Simulation safety spotlight – a call for safety briefings in sim?

By Victoria Brazil (@SocraticEMand Eve Purdy (@purdy_eve)

We’ve previously highlighted the safety risks related to healthcare simulation on the ICEnet Blog, inspired by the work of Dan Raemer and colleagues at the Foundation for Healthcare Simulation Safety, and discussed the same in a Simulcast podcast. These included diverse categories of risk – including patient risks from fake medications and/or equipment, occupational health and safety risks from sharps, electrical equipment and cables, and unintended triggering of hospital responses to simulation activities.

The spotlight is back on this issue with the publication of an editorial by Dr Raemer, jointly released in Advances in Simulation, Simulation in Healthcare and the Journal of Surgical Simulation, and again discussed on Simulcast. In this editorial, Dan and colleagues highlight the risks, and provide ‘10 commandments’ for simulation safety, including principles to prevent issues such as medication misadventure. He also cites the excellent work by Komal Bajaj and colleagues in developing ‘no go’ criteria for in situ simulation. Chris Nickson has recently provided a practical guide to in situ simulation safety issues on LifeintheFast Lane.

As one part of this comprehensive approach, we’re advocating safety briefings for simulation related events, especially when conducted in situ – i.e. in the real clinical environment. Our suggested approach aims to balance detail with reality of time constraints for in situ sim, and we’re very interested in feedback or comments about what others do.

Click here to download a PDF copy of the In Situ Simulation Safety Briefing Checklist.

In situ Simulation safety checklist Brazil Purdy December 2018

This briefing should be referenced in the institutional in situ simulation policy and procedure, and a checklist may be useful to aid recall of details.

This briefing approach is based on experience only and not formally tested. Please let us know your thoughts or other ideas and practices. Specifically,

  • How do we balance the time constraints of busy in situ simulation with detail required for safe practice?
  • What elements you perceive are higher or lower risk than the ones we’ve identified?

Happy, safe simulation!


  1. Raemer D, Hannenberg A, Mullen A. Simulation Safety First- An Imperative. Simul in Healthc 2018: 13(6):373–375. doi: 10.1097/SIH.0000000000000341
  2. Bajaj K, Minors A, Walker K, Meguerdichian M, Patterson M. “No-go considerations” for in situ simulation safety. Simul Healthc 2018;13(3):221–224. PMID 29621037.