mechanisms then existing for mobile emergency care; SAMU units would not be authorized to bill the Trauma I and Trauma II procedures through the SIA-SUS table.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 5, caput and sole paragraph, I. Accessed October 13, 2026.
      “Art. 5º Estabelecer que o recebimento dos recursos de custeio previstos nesta Portaria, implicará na interrupção e revisão dos mecanismos de financiamento atualmente estabelecidos, correspondentes às atividades de atenção móvel às urgências.”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 5, sole paragraph, I. Accessed October 13, 2026.
      “I. Aos SAMU não será autorizada a apresentação de faturamento de serviços com base na tabela SIA-SUS, por intermédio dos procedimentos Trauma I e Trauma II”

  8. 8. Ordinance 1,864/2003 made the obtaining of federal funds conditional, among other prerequisites, on the submission of Municipal or Regional Comprehensive Emergency Care Plans approved by the respective health councils and by the Bipartite Intermanagerial Commission and of a project to implement SAMU with its respective SAMU-192 Center, with free access through the national emergency number (192), in line with the Technical Emergency Regulation (MS Ordinance No. 2048, of November 2002).

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 6, subitem a. Accessed October 13, 2026.
      “a) elaboração, formalização e apresentação de Planos Municipais ou Regionais de Atenção Integral às Urgências, articulados ao Plano Estadual de Atenção às Urgências, aprovados pelos respectivos conselhos de saúde e pela Comissão Intergestores Bipartite.”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 6, subitem b. Accessed October 13, 2026.
      “b) Apresentar projeto de implantação/implementação do Serviço de Atendimento Móvel de Urgência – SAMU, com sua respectiva Central SAMU-192, de caráter local ou regional, com acesso gratuito pelo número nacional de urgências (192), em consonância com as diretrizes contidas no Regulamento Técnico de Urgências (Portaria MS n.º 2048, de novembro de 2002).”

  9. 9. In its recitals, Ordinance 1,864/2003 records resolutions of the National Health Council (131st meeting, June 2003) and contributions from CONASS and CONASEMS approved in a plenary session of the Tripartite Intermanagerial Commission on August 13, 2003.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: final recitals. Accessed October 13, 2026.
      “Considerando as contribuições apresentadas pelo Conselho Nacional de Secretários de Saúde (CONASS) e pelo Conselho Nacional de Secretários Municipais de Saúde (CONASEMS), aprovadas em Plenária da Comissão Intergestores Tripartite – CIT, realizada em 13 de agosto de 2003, resolve:”
    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: recital on the CNS. Accessed October 14, 2026.
      “Considerando as deliberações do Conselho Nacional de Saúde (CNS), aprovadas na sua 131ª reunião, de 4 e 5 junho de 2003”

  10. 10. Decree No. 5,055 of April 27, 2004, signed by Luiz Inácio Lula da Silva, Humberto Sérgio Costa Lima, and Eunício Oliveira, established SAMU in municipalities and regions of the national territory.

    • Decreto nº 5.055, de 27 de abril de 2004 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 1. Accessed October 13, 2026.
      “Fica instituído, em Municípios e regiões do território nacional, o Serviço de Atendimento Móvel de Urgência - SAMU, visando a implementação de ações com maior grau de eficácia e efetividade na prestação de serviço de atendimento à saúde de caráter emergencial e urgente.”
    • Decreto nº 5.055, de 27 de abril de 2004 · Presidency of the Republic (Planalto) Official legal act
      Where: closing and signatures. Accessed October 13, 2026.
      “Brasília, 27 de abril de 2004; 183 da Independência e 116 da República. LUIZ INÁCIO LULA DA SILVA Humberto Sérgio Costa Lima Eunício Oliveira”

  11. 11. Ordinance 1,864/2003 is based on Ordinance GM/MS No. 1,863 of September 29, 2003, which established the National Emergency Care Policy.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando a Portaria nº 1863/GM de 29 de setembro 2003, que instituiu a Política Nacional de Atenção às Urgências;”

  12. 12. Decree 5,055/2004 established, for SAMU care, national access through the single telephone number 192, made available by Anatel exclusively to the medical regulation centers linked to SAMU; municipalities or regions wishing to join would apply to the Ministries of Health and Communications, which would jointly decide on an agreement.

