Introduction: Sedation for medical procedures in the emergency department (ED) is a critical skill that Emergency Medicine (EM) residents must acquire, typically performing 15 procedures before graduation (as per ACGME graduation requirements). Complications arising from procedural or conscious sedation are uncommon, occurring in 0.4-4% of cases (involving both adult and pediatric patients). Given the minimum sedation requirement and the low likelihood of complications, most EM physicians may not encounter a clinically significant complication during their training. It is essential to provide EM residents with opportunities to manage potential complications associated with this vital skill before they transition to unsupervised practice. Furthermore, nurses responsible for sedation monitoring are often mandated to complete a minimum number of cases annually to maintain certification, which varies by state and institution. We hypothesized that implementing simulation-based team training would increase providers' comfort levels when managing sedation complications, help residents meet their minimum case volume, and address the shortage of sedation-certified nurses. Methods: We developed and validated pediatric and adult sedation simulation scenarios in collaboration with credentialed physicians. Utilizing standard equipment available in the ED, we employed both child and adult simulators. EM resident physicians and ED nurses performed sedations on the adult and child simulator patients and managed complications arising from procedural sedation. Learners completed pre and post-simulation surveys to assess their comfort levels in managing complications. Learner performance was evaluated using a checklist and a review of sedation documentation, followed by debriefing sessions. Results: While our study is in its early stages, preliminary results are encouraging. Eleven resident-nurse teams have participated in the simulations. Pre and post-simulation survey data indicate a significant increase in participants' comfort levels regarding potential sedation complications. The average comfort level, rated on a scale of 1-5, increased from 3.86 pre-simulation to 4.46 post-simulation. Additionally, anecdotal evidence suggests that residents have particularly benefited from practicing interactions with and providing instructions to nursing care during simulated complications. Discussion: While EM residents receive training in sedation, they often have limited exposure to managing complications associated with sedation or sedative medications. The simulation scenarios we implemented effectively enhanced their comfort in handling well-known complications. We recommend that EDs and residency programs consider incorporating this practice into their initial training and ongoing skills sustainment programs.