Ever felt that preparing equipment for advanced airway management in your ED is ‘messy’?  In this episode Vic interviews Dr Ava Butler, an emergency doctor and QI/ simulation practitioner from rural British Columbia. We discussed her recent article about how equipment re-design and translational simulation was used to dramatically improve preparation speed and staff level of comfort with advanced airway management.  The conversation was informative and inspiring. We talked about the liberating structures process of brainstorming ideas for improvement, the role of patient partners in improvement, the hierarchy of interventions in quality improvement, and the significance of qualitative measures and stories in improvement efforts.  We marvelled at the dramatic improvements they achieved using a color-coded airway cart and translational simulation; a 76% reduction in time taken to prepare airway equipment, and significant improvements in staff comfort and team culture. EM sim cases got an honourable mention 😊, as did quality improvement initiatives that bring teams to the forefront. Ava explained just how rewarding it is to be part of a rural practitioner team who design improvements with patients at the centre.  Learn about the implementation of a color-coded airway cart and how quality improvement techniques empowered healthcare workers, increased their confidence, and enhanced patient experiences.  Happy Listening    The paper   Ava Butler, Michael Chen, Shruti Kaushik, Terra Lee, Liam Raudaschl & Audrey Giles. From “Airway scares me” to “I would say I’m pretty comfortable”: quality improvement for reducing time to obtain equipment for adult advanced airway management in a rural emergency department. Can J Emerg Med (2025).