    • Decreto nº 5.055, de 27 de abril de 2004 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 2. Accessed October 13, 2026.
      “Art. 2 o Para fins do atendimento pelo SAMU, fica estabelecido o acesso nacional pelo número telefônico único – 192, que será disponibilizado pela ANATEL exclusivamente às centrais de regulação médica vinculadas ao referido Sistema.”
    • Decreto nº 5.055, de 27 de abril de 2004 · Presidency of the Republic (Planalto) Official legal act
      Where: art. 3. Accessed October 13, 2026.
      “Art. 3 o Os Municípios ou regiões que pretenderem aderir ao SAMU deverão formular requerimento aos Ministérios da Saúde e das Comunicações, que decidirão, conjuntamente, sobre a assinatura de convênio para a disponibilização do número de acesso nacional, bem como a definição dos procedimentos a serem adotados.”

  13. 13. According to the Ministry of Health, SAMU 192 is reached by dialing 192, operates 24 hours a day, 7 days a week, provides guidance and sends vehicles staffed by a trained team, dispatched by an Emergency Regulation Center; calls are forwarded to the Regulating Physician, who provides guidance and dispatches ambulances when necessary.

    • SAMU 192 · Ministry of Health Government communication
      Where: Info block, 3rd paragraph. Accessed October 13, 2026.
      “acessado pelo número 192, funciona 24 horas por dia e 07 dias por semana”
    • SAMU 192 · Ministry of Health Government communication
      Where: Info block, 3rd paragraph. Accessed October 13, 2026.
      “por meio da prestação de orientações e do envio de veículos tripulados por equipe capacitada, acionados por uma Central de Regulação das Urgências.”
    • SAMU 192 · Ministry of Health Government communication
      Where: section When to Call SAMU 192?. Accessed October 13, 2026.
      “Em seguida, as chamadas são remetidas ao Médico Regulador”

  14. 14. Ordinance GM/MS 1,864/2003 provided for the purchase of ambulances at a ratio of one basic support vehicle for every group of 100,000 to 150,000 inhabitants and one advanced support vehicle for every 400,000 to 450,000 inhabitants.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: art. 3, § 3. Accessed October 13, 2026.
      “As ambulâncias serão adquiridas na proporção de um veículo de suporte básico à vida para cada grupo de 100.000 a 150.000 habitantes, e de um veículo de suporte avançado à vida para cada 400.000 a 450.000 por habitantes.”

  15. 15. The Ministry of Health lists among the situations for calling SAMU 192 cardiorespiratory problems, poisoning, severe burns, labor with risk of death, suicide attempts, accidents with victims, and suspected heart attack or stroke, and lists among those that do not justify a call prolonged fever, chronic pain, and taking patients to appointments or tests.

    • SAMU 192 · Ministry of Health Government communication
      Where: list WHEN TO CALL. Accessed October 13, 2026.
      “Na ocorrência de problemas cardio-respiratórios; Intoxicação exógena e envenenamento; Queimaduras graves;”
    • SAMU 192 · Ministry of Health Government communication
      Where: list WHEN TO CALL. Accessed October 13, 2026.
      “Trabalhos de parto em que haja risco de morte da mãe ou do feto; Em tentativas de suicídio;”
    • SAMU 192 · Ministry of Health Government communication
      Where: list WHEN TO CALL. Accessed October 13, 2026.
      “Quando houver acidentes/traumas com vítimas;”
    • SAMU 192 · Ministry of Health Government communication
      Where: list WHEN TO CALL. Accessed October 13, 2026.
      “Suspeita de Infarto ou AVC”
    • SAMU 192 · Ministry of Health Government communication
      Where: list WHEN NOT TO CALL. Accessed October 13, 2026.
      “Febre prolongada; Dores crônicas; Vômito e diarreia; Levar pacientes para consulta médica ou para realizar exames;”

