Advances in medical simulation technology have become a vital and exciting facet of the evolving way that EM residents undergo training. Simulation can provide training in a risk-free, supportive environment where the complex nuances of best-practice patient care can be identified, recreated, practiced and tested among different learners to ensure the highest levels of competency. At SIU, we strive to create common as well as unique crisis scenarios. Chaos can be created on demand and scenarios can mimic physiologic changes just as they would occur in real patients. We have a focus on