Ten-to-fifteen-minute low-fidelity drills that chain the manual's real workflows together — birth into dystocia into a blue baby, asthma into arrest into post-ROSC. One person reads the script; the recorder drives the actual cards. No mannequin required.
⚠ IN-SITU SIM SAFETY: announce "this is a simulation" at start and end, and post someone to catch real patients/calls. Never open real medications or sterile kits — sim props stay labeled SIM and never enter real stock. A real clinical need ends the sim immediately. Nothing about a real patient goes on the whiteboard or into the tools.
ORIENTATION MODE — new provider, nurse or tech?
Every sim below carries a FIND IT block: the equipment that case actually needs, with where the manual says it lives. Walk it with the person you are orienting — they find each item and say the location out loud, you tap FOUND. Anything that is not where it should be gets logged as a gap right there.
What you record goes into the same readiness record as the department's cart walk, on this device only. So an orientation session stops being a tour and starts being an audit: the new hire learns the room, and the department learns what is missing.
Sealed trays stay sealed — point at the thoracotomy tray, do not open it. Finding it is the drill; opening it costs a re-check.
HOW TO RUN A PILLOW SIM
Cast: 3–6 people. Minimum: a leader, a recorder (drives the manual — that's the skill being drilled), and a facilitator who reads the script and voices the monitor ("sat is 82"). Add hands, meds, and a family actor as available.
Stage: pillow in a gown on a stretcher. A rolled towel in a pillowcase is the baby. Vitals live on a whiteboard or the facilitator's voice. Point at where you'd push, cut, or place — say the dose out loud, give nothing.
Advance on actions, not time: each phase ends when the team does the things under ADVANCE WHEN. If they stall, the facilitator drops a hint ("what does the card say comes next?"), not the answer.
Recorder really uses the tools: open the linked card, enter the (fictional) weight, start the timers, tap the dose buttons. Half the value of these drills is fluency with the manual itself. RESET FOR NEXT CASE when the sim ends.
Always debrief — five minutes, same shift, using the Debrief card. Plus/delta/plus; one or two takeaways, owners named.
⌕
No sim matches — try a chain term like “arrest”, “airway”, or “PPH”.
Pillow-mom in a gown on the stretcher, knees-up. Towel-roll baby hidden under the gown. Whiteboard: G3P2 at term, "the baby is coming," 5 minutes out the door.
Roles: leader/deliverer · recorder (drives the OB tool) · nurse · facilitator (voices mom + vitals). Family actor optional.
Walk to the real OB cart — point at (don't open) the vaginal-delivery drawer and the airway/breathing drawer, so hands know where things live.
EQUIPMENT TO STAGE
Sim props: pillow + gown (mom) · rolled towel in a pillowcase (baby) · whiteboard + marker · one dry towel and a hat for the "baby" (these two may be real — they touch nothing sterile).
OB / Neonatal Cart · VAGINAL DELIVERY drawer: point, don't open — clamps, cord scissors, bulb suction live here.
OB / Neonatal Cart · AIRWAY / BREATHING drawer: point — infant BVM + masks. Stage a separate SIM-labeled infant BVM if you want hands-on PPV.
Radiant warmer: turn it on for real — warm-up time is part of the drill.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · IMMINENT DELIVERY
"She's pushing. You can see hair at the introitus. She screams — it's coming NOW."
Team says it out loud, calls for help, and works the maneuvers in order on the pillow — legs back (McRoberts), suprapubic pressure (someone actually places hands and says where and which direction).
Facilitator releases the "baby" after two maneuvers done correctly and narrated.
ADVANCE WHEN › two maneuvers are performed and narrated correctly.
PHASE 3 · THE BABY IS OUT — AND BLUE
"Baby's out — floppy, blue, not crying. Cord is cut. What do you do, and where?"
Towel-roll baby to the warmer. Warm–dry–stimulate, then PPV narrated at the right rate (use the card's metronome). Facilitator gives HR by voice: "HR 50… now 90 with good PPV."
Recorder logs 1- and 5-minute marks from the time-of-birth clock stamped in Phase 1 — that's the payoff of stamping it early.
END WHEN › HR > 100 narrated, baby "pinking up," 5-minute mark logged.
WHAT GOOD LOOKS LIKE + DEBRIEF
Time of birth stamped at delivery, not reconstructed later. Dystocia named out loud within seconds of the turtle sign. Nobody pulls harder — they change geometry.
The baby moves to the warmer with a named person, and PPV starts inside a minute of "not crying."
