MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. -- A few ticks before 7 a.m. just a week before a recent holiday break, a mass of surgeons, nurses, techs and anesthesia providers swarmed in front of the operating room's board of cases to get an introductory overview of equipment and expectations before heading into rooms prepped for a simulated training of a cardiac arrest during surgery.Maj. (Dr.) Jillian Phelps, the director of the Andersen Simulation Center and an emergency physician, was ready in scrubs with praise for the exercise."This is a great training because it's one of the few opportunities we have to get all the surgeons, nurses, techs, everybody together at once," she said.Phelps, who assisted in the planning and support of this exercise through the Sim Center, was particularly pleased that some in the room she was in were trained in other facilities. She found that knowledge of how things are done in other hospitals informative."It was really nice because the staff surgeons that were involved had a lot of experience. Two of them had had intra-OR cardiac events," she added.Col. Andrew Foster, the chief of the Department of Anesthesia and Operative Services, has worked diligently to ensure these trainings occur on a regular basis. Preparedness for any potential situation is important to patient safety."We definitely have found some good oversights in the past as a result of this training. We've been able to change how SOPs work here," Phelps concluded.The training's proctors offered a slide presentation with a scenario of the patient going into cardiac arrest during the surgery. The team then performed the simulated protocol on mannequins. In other trainings the scenario includes a fire in the OR and mass blood transfusion, among others. These situations are rare, but having a chance to work through them with the whole team present builds competence and confidence.Col. Thomas Rawlings, the deputy chief of DOAOS, led the training and acknowledged that it's the team aspect that is paramount."At the end of the day, it's all about team communication, team building, how the team responds in a crisis," noted Rawlings.The training involves answering important questions about how to improve the team's functionality for future situations."What are things they can learn from that response to be better prepared next time for some of these kind of rare events that happen," asked Rawlings.Phelps determined, "It's the group as a team that passes or fails."