Purpose: Simulation training has been described as a positive participatory training and education method for paramedics. Therefore, we developed simulation programs for the continuing education of paramedics to improve prehospital acute medical care and medical transport for patients with illnesses and injuries and prevent further injuries by educating emergency medical service (EMS) paramedics Methods: A high-fidelity scenario simulation was performed to create a realistic scene. Skills, communication and leadership required during for the practices in the field were considered to develop simulation scenarios. The simulation curriculum was developed by working group consensus meetings and pre-course scenario discussions. The Ottawa Global Rating Scale (Ottawa GRS) were used to assess teamwork activities such as leadership, problem solving, situational awareness, resource utilization, and communication. Results: Procedures such as working group discussions, establishing training goals, simulation scenario developments and scenario outcome assessments were used to establish and evaluate the effects of the training curriculum. Four scenarios, including respiratory distress, arrhythmia, intoxication, and trauma, were used in the final curriculum. One hundred twenty-five paramedics attended the continuing medical education (CME) course and completed the simulation. The average class size for the simulation was 9 paramedics. Three paramedics were randomly grouped as a team during each simulation scenario. During the simulation, triage, initial survey, and management were performed according to standard practice guidelines. A videotape review and debriefing were performed after the simulation. Higher scores were noted in the group receiving repeated situational awareness and communication skills training (4.93 ± 0.73 versus 5.18 ± 0.70; 4.86 ± 0.75 versus 5.18 ± 0.73). Conclusions: This study successfully demonstrated the application of simulation training for paramedics in CME. Furthermore, repeated training improved teamwork performance and should be included as part of paramedic CME.