Debrief card prompts: where did the extra hands come from at the dystocia call — and was that the fastest path? · who watched mom while everyone watched the baby?
Runs on a table as a VEMS deck when you cannot get the room or the people.
S2Delivery → Postpartum Hemorrhage → MTP
OB SET · 12 MIN + DEBRIEF
DELIVERY DONE→PPH→MASSIVE TRANSFUSION
SETUP · 2 MIN
Pillow-mom post-delivery, placenta "out 10 minutes ago." A red towel or sheet under her is the growing puddle. Whiteboard: BP 112/70 → will fall.
Roles: leader · recorder (OB tool + Codes MTP card) · meds voice · facilitator. The facilitator adds "more blood on the sheet" every 90 seconds until the team escalates correctly.
EQUIPMENT TO STAGE
Sim props: pillow-mom · red towel/sheet (the growing puddle) · whiteboard for vitals + running EBL.
OB / Neonatal Cart · POSTPARTUM HEMORRHAGE drawer: point, don't open — uterotonics are named aloud, never handled.
Blood bank: the real MTP activation number, written where the team can read it (say it, don't dial).
JADA / balloon kit: point at where your department actually stocks it (see the labels tool).
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · IT'S NOT STOPPING
"The nurse calls you back in: 'she's soaking through pads.' Fundus feels boggy. Estimated loss so far: 700 mL and climbing."
Team works the card in order and says each dose out loud: uterine massage (hands on pillow, narrated), oxytocin, TXA with the time window stated, second IV, call OB.
ADVANCE WHEN › massage + two meds verbalized with doses, second IV named.
PHASE 2 · CURVEBALL — SHE'S CRASHING
"Loss is past 1.5 L. BP 78/40, HR 132, she's pale and confused. Uterotonics are in. What now, and who are you calling?"
Someone activates MTP by its actual phone number / process (say it, don't dial). Recorder opens the MTP card and assigns a blood runner and a checker.
Bonus branch if time allows: leader states the next mechanical step from the PPH card (balloon / JADA) and where that kit lives.
END WHEN › MTP activation is verbalized end-to-end and roles for blood are named.
WHAT GOOD LOOKS LIKE + DEBRIEF
Escalation happens on the trajectory (climbing loss + falling BP), not after a magic number. TXA's window is said out loud. The MTP call is a sentence, not a debate.
Debrief card prompts: what number or trigger would have made us call MTP one loop earlier? · did the recorder's card-driving keep pace with the room?
Runs on a table as a VEMS deck when you cannot get the room or the people.
S3Pediatric Asthma → Arrest → Post-ROSC
PEDS SET · 15 MIN + DEBRIEF
SEVERE ASTHMA→ARREST (PEDS MODE)→POST-ROSC
SETUP · 2 MIN
Small pillow = a 4-year-old, parent-reported 16 kg. Whiteboard: sat 84% on room air, silent chest. A parent actor at the bedside raises the difficulty nicely.
First move of the sim: recorder enters 16 kg in the Peds weight bar — every dose downstream, including in the arrest tool, hangs off it. That hand-off is the thing being drilled.
EQUIPMENT TO STAGE
Sim props: small pillow (the 4-year-old) · whiteboard · a phone/tablet with the Peds tool open — the weight bar is the first prop used.
Pediatric (Broselow) Cart · WHITE drawer (15–18 kg): point, don't open — this is the drawer 16 kg maps to.
SIM-labeled pediatric BVM (or mime it) · defib pads mimed on the pillow.
Code Cart · MEDICATIONS drawer: point — epi is named with its weight-based dose, never drawn up.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · SEVERE ASTHMA
"Four-year-old, third albuterol neb done, still sat 84, silent chest, sleepy. Parent: 'he's never been this bad.'"
Team escalates per the card and says the weight-based doses aloud (the card computes them from the 16 kg). Someone states what "getting worse" will look like and what the trigger to bag is.
ADVANCE WHEN › escalation doses verbalized from the card and the arrest trigger is stated.
PHASE 2 · CURVEBALL — HE STOPS
"He goes limp. No pulse. Monitor shows a slow wide rhythm, then nothing organized."
Compressions on the pillow at real rate. Recorder starts the arrest tool — confirm it shows the pediatric weight carried over — and taps the epi timer as the "dose" is announced.
Leader states the asthma-arrest specifics from the reference accordions: what to do about the vent/bagging (slow rate, watch for breath stacking).
ADVANCE WHEN › two epi cycles timed in the tool; facilitator then grants ROSC.
