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

Emergency medical services (EMS) in St. Gallen face increasing strain due to a rise in non-urgent rescue operations that still consume critical resources. To address this inefficiency, a new role—the pre-clinical specialist (PFS)—is being developed to manage low-urgency cases. This study examines the systemic challenges and dynamics involved in implementing this role within EMS. This work applies a system dynamics approach embedded in a real-world implementation project. Through participatory modelling, stakeholders defined reference modes and key variables, which informed the development of a qualitative causal loop diagram. The model captures feedback mechanisms such as learning effects, resource constraints, and decision-making behaviors to explore the evolution of the PFS role. Preliminary results highlight interacting reinforcing and balancing feedback loops shaping the implementation. Learning-by-doing and increasing acceptance can drive higher deployment of PFS, while risk-averse decision-making, delays in competence development, and financial constraints may limit utilization. These dynamics can lead to path dependencies and potentially trap the system in a suboptimal equilibrium with underused capacity. The findings emphasize that successful implementation of new EMS roles depends not only on structural feasibility but also on dynamic organizational processes. Early-phase underutilization may hinder long-term success, suggesting the need for targeted support, training, and confidence-building. The model provides a foundation for future simulation and decision support to guide sustainable integration of the PFS role. used to improve clarity and wording