Rescue breathing performance skills on a pediatric simulator for a four month old baby of 10 – 12 pounds reported. Students in a regular PALS class were given training on correct protocols and given access to an accurate device with real time feedback. 135 students across multiple classes demonstrated rapid improvement; average of their best score 62.6% (mode = 77.5; median = 69.8). 22.2% achieved the target score of 70% or better when performing according to the AHA guidelines. A two tail t-Test shows significant difference of 21.3 (probability < 0.0001) where students perform well and where they have difficulty in the performance of sub skills. Further analysis shows that 72.6% of students struggle with the rate to deliver the inhalation. This study suggest that given the current time constraints of existing PALS classes even with sophisticated detailed feedback which shows rapid dramatic skills improvement the majority of students meet a plateau which requires more time in order to master.