Paramedic prehospital critical care has advanced significantly, despite these improvements, challenges persist, particularly in addressing knowledge and skill gaps among paramedics during critical situations (Brown, 2017.) As frontline responders in medical emergencies, paramedics play a crucial role in patient outcomes, with their interventions often determining the difference between life and death (Cimino and Braun, 2023).

The importance of continuous skill enhancement and knowledge updating for paramedics cannot be overstated. Research has demonstrated that paramedics can experience significant skill degradation over time. Studies have shown that trained paramedics may lose up to 50-61% of certain skills within 6 after completing their training programs.

Paramedic airway skills have been observed to decline by approximately 25% within 40 weeks after training (Garza et al., 2003). These findings underscore the critical need for regular refresher training to maintain and improve paramedic competencies.