PHASE 3 · ROSC — NOW WHAT?
"Pulse is back, sat climbing. He's not waking up. The next ten minutes decide the next ten days."
Recorder opens Post-ROSC — the ROSC clock should already be running, handed across from the arrest tool. Team walks the checklist: pressure target, sat/CO2 window, temperature, who they're calling for transfer.
END WHEN › post-ROSC checklist walked and the transfer call is named.
WHAT GOOD LOOKS LIKE + DEBRIEF
Weight entered once, early, and trusted everywhere after. Arrest recognized inside 10 seconds of the limp doll. Post-ROSC opened before anyone relaxes.
Debrief card prompts: did the tools' shared weight/clock hand-offs actually work for us? · who was talking to the parent during compressions?
S4Pediatric Status Epilepticus → RSI → Vent Crash (DOPE)
PEDS SET · 12 MIN + DEBRIEF
STATUS EPILEPTICUS→RSI→DOPE CRASH
SETUP · 2 MIN
Pillow = a 6-year-old, ~20 kg, "seizing for 10 minutes, one dose of midazolam by EMS." Recorder enters the weight first.
Roles: leader · airway · meds voice · recorder · facilitator. Stage a real (empty, SIM-labeled) BVM if available; otherwise mime it.
EQUIPMENT TO STAGE
Sim props: pillow (the 6-year-old) · whiteboard · SIM-labeled BVM · working suction to point at.
Pediatric (Broselow) Cart · BLUE drawer (19–23 kg): point — 20 kg maps here; tube sizes live on the card.
Code Cart · INTUBATION + ETT / BOUGIE drawers: point — laryngoscopes, tubes, bougie.
Vent: if a real one is nearby, stand next to it for the DOPE phase — touch nothing.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · STILL SEIZING
"Second benzo is in. Three minutes later he is still seizing. What's your second-line, at what dose, and how long does it take to run in?"
Run the RSI checklist out loud as a challenge-response: drugs with peds doses, tube size, backup plan. Airway "intubates" the pillow; recorder logs the time.
ADVANCE WHEN › checklist completed as challenge-response and tube "placed."
PHASE 3 · CURVEBALL — HE CRASHES ON THE VENT
"Five minutes later: sat 79 and falling, pressure alarm. He's intubated and sedated. Why — work it as a list, not a guess."
Team walks D-O-P-E out loud, states the action for each letter, and the facilitator reveals the answer (a plugged tube — suction fixes it) only when the letter is actually reached in order.
END WHEN › DOPE walked in order and the plug found at its letter.
WHAT GOOD LOOKS LIKE + DEBRIEF
Second-line is named without a phone-a-friend. RSI is a checklist, not a vibe. The desaturation triggers the mnemonic, not random tweaking.
Debrief card prompts: which RSI checklist line would we actually skip under pressure — and what would catch us?
S5STEMI → VF Arrest → PEA → Code Status → Debrief
MEDICAL SET · 18 MIN + DEBRIEF
STEMI→VF→PEA→CODE STATUS→DEBRIEF
SETUP · 3 MIN
Pillow = a 68-year-old with crushing chest pain. Print or pull up any old STEMI teaching EKG. A family actor is required for this one — that's the point of the chain.
Roles: leader · compressor(s) · meds/defib voice · recorder · family actor · facilitator.
EQUIPMENT TO STAGE
Sim props: pillow · any old STEMI teaching EKG (printed) · whiteboard · two chairs for the family conversation · a phone/tablet with the arrest tool open.
Code Cart · MEDICATIONS drawer: point — lytic checklist is read from the card, drugs stay shut.
Defibrillator: pads mimed on the pillow; shocks are called out loud with the tool's timer.
Transfer: the transfer-center number visible on the whiteboard (say it, don't dial).
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · STEMI
"EKG in hand: anterior STEMI. You are 90 minutes from a cath lab. Walk your card: who do you call, what does the patient get, what's the lytic decision?"
Compressions on the pillow, real rate. Shocks called with the tool; epi/amio timed on its buttons. After two shock loops the facilitator changes the story: "rhythm check — organized and slow, no pulse. PEA." Team switches branches in the tool and hunts causes (H's & T's) out loud.
Nobody sends the family away — someone is assigned to them. That assignment is a scored behavior in this sim.
ADVANCE WHEN › VF→PEA branch switch done in the tool and a family support person is named.
PHASE 3 · THE CONVERSATION, MID-CODE
"Twenty minutes in. The nurse says quietly: 'his daughter says he has a POLST at home — he never wanted this.' You're still coding him."
