System-Level Barriers Impede CPR Performance Among EMTs in Taiwan

Strategic Insights -

Despite regular cardiopulmonary resuscitation (CPR) training, emergency medical technicians (EMTs) in Taiwan often struggle to transfer learned skills into real-world performance. A recent study using the Systems Engineering Initiative for Patient Safety and Kirkpatrick frameworks explored how system-level and contextual factors affect learning transfer in Taiwan. The research revealed that real-world CPR performance is more influenced by systemic and contextual obstacles than by individual competencies.

Key Takeaways:

  • EMTs in Taiwan face significant system-level barriers that hinder their ability to perform CPR effectively in real-world scenarios.
  • Automated external defibrillator voice prompts were found to be significantly associated with improved compression rates, while demographic factors had no impact on compression depth or recoil.
  • The regression model explained only a small fraction of performance variance, indicating that other factors beyond individual competencies play a crucial role in CPR performance.
  • Video data revealed common field errors, including equipment misplacement, delayed automated external defibrillator use, and poor team coordination.
  • Reflections from EMTs highlighted environmental barriers and the lack of structured debriefing as significant challenges in real-world CPR performance.
  • The integration of simulation, field video, and EMT reflections underscores that training-performance gaps must be addressed through system-level reforms rather than isolated technical retraining.

Statistics:

  • 123 EMTs participated in the study, which employed a mixed-methods design involving quality CPR simulation scores, video-recorded out-of-hospital cardiac arrest events, and EMT reflections.
  • The regression analysis found a significant association between automated external defibrillator voice prompts and improved compression rates (P = .03).
  • The regression model explained only a small fraction of performance variance, with an adjusted R2 of 0.04.
  • Video data revealed frequent field errors in 125 out-of-hospital cardiac arrest events.

Sources:

  • Huang, W.-H., et al. "From Training to Reality: System-Level Barriers and Behavioral Gaps in Prehospital Cardiopulmonary Resuscitation Among Emergency Medical Technicians in Taiwan." Journal of Continuing Education in the Health Professions, 2025.
  • Lippincott Williams & Wilkins. Journal of Continuing Education in the Health Professions. Two Commerce Sq, 2001 Market St, Philadelphia, PA 19103, USA.
  • NewsRx. Findings from Wei-Hsiang Huang and Co-Researchers in the Area of Health and Medicine Reported (From Training to Reality: System-Level Barriers and Behavioral Gaps in Prehospital Cardiopulmonary Resuscitation Among Emergency Medical Technicians ...). Medical Devices & Surgical Technology Week, November 2, 2025; p 454.