  16. 16. In SIOP, nominal values: in 2008, action 8761 (Mobile Emergency Care Service - Samu 192) had an authorized appropriation (law plus credits) of R$375,029,450, commitment of R$299,294,296, liquidation of R$299,294,296, and payment in the fiscal year of R$278,297,831; and in 2010, action 8761 had an authorized appropriation (law plus credits) of R$575,929,490, commitment of R$522,151,218, liquidation of R$522,151,218, and payment in the fiscal year of R$453,818,103.

  17. 17. In a presentation to the Chamber of Deputies (file dated June 7, 2021), the Ministry of Health reports that SAMU 192 currently provides coverage to 85.45% of the Brazilian population and that since 2004, 10,433 mobile units have been donated for implementation, enlargement, expansion, and renewal of the fleet.

  18. 18. According to a presentation by the General Coordinator of Emergency Care of the Ministry of Health to the Chamber of Deputies (file dated September 12, 2023), the ministry reported SAMU 192 coverage of 86.6% of the population, in 3,917 municipalities.

  19. 19. In Report No. 61 on the Evaluation of the Execution of a Government Program (August 2016), with inspections in the fiscal years 2013 to 2015, the CGU attested to the uninterrupted operation of the 27 Emergency Regulation Centers evaluated, but identified deficiencies in minimum structure in 8 and a shortage of professionals in 14 (51%) of them; of the 806 ground mobile units qualified in the municipalities evaluated, 151 (18.73%) were out of service at the time of the inspections.

  20. 20. In Ruling 1147/2026-Plenary (monitoring of the patient journey for acute myocardial infarction in the SUS in Belo Horizonte, Brasília, and Fortaleza), the TCU found that SAMU's total transport time (from the call to 192 until delivery at the hospital) systematically exceeds the operational limit of 60 minutes in the capitals analyzed: in Fortaleza, only 12.8% of patients reached the reference hospital within 60 minutes, with the average transport time at 127.6 minutes, and in Belo Horizonte the average was 67.9 minutes. According to the report, the technical director of SAMU Fortaleza acknowledged that the time records in the system do not accurately reflect the real dynamics of the incidents.

  21. 21. According to the study by O'Dwyer et al. (Cadernos de Saúde Pública, 2017), based on document analysis, interviews with state emergency coordinators, and an expert panel, the implementation of SAMU was uneven across states and regions, with structural difficulties in retaining physicians, poorly equipped regulation centers, and a shortage of ambulances, especially in the North and Northeast; the performance of the service was affected by the limited participation of primary care in the emergency network and mainly by the lack of hospital beds.

  22. 22. According to the census-based descriptive study by Malvestio and Sousa (Ciência & Saúde Coletiva, 2024), with data from the Outpatient Information System on SAMU 192 between 2015 and 2019, the 116.8 million procedures analyzed result from a 28.5% increase over the period, while the population covered and the mobile resources grew by 9.7% and 14.4%; the production of procedures exceeded the growth in population covered, but national productivity proved lower than international productivity.

  23. 23. In its recitals, Ordinance 1,864/2003 cites Ordinance No. 2048/GM of November 5, 2002, which establishes the Technical Regulation of the State Urgency and Emergency Systems.

    • Portaria GM/MS nº 1.864, de 29 de setembro de 2003 · Ministry of Health (Saúde Legis / BVS) Official legal act
      Where: recitals. Accessed October 13, 2026.
      “Considerando a Portaria n.º 2048/GM, de 5 de novembro de 2002, que institui o Regulamento Técnico dos Sistemas Estaduais de Urgência e Emergência;”

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