Leader (or a designated second physician) has the conversation with the daughter while compressions continue — using the card's language. The team then acts on the answer: transition to comfort, stop compressions, note the time.
ADVANCE WHEN › the conversation happens in-role and an explicit stop decision is made and time-stamped.
PHASE 4 · DEBRIEF FOR REAL + WHAT GOOD LOOKS LIKE
Run the actual Debrief card as Phase 4, in-sim — state the Basic Assumption out loud, walk the timeline from the arrest tool's log, plus/delta/plus. This is the phase teams skip in real life; here it's scripted.
Good looks like: the STEMI transfer call already made (so the arrest doesn't orphan it), clean VF→PEA branch handling, family never abandoned, and the goals-of-care conversation changing what the team does.
Pillow = a dialysis patient who missed two sessions. Whiteboard: K 7.8, wide QRS. Stage near the TVP kit's real location (point, don't open).
EQUIPMENT TO STAGE
Sim props: pillow (dialysis patient) · whiteboard (K 7.8, wide QRS) · a printed ugly-QRS strip if you have one.
Code Cart · MEDICATIONS drawer: point — calcium, insulin/dextrose, albuterol all named with doses, never drawn.
Pacing pads: mimed on the pillow; the generator settings are said out loud.
Room 7 cabinets · TRANSVENOUS PACING kit: point, don't open — the walk to it is part of the drill.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · CRASH THE POTASSIUM
"K is 7.8 with a wide, ugly QRS. Order the sequence — drug, dose, what it does, what it doesn't."
Walk the checklist on the pillow: access site, sheath, balloon up at the right depth, generator settings said out loud (rate / output / sensing), capture confirmed, balloon down, secure.
END WHEN › generator settings verbalized correctly and capture confirmed in narration.
WHAT GOOD LOOKS LIKE + DEBRIEF
Calcium before anything shifty. Pacing decisions driven by perfusion, not the monitor number. The TVP checklist actually read, not recalled.
Debrief card prompt: who in the room has actually floated a wire — and how do the rest of us borrow that before the real one?
S9Angioedema → Failed Airway Ladder → FONA
MEDICAL SET · 15 MIN + DEBRIEF
ANGIOEDEMA→FAILED LADDER→SALAD→CICO → FONA
SETUP · 2 MIN
Pillow = a 55-year-old on lisinopril, tongue and lips swelling for an hour, voice getting muffled. Stage near the airway cart; point at where the video laryngoscope, bougie, and the FONA kit actually live.
Roles: leader · airway operator · second operator (neck) · meds voice · recorder (drives the ladder) · facilitator. This one is about saying the next rung out loud before you need it.
EQUIPMENT TO STAGE
Sim props: pillow · whiteboard (sat trend) · a marker for the neck landmarks — marking the pillow's "neck" is encouraged.
Code Cart · VIDEO + DIRECT LARYNGOSCOPY and ETT / BOUGIE drawers: point — every ladder rung has a drawer.
Code Cart · SURGICAL / SUPRAGLOTTIC + iGEL + FRONT OF NECK ACCESS drawers: point — every person in the room should be able to find FONA blind.
Room 7 cabinets · SALAD SUCTION: point — suction leads in the soiled-airway phase.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · THE AIRWAY IS CLOSING
"Voice is muffled, he's drooling, tongue looks like a fist. You will not get a second look at this airway. Plan it out loud."
Meds verbalized per the card — and the team states plainly what meds will and won't do for bradykinin-mediated swelling. Double setup declared: who intubates, who owns the neck, where the FONA kit is physically.
ADVANCE WHEN › double setup assigned and the neck is marked (narrated) before any attempt.
PHASE 2 · WORK THE LADDER
"First look: all you see is swollen tissue. Sat 91 and drifting. Call the rung you're on and the next one."
Recorder drives the ladder tool; the operator narrates each rung — optimize, change device/operator, supraglottic attempt — with the sat read out between rungs. The leader's job: keep the room ahead of the ladder, not behind it.
ADVANCE WHEN › two rungs attempted and the team states the CICO trigger unprompted.
PHASE 3 · CURVEBALL — BLOOD IN THE AIRWAY
"The last attempt made him bleed — the view is now blood and swelling. Sat 84."
Someone declares "this is CICO — we are cutting" out loud, and the second operator (already on the neck since Phase 1) walks the card on the pillow: laryngeal handshake, vertical incision, finger, bougie, tube. Facilitator grants sats once the sequence is narrated correctly.
