A few years back, I was at a medical conference where a healthcare professional with past military experience stressed how simulation training is important in maintaining safe patient care. In the military, they drill again and again until responses become second nature. I wanted our MH simulation to mirror that approach.

Our SBT is done in an OR on a morning before cases start. I have access to CPR mannequins and went to work creating a training environment that was as accurate and realistic as possible. That meant intubating the mannequin with an anesthesia circuit, placing an IV line and draping it for surgery.

We also placed a warming blanket on the "patient" and set up the back table and mayo stand. Finally, we gathered all the supplies we'd likely use in the event of an MH crisis, including expired dantrolene and sterile water, syringes, mini-dispensing pins, an extra anesthesia cart, Foley catheter, vascular access supplies and empty syringes that we mark up for emergency medications during the simulation. All the supplies were placed outside of the OR where we conducted the drill.

When staff — nurses, surgical techs and, of course, an anesthesia provider to lead the drill — enter the OR for the training, the first thing they're asked to do is answer a seven-question pre-simulation questionnaire that tests their knowledge of proper response protocols.

After completing the questionnaire, staff are instructed to gather the practice items — everything from the MH cart to bags of ice — they'd use during an MH event.

We require staff to do everything exactly as they would in the event of a real emergency. That means making sure they physically leave the training site to get the ice and cool saline solution, and that they actually open the MH cart and handle everything they'd use. We also have staff use expired dantrolene to practice reconstituting the drug for administration.

When the supplies are ready, a crisis scenario is introduced and MH-specific task cards are distributed to staff taking part in the drill. The cards (see "Task Cards Organize Response Efforts"), which are color-coded and spell out the disciplines that are able to perform each role, not only tell staff what their various responsibilities will be during an MH event, they also break down those tasks into an easy-to-follow, step-by-step format.

For example, the ice gatherer and runner's card states the overall task — You will be responsible for getting items from the MH cart or supply room — as well as the four steps involved in the process that should answer every question the runner could potentially have about this task (There are bags of ice and ice packs in the freezer in sub-sterile between OR 1 and OR 2 ).

The cards are designed to be as descriptive as possible in order to avoid confusion among responding staff members. During a crisis, your team shouldn't waste time trying to figure out exactly what their role should be in the effort. After the assigned tasks are completed, everyone is allowed to take an active role in mixing and administering dantrolene — all staff members should be prepared to jump in to help reconstitute the drug — and pulling items from the MH cart. The more tasks staff actually perform during the drill, the more prepared they'll be to react appropriately when they're called into action during a real-life emergency.