We aim to compare the quality of CPR performed with our new EMS transport protocol to standard transport protocol using during on scene resuscitation and during transport within a high-rise building using elevator with ongoing resuscitation in a manikin simulation trial. Total 44 simulations were underwent by 3 teams. In 2 simulations (1 standard-CPR, 1 flexible stretcher with ACD CPR), CPR data lost due to mechanical error of resuscitation manikin CPR. Data from 42 simulations were collected for final analysis. Mean total no-flow fractions were 33.4% for standard CPR and 31.7% for FS with ACD CPR (p=0.06). Mean chest compression depth was deeper and proportion of chest compressions with adequate depth was higher in FS with ACD CPR (55.1 mm vs. 58.2 mm; p<0.01 and 83.2% vs. 92.9%; p<0.01, respectively). In simulation with resuscitation manikin in 3 EMT vertical transport scenario , using flexible stretcher and ACD device decreased no-flow fraction and proportion of chest compressions with adequate depth