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How to Run a Simulated Cardiac Event
Manager of simulation operations, Chris Larkner, CCEMT-P, CHSOS, CHSE, shares best practices on how Jump Simulation runs simulated cardiac events.
July 20, 2026
A new nurse walks into a hospital room to find their patient, John Doe, grasping his chest and saying, "I can't breathe, please help me!" Shortly after, John Doe loses consciousness. The nurse caring for him tries to wake the man to no avail, "Sir, can you hear me?"
With their heart racing, they have to think fast about what to do next. The nurse calls out to other staff on the hospital room floor, "I need help in here. John Doe is not breathing!" After calling for help, the nurse activates the blue code alarm. The code team responds, determines the patient has possibly had a cardiac event and acts appropriately.
This is a frequent scenario simulated at Jump Simulation and in hospitals throughout the OSF HealthCare known as in-situ. In-situ comes from the Latin words place or location. Here at OSF, we never want a situation where members of a care team are unsure of what to do when faced with a critically ill patient. Our simulated cardiac arrest events help providers of all levels familiarize themselves with the process and ensure they are following the necessary steps, guidelines and algorithms to provide our patients with the best possible outcome.
As more hospitals and newly developed simulation centers look to develop their own code simulations, we thought it would be beneficial to share some of our best practices that we have learned over the years.
One Size Doesn't Fit All
It's important to note that there are numerous types of simulated events medical facilities can run. The event should be something that the learners will see with relative belief to suspend the reality that this is a simulation. Those simulations that take place at Jump are based on education developed by faculty within University of Illinois College of Medicine Peoria, as well as clinical educators and scholars from OSF. Here are some things facilitators must consider as they put together their curriculum for in-situ simulations:
- Who are the learners (medical students, residents, RNs, paramedics, etc.)?
- Who is the patient (baby, infant, child or adult)?
- What unit are you in, and why is your patient in that specific unit?
- What should this learning group be able to achieve at the end of the simulation (activating a code blue, using a defibrillator, CPR, administering medications, etc.)?
- What are the learning objectives (how long does it take a clinician to recognize a patient is in cardiac arrest, how long does it take to begin chest compressions after a patient goes into cardiac arrest, was CPR continuous or interrupted, etc.)?
- Are we trying to solve a problem and drive change, or is it to meet a regulatory requirement?
- Will this be a surprise simulation or a planned simulation?
The most common type of code we conduct is for an adult patient who has experienced a cardiac event resulting in ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), conditions in which the heart is no longer pumping blood to sustain life.
The learners are most likely a team of nurses and residents certified in Basic Life Support (BLS). They should be able to activate a code blue, start chest compressions, deliver ventilations and operate a defibrillator. These tasks occur within the first five minutes of any cardiac event and are listed, according to the American Heart Association, as the most important in the chain of survival.
Setting Up the Simulation
The space where you conduct a simulated cardiac event must mirror where an actual code would take place to assist in enhancing the reality of the case. The simulation specialists at Jump set up our virtual medical rooms with everything a code team would need in the event of an emergency based on both the nature of the emergency and learning objectives designed by the facilitator and educator.
The room is typically equipped with an adult bed, bedside table and phone to call for a consult. There would also be a crash cart stocked with appropriately labeled medications, a defibrillator, an extra bag of fluids hanging next to the bedside for future use and oxygen supplies. Everything from the code cart to the pumps is the exact items that are being used and set up at hospitals across the Ministry. This supports translational learning, especially when all equipment should be consistent with what learners are using in their daily practice.
The code simulation can be performed on a low- or high-fidelity manikin that displays EKG, heart rate, blood pressure and ETCO2, as well as simulated imaging and lab values to support or guide clinical decisions and treatments. A high-fidelity simulator will have more pulse points and chest rise and fall to represent breathing. It collects statistical and real-time data as procedures or tasks are performed. This information can be given to the learners during the debriefing as observed by the facilitator. These manikins can be connected to all models of defibrillator and energy can be delivered safely.
Running the Code
The educator or faculty who developed the simulation are typically on-site, behind the scenes observing and evaluating how the team performs. Our simulation specialists execute the entire simulation with the guidance of the facilitator.
Before learners are thrown into any simulation, they are briefed on the room set-up and how the manikin works. They are then provided with learner instructions to provide them with the appropriate amount of patient history and background. Then they are asked to leave the room and come back within one minute. The scenario will then begin as they reenter the room.
Upon entering the hospital room, they either find their patient pulseless or awake and complaining of chest pain and shortness of breath. The patient's condition quickly deteriorates to where they become pulseless and unresponsive.
The learners are expected to perform as though it's a real situation. In this case, they would be expected to immediately call a code blue, analyze their patient's vitals like heart rhythm, start chest compressions, insert an IV and use a defibrillator if needed. Meanwhile, the educator is observing the team's performance. They may be timing how long it takes to start chest compressions after cardiac arrest or whether there were interruptions in CPR. They could also be watching and listening for the team dynamics of communication.
The simulation specialists behind the scenes will likely leave the manikin in a pulseless state until the educator determines the team has followed and completed their established learning objectives. The code can take up to ten minutes depending on the steps the learners take to revive their patient. Once the care team is finished with their simulation, they will debrief with their facilitator, separate from the simulation space. This is purposeful for the learners to have a neutral area, as well as allow time for the simulation specialists to reset the room for the next learner group.
Simulation Debrief
Debriefing is the most important part of any simulation. In the case of a simulated cardiac event, an educator or facilitator will give feedback on the team's performance based on the learning objectives generated, observed behaviors and actions and data collected from the manikin. However, a good debrief is one that is driven by the learners themselves. Allowing for self-evaluation means the educator may never have to say anything because the learners identified what they did well and where they find opportunities to improve.
The goal is to ensure our learners are adequately prepared before they are faced with a real code blue situation. We want learners walking out of our facility feeling confident and most importantly, equipped to save lives in a fast, efficient and safe manner.
