Patient care in the prehospital and retrieval medicine (PHARM) environment presents many technical and non-technical challenges. Clinicians are frequently required to perform complex interventions in a time critical and resource limited setting. Intensive training is required prior to operational deployment, and ongoing training is vital to ensure optimal team performance in the delivery of high quality patient care. Regular simulation training with high situational fidelity is valuable in developing and maintaining excellence in PHARM. We describe the methods employed by two Australian aeromedical retrieval services to facilitate daily on shift simulation.