Assessment of cardiopulmonary resuscitation skills using a clinical simulation approach among emergency medical personnel of the Kerman Emergency and Incident Management Center

Out-of-hospital cardiac arrest (OHCA) remains a major public health and emergency medical challenge worldwide, with generally poor survival outcomes. The quality of cardiopulmonary resuscitation (CPR) provided by prehospital emergency personnel plays a critical role in improving outcomes. This study aimed to assess basic and advanced CPR skills among operational staff of the Kerman Emergency and Incident Management Center using a clinical simulation-based approach. This descriptive cross-sectional study was conducted among 267 operational personnel, including emergency medical technicians (EMTs), nurses, and Red Crescent personnel, recruited using a census sampling method. CPR performance was assessed through a standardized adult cardiac arrest simulation using a newly developed 40-item CPR skills checklist based on the 2025 American Heart Association recommendations. The checklist covered key domains of basic life support (BLS) and advanced cardiac life support (ACLS). Data were analyzed using descriptive statistics, one-way analysis of variance (ANOVA), and multiple linear regression. The overall mean CPR skill score was 85.67 ± 19.11 out of 120. A significant difference was observed among professional groups (F = 9.89, P < 0.001), with EMTs having the highest mean score (90.00 ± 19.08) and Red Crescent personnel the lowest (79.20 ± 18.58). EMTs scored significantly higher than Red Crescent personnel, whereas the difference between EMTs and nurses was not significant. Significant group differences were observed in airway opening, bag-valve-mask ventilation, arrhythmia recognition, defibrillation, and Alert, Voice, Pain, Unresponsive (AVPU) assessment. In the adjusted regression model, Red Crescent personnel had significantly lower CPR skill scores than nurses, while work experience was positively associated with CPR skill scores. CPR skill levels differed among professional groups. EMTs demonstrated higher overall performance than Red Crescent personnel, particularly in airway opening and BVM ventilation, while nurses demonstrated higher performance in arrhythmia recognition and defibrillation. These findings support the need for regular competency-based training, simulation-based assessment, and targeted reinforcement of CPR skills among prehospital emergency personnel.