The Code SET (Surgical Emergency Team) Program was born from real events involving delay in care and failure to rescue for Veterans experiencing surgical emergencies. While Rapid Response Teams and Code Teams are familiar with cardiac arrest, they do not meet the unique needs of intraoperative and postoperative hemorrhagic emergencies. The perceived barriers among staff, system failures, and lack of knowledge of emergency processes were shown to cause barriers in providing emergent surgical care. SimLEARN, The Veteran Health Administration (VHA) Simulation Program, developed this novel approach to system failure by utilizing simulation, recreating these events to identify potential failures in real time. A multidisciplinary team of subject matter experts collaborated to create a process that operationalized emergency clauses in Perioperative Directives, allowing for resuscitation in place and expedited return to surgery while maintaining the highest level of patient safety. Using simulation-based training, Code SET prepares teams by creating clear roles and defined processes to guide teams through perioperative emergencies. The Code SET Process was successfully piloted within the VHA, showing a significant reduction in the time to receive emergency blood products, and a comprehensive educational package is currently being piloted for implementation. This two-tier education approach provides facilitators with the tools they need to implement Code SET utilizing simulation education modalities with their teams, along with a package for front line staff who will be part of the code response and hospital wide activation. Code SET rollout addresses each facility individually, to ensure that the response is tailored to that hospital’s specific service lines and available resources. This program is built on High Reliability Organization (HRO) principles, with sensitivity to operations and a preoccupation with failure. With a focus on early salvage, this process aims to reduce morbidity and mortality for Veterans experiencing a surgical emergency. Standardized data tools allow for documentation of real and simulated Code SET events to allow for continuous process improvement, and pursuit of The Veteran Health Administration’s mission of Zero Harm.