END WHEN › CICO declared in words and the FONA sequence narrated start to finish.
WHAT GOOD LOOKS LIKE + DEBRIEF
The neck is owned and marked before the first look. Every rung is named before it's climbed. CICO is declared by its name — the failure mode this sim exists to kill is the room that keeps trying "one more look" at sat 70.
Debrief card prompts: what sat number or attempt count is OUR line in the sand — and did we say it before or after we crossed it? · could every person in the room find the FONA kit blind?
Pillow = a 40-year-old, high-speed MVC, 5 minutes out by EMS radio. Team assembles before arrival — that pre-brief is Phase 1. Stage next to the trauma cart; point at the chest-tube shelf.
EQUIPMENT TO STAGE
Sim props: pillow · whiteboard (EMS report + vitals) · SIM-labeled trauma shears · a marker X on the pillow's right chest.
Trauma Cart · NEEDLE DECOMPRESSION drawer: point — first move of the tension phase.
Blood bank: MTP number on the whiteboard; the chamber "output" is the facilitator's voice.
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · THE FIVE MINUTES BEFORE
"EMS radio: high-speed rollover, hypotensive on scene, intubated in the field. Five minutes out. Set your room."
Roles claimed out loud, activation criteria checked, blood asked about now, airway/suction checked, who's cutting clothes.
ADVANCE WHEN › roles + activation verbalized before the "patient" rolls in.
PHASE 2 · CURVEBALL — HE TENSIONS
"Two minutes into the primary survey: sat 78, BP 74/38, trachea deviated, no breath sounds on the right, neck veins full. He's intubated — pressure alarm climbing."
Chest tube walked on the pillow from the checklist: triangle landmarks said out loud, finger sweep, tube secured. The chamber output triggers the MTP conversation — activate it and name the transfer decision (this patient is leaving).
END WHEN › tube checklist done, MTP activated, and "he needs a trauma center" said by name.
WHAT GOOD LOOKS LIKE + DEBRIEF
The room is set before the doors open. Tension is a clinical call — nobody waits for imaging. The chamber number changes the plan (blood + transfer), not just the dressing.
Debrief card prompt: what did we touch on the cart that we couldn't find in one reach? — feed that straight to the kit-label system.
Pillow = a 25-year-old, single stab wound left chest, agonal on arrival. A family actor (partner) arrives mid-sim. This sim ends in a death — schedule it when there's time to debrief properly.
EQUIPMENT TO STAGE
Sim props: pillow with a taped X just left of the sternum · whiteboard · a quiet room + two chairs staged for the SPIKES phase.
Trauma Cart · NEEDLE DECOMPRESSION drawer: point — bilateral decompression is narrated first.
Trauma Cart · THORACOSTOMY + RIB SPREADER shelves: point, don't open — the thoracotomy is talked through with the card.
Family actor: briefed separately before the sim starts (they should not hear the script).
FIND IT — EQUIPMENT WALK
The person being oriented finds each item and says where it is. Tap FOUND to confirm the location the manual carries, or record where it really was. Not there? Log the gap.
PHASE 1 · HE ARRESTS ON THE DOOR
"He had a pulse in the rig. As you move him over: nothing. Stab wound just left of the sternum."
The team states why TCA is not a medical code: reversible causes first — bilateral chest decompression narrated, blood in motion, the thoracotomy decision made out loud with its actual criteria (penetrating + witnessed loss = candidate).
ADVANCE WHEN › both chests decompressed (narrated) and the thoracotomy call is made with criteria.
PHASE 2 · OPEN THE CHEST
"You have the kit. Talk your way through it — incision, spread, what you're looking for, what you'd do for a hole in the heart."
Clamshell narrated on the pillow with the card open — landmarks, rib spreader, pericardiotomy, aortic compression. Facilitator, after a genuine effort: "the heart is empty and still. Twenty-five minutes. Nothing reversible left." The leader calls it, with the time.
ADVANCE WHEN › the procedure is narrated start-to-finish and death is pronounced with a time.
PHASE 3 · TELL HIS PARTNER
"His partner has been in the family room for ten minutes. She knows it's bad. Go tell her."
The leader (or whoever will really do this on shift) has the conversation in-role using the card's structure — sit down, warn, say "died," stop talking. The family actor gets to be human about it.
ADVANCE WHEN › the notification happens in-role, with the word "died" used.
PHASE 4 · DEBRIEF + WHAT GOOD LOOKS LIKE
Run the Debrief card for real — this one needs it, and practicing the emotional debrief after a scripted death is the safest rehearsal there is.
