By: Emiliano Da Chagas, Communications Advisor, Institut du Savoir Montfort, and Elliot Verburg, Communications Officer, Institut du Savoir Montfort.
At Montfort Hospital, in-situ Code Blue simulations enable teams to prepare for a range of emergency situations, directly in the environments where care is delivered. They also serve a second, equally important purpose: training the next generation of health professionals through hands-on, experiential learning.
Recently, the mental health department collaborated with simulation educators from the Institut du Savoir Montfort to design a scenario tailored to their unit. The case involved a middle-aged adult admitted for severe depression and suicidal ideation, who was found unconscious following a hanging incident in a patient room, triggering a Code Blue.
The exercise brought together a record number of 31 participants, including both staff and students, and supported learning that went well beyond technical skills. Nurses, clinical educators, interprofessional staff members, and students worked side by side, highlighting Montfort’s role as an academic hospital where education and clinical excellence are closely intertwined. The exercise helped identify unit-specific risks, clarify roles, and improve interprofessional communication under pressure - skills that are essential for both experienced clinicians and those in training.
Why Practise Code Blue Scenarios in Mental Health?
Cardiac arrest emergencies in mental health may be rare, but when they occur, every second counts. Without regular exposure, teams—including students—may lose confidence in their ability to coordinate rapid and effective responses. In-situ simulation offers powerful solutions: practising in the real care environment, with real equipment and real teams, allows participants to collectively develop muscle memory, situational awareness, and clinical judgment.
The importance is clear. According to Statistics Canada in 2022, more than five million Canadians aged 15 and older were living with a mood disorder, anxiety disorder, or substance use–related disorder, and approximately 12 people die by suicide every day. Preparing mental health teams—today’s clinicians and tomorrow’s professionals—for rare but potentially life-threatening events is essential to delivering safe and compassionate care.
Mental health emergencies also require heightened sensitivity: a trauma-informed response that prioritizes the safety and well-being of patients, staff, and students.
A High-Fidelity Scenario That Supports Learning
Prior to the simulation, mental health department leaders conducted a structured pre-briefing that included both staff and students. Roles, the environment, and expectations were reviewed, and psychological safety was emphasized. Participants were informed in advance of the nature of the scenario (a hanging case), as surprise was not a pedagogical objective. The pre-briefing also addressed physical safety, reminding participants that moving a patient or mannequin alone, even during high-stress moments, can result in injury.
Students actively participated in the scenario, including by assuming the role of a “witness,” observing team dynamics, and supporting clinical tasks under supervision. This direct involvement allowed them to experience first-hand how emergency interventions unfold in a real clinical setting.
The scenario then unfolded in real time on the unit: a nurse discovered the patient, activated the Code Blue, and the response team arrived under authentic conditions. Evidence shows that this type of in-situ simulation helps uncover latent safety threats, such as access to equipment, room layout, power supply, and space constraints—insights that benefit both patient safety and education.
Debriefing for skills, systems, and learning
Montfort facilitators led two structured debriefing sessions to maximize learning for all participants. The first brought together the full Code Blue team, unit nurses, and students, and focused on communication, role clarity, logistics, and teamwork. The second, primarily with mental health nurses, allowed for deeper reflection on unit-specific workflows and care delivery.
Students were encouraged to share their observations and questions, reinforcing reflective practice as a core academic competency. Feedback highlighted the value of this approach. “It makes you think: what would you do in that situation, what is your role and the role of others?” shared nurse Odile Thérèse Tefouet Ngueko. “Communication is essential,” she added. Clinical educator Rabens Fenton noted, “It’s a reminder for the team—it encourages reflection,” a sentiment echoed by students who appreciated seeing theory applied in practice.
Conclusion
Montfort’s experience demonstrates that simulation is far more than a technical exercise; it is a cornerstone of patient safety and academic training. By practising in real environments, mixed teams of staff and students identify hidden risks, strengthen communication, and build confidence under high-pressure conditions. Integrating trauma-informed care and student participation makes these exercises even more impactful.
For the mental health team and students, this was not just an exercise: it was an investment in safer, more coordinated care today, and in better-prepared professionals for tomorrow.
A sincere thank you to all participants, staff and students alike, and especially to the simulation educators from the Institut du Savoir Montfort, whose expertise and creativity made this experience both clinically meaningful and academically enriching.