Abstract for: Understanding the Dynamic Challenges of Introducing Pre-Clinical Specialists in Emergency Medical Services: A System Dynamics Approach

Emergency medical services in the federal state of St. Gallen face growing strain as a rising share of missions involve non-urgent cases that still tie up scarce personnel, vehicles, and capacity. The Pre-Clinical Specialist (PFS) pilot role was introduced to manage these low-acuity operations and relieve existing EMS resources. Using a participatory system dynamics approach, stakeholders from operations, medical management, and project leadership co-developed reference modes of behavior for variables relevant to the PFS role. These were analyzed to derive an initial qualitative causal loop diagram capturing feedback mechanisms between deployment volume, staff competence, organizational support, and financial viability. As a qualitative, exploratory model, this work does not yet report simulated behavior. Preliminary structural analysis suggests reinforcing dynamics tied to dispatcher learning-by-doing may compete with balancing effects of risk-averse case assignment, potentially producing path-dependent underutilization of the new role. These findings indicate that policy-feasible role design alone may not translate into sustainable adoption without addressing dispatcher trust and learning delays. A planned stakeholder workshop will validate the model structure and inform subsequent simulation to test implementation scenarios and support strategic decisions for the PFS rollout. used to improve clarity and wording