Good looks like: reversible causes attacked before rhythm rituals, a thoracotomy decision made on criteria (either answer can be right — it must be reasoned), a pronouncement with a time, and a notification that doesn't hide behind euphemism.
S10Prolapsed Cord → Crash Section → ED Doc on Airway → Newborn
OB SET · 18 MIN + DEBRIEF
CORD PROLAPSE→CRASH SECTION→ED DOC ON AIRWAY→HANDOFF→NEONATAL RESUS
SETUP · 2 MIN
Pillow-mom on the stretcher. A length of IV tubing hanging out from under the gown is the cord. Towel-roll baby hidden. Whiteboard: 37 weeks · 02:10 · FHR 70.
Roles: ED physician (the one who will do everything) · recorder · one or two nurses · facilitator voicing mom, the fetal heart rate and OB on the phone. Deliberately understaff this one — the whole point is 02:10 on a weeknight.
The facilitator plays OB arriving at 9 minutes and scrubbing. OB does the operation; OB does not help with the airway or the baby.
Run this one after the team has done SIM 1, so the newborn half is already familiar and the new load is the role switch, not the NRP.
EQUIPMENT TO STAGE
Sim props: pillow-mom + gown · IV tubing as the cord · towel-roll baby · whiteboard for the clock, the FHR and who is holding what.
OB / Neonatal Cart · C-SECTION drawer: point, don't open — this is the drawer most people have never opened, which is the reason to run this.
OB / Neonatal Cart · AIRWAY / BREATHING drawer: point — infant BVM + masks for the newborn half.
Code Cart · airway drawers: point at the RSI kit and the front-of-neck access drawer. Priming FONA before inducing a term pregnant patient at 02:10 is the point of Phase 3.
Radiant warmer: turn it on for real, before the "section" starts. Warm-up time is part of the drill.
PHASE 1 · A CORD, AT 02:10
"37 weeks, membranes ruptured in the car. She walks in and the triage nurse sees a cord in the vagina. Fetal heart rate 70. You are the only physician in the building. First thirty seconds — go."
Pre-oxygenation stated off the card. What is different about this airway is named out loud.
A plan B exists and the front-of-neck kit is primed before anyone gives a drug. If it is not, stop the sim and say why — this is the rewind that matters most in this case.
ADVANCE WHEN › pre-oxygenation, drugs and a stated plan B all exist before induction, and the tube is confirmed with capnography.
PHASE 4 · CURVEBALL — TWO PATIENTS, ONE DOCTOR
"Baby is out at 02:32 — floppy and blue. Mom is still intubated on the table. You are the only physician. What happens now?"
The physician cannot be in two places, so a handover has to be spoken out loud: a named person on mom, a specific number they are watching, and an explicit trigger that brings the doctor back. "Keep an eye on her" does not count.
Time of birth written down. Baby to the warmer. Warm–dry–stimulate, then PPV narrated at the rate off the card — NRP, not the pediatric pathway.
Facilitator: if the physician walks to the baby without saying anything, freeze it and ask the room who is watching mom. Then run the phase again.
END WHEN › a named person holds mom with an explicit call-back trigger, effective PPV is running, and both patients have a stated destination.
WHAT GOOD LOOKS LIKE + DEBRIEF
The airway role is claimed early and out loud, not assumed in the moment. FONA is primed before induction because there is no second physician. The handover at delivery is a sentence with a name, a number and a trigger in it.
Time of birth is stamped at delivery. Somebody reports on mom without being asked.
Debrief card prompts: at 02:10 on a weeknight, who else is actually in this building — and did we call all of them in the first minute? · when the baby came out, what exactly was said about the mother? quote it.
Runs on a table as a VEMS deck when you cannot get the room or the people.
Sources & method: scenario design follows low-fidelity in-situ simulation and rapid-cycle deliberate-practice conventions (Hunt EA, et al. Resuscitation 2014;85:945-51; Rosen MA, et al. In situ simulation in continuing education, J Contin Educ Health Prof 2012;32:243-54). All clinical content — doses, criteria, maneuvers — deliberately lives on the linked cards, which carry their own citations; these scripts add no clinical values of their own. The debrief structure is the manual's own Debrief card (adapted from the Center for Medical Simulation's Basic Assumption).
— personal/unofficial training aid, not part of the hospital IT system/EHR, not a substitute for clinical judgment or accredited simulation programs. Never run these during live patient care without announcing and staffing around them.