Simulation Safety Policies: Where to Begin?

We were thrilled to read the recently published work by Dr. Victoria Brazil, emergency physician and medical educator, based on the Gold Coast, Australia. As the medical director of the Gold Coast Simulation Service, she leads in situ simulation programs in a wide range of settings. Dr Brazil, Clare Scott, Jack, Matulich, and Brenton Shanahan developed a simulation safety policy and published a comprehensive and practical guide to help others to do the same.

The article, Developing a simulation safety policy for translational simulation programs in healthcare, was published in Advances in Simulation in January 2022. The authors shared their process for developing a policy as well as the challenges in translating policy statements into practical application.

Advances in Simulation is an open access journal; there are no barriers to accessing this treasure trove of  information. We share some highlights from the paper and encourage you to take advantage of this valuable resource. 

The authors identify important steps in the policy development process:

  1. Form a steering group for development and implementation of the simulation safety policy and identify relevant stakeholders required for advice and approval.
  2. Identify existing safety procedures for the health service/ educational institution that are relevant for the simulation program.
  3. Incorporate simulation safety practices required in SSH accreditation processes and Raemer’s ‘Ten commandments’ 
  4. Consider the nature and extent of predicted safety risks, based on reports in the literature and local experience—adverse events and near misses.
  5. Prioritize medication safety and liaise with health service pharmacy representatives.
  6. Effectively communicate the existence of the simulation safety policy, and the need for staff involved in simulation delivery to comply with it.
  7. Enable simulation faculty to conduct safe simulation sessions that are compliant with the policy, including structured briefings, cognitive aids and environmental cues.
  8. Develop a reporting process for simulation related adverse events or near misses, preferably integrated within the health service clinical adverse event reporting framework.

They also share practical tools for implementation, with excellent graphics and photos. These tools are directly connected to # 7 above. It is not sufficient to have policies; simulation professionals need structured templates, signage, labels and cognitive aides to carry out the policies.


  • Cognitive aid for simulation delivery teams conducting translational simulation activities
  • Signage and staff uniforms to identify the simulation delivery team. 
  • Simulation safety officer is designated for each in situ simulation
  • Safety briefing incorporated into the overall simulation delivery team briefing and again during participant introductions and pre-briefing. 
  • Integrate simulation safety procedures into faculty development programs.

Safety checklists are an important tool for all simulation planning, and especially vital for in situ simulation.  The Foundation for Healthcare Simulation Safety has additional examples on the website.  We encourage you to use these to guide your team to develop your own checklist and customize it to meet the needs of your organization. 

It is important to inform everyone in attendance about the simulation activity.  Clear signage can be one part of this messaging. This can reduce the chance of causing distress and confusion for visitors or other staff who are not involved in the simulation.

The simulation safety officer has an important role. That person leads the work of  maintaining situational awareness, alerts the team to any safety concerns, and is empowered to halt the simulation. However, it is important that simulation teams and learners are included in this effort, so we strongly support the practice of including safety briefings in the sim team briefing and in the course pre-briefing. 

 It is important to inform everyone in attendance about the simulation activity.  Clear signage can be one part of this messaging. This can reduce the chance of causing distress and confusion for visitors or other staff who are not involved in the simulation. 

Simulation is a complex activity, taking place within a complex healthcare system and we should expect the unexpected. We are grateful to the Gold Coast Simulation team for doing this work and for writing this useful guide. 

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