to assess chest compression competency in healthcare providers following ALS training to identify areas for improvement and ensure high-quality CPR delivery.

Assessment of certain CPR metrics will be done by the following approach;

Pre-course assessment:

Baseline measurement of CPR skills for two minutes cycle using a validated simulator by specialized adult feedback manikins e.g. Prestan CPR Feedback Manikins (i.e. built-in indicators for compression rate and depth), the following metrics will be followed and recorded:

1. Chest Compression Metrics:

   A. Compression Depth: at least 2 inches (5 cm) for adults, with a maximum of 2.4 inches (6 cm)3.

   B. Compression Rate: 100 to 120 compressions per minute3. C. Release (Recoil): Full chest recoil is essential to allow for effective venous return3.

   D. Hands-off time (Pause): Measured during the simulation, less than 10 seconds3.

   E. Chest Compression Fraction (CCF): Calculated as the ratio of the time spent performing compressions to the total time spent on CPR (including compressions, ventilations, and any pauses). Target will be ≥80%4.

   F. Compression Quality: An overall assessment (percentage shown by the feedback device) of the effectiveness of compressions, which may include depth, rate, and continuity.

2. Ventilation Metrics:

A. Tidal Volume: Target will be 400-700 mL of air for visible chest rise (in adults)3.

B. Ventilation Rate: 1 breath every 6 seconds (10 breaths per minute during continuous chest compressions for adults)3.

Intervention:

Participants complete an ALS course, including theoretical and practical components focused on scenario based simulations for CPR and chest compressions.

Post-course assessment:

Immediate assessment at the end of the second day for CPR competency of 2 minutes cycle using the same simulator and the same parameters assessed pre-course.The scoring method is designed so that each item in the checklist is awarded zero or one point, with zero indicating lack of skill and one is indicating proficiency in the relevant area. Thus, participants' skills levels are determined and categorized.

Inclusion Criteria:

• Providers who will complete an ALS training course (two day-course).

Exclusion Criteria:

• Providers who will not complete ALS training course, those with physical limitations preventing effective chest compressions. Providers who will take immediate life support course (one day course), candidates attend from other courses to attend missed session and candidates who arrive late and cannot join the pre-course assessment.

results after acceptance for publication