Comprehensive Risk Analysis of Emergency Medical Response Systems in Serbian Healthcare: Assessing Systemic Vulnerabilities in Disaster Preparedness and Response

Emergency Medical Response Systems (EMRSs) play a vital role in delivering medical aid during natural and man-made disasters. This quantitative research delves into the analysis of risk and effectiveness within Serbia's Emergency Medical Services (EMS), with a special emphasis on how work organization, resource distribution, and preparedness for mass casualty events contribute to overall disaster preparedness. The study was conducted using a questionnaire consisting of 7 sections and a total of 88 variables, distributed to and collected from 172 healthcare institutions (Public Health Centers and Hospitals). Statistical methods, including Pearson's correlation, multivariate regression analysis, and chi-square tests, were rigorously applied to analyze and interpret the data. The results from the multivariate regression analysis revealed that the organization of working hours ( = 0.035) and shift work ( = 0.042) were significant predictors of EMS organization, explaining 1.9% of the variance ( = 0.019). Furthermore, shift work ( = -0.045) and working hours ( = -0.037) accounted for 2.0% of the variance in the number of EMS points performed ( = 0.020). Also, the availability of ambulance vehicles ( = 0.075) and financial resources ( = 0.033) explained 4.1% of the variance in mass casualty preparedness ( = 0.041). When it comes to service area coverage, the regression results suggest that none of the predictors were statistically significant. Based on Pearson's correlation results, there is a statistically significant correlation between the EMS organization and several key variables such as the number of EMS doctors ( = 0.000), emergency medicine specialists ( = 0.000), etc. Moreover, the Chi-square test results reveal statistically significant correlations between EMS organization and how EMS activities are conducted ( = 0.001), the number of activity locations ( = 0.005), and the structure of working hours ( = 0.001). Additionally, the results underscore the necessity for increased financial support, standardized protocols, and enhanced intersectoral collaboration to strengthen Serbia's EMRS and improve overall disaster response effectiveness. Based on these findings, a clear roadmap is provided for policymakers, healthcare administrators, and EMS personnel to prioritize strategic interventions and build a robust emergency medical response system.