Introduction/Background Trauma simulation has high demands for medical fidelity and realism. The commercially available human patient simulators often lack some crucial features necessary to create a comprehensive and more realistic simulation scenario. MSR, the Israel Center for Medical Simulation, has been conducting in-situ trauma simulations for multidisciplinary teams at different hospitals across the country for the past seven years. The participants in the training voiced their discontent with the realism of the simulation. We came to realize that we needed to develop and invent additional features in order to bridge gaps in existing simulation technology and to better facilitate trauma simulations. Simulation specialists/technicians at MSR utilized makeup, latex, special adjuvants to the simulator, a vigorous bleeding machine and incorporation of hospital labs Results and radiology tests into the simulator platform to enhance realism of the scenario. These innovative and creative improvements enriched and upgraded the performance of the trauma scenarios and produced better satisfaction among participants. It is important to note that these developments were not expensive and sophisticated but rather simple and ingenious and really made a difference. This training has enabled fruitful experiments of various innovations in high fidelity simulations. Methods In order to comply to the trainees demands, we had to find inexpensive and easy to use and manufacture solutions for multiple trauma injuries. We had to create several technological and mechanical adjustments to make our manikins and training environment real. Responding to one of the major demands raised by the participating teams we undertook the challenge to create intense bleeding using a self manufactured, custom designed bleeding machine which can deliver up to six liters of blood from various injuries simultaneously in a synchronized rhythm. Connected to our wound moldings it can also readily connect to any commercially available injury patch or prosthesis such as leg amputation, open fracture etc. The machine is working on batteries and is remotely controlled. The blood is pushed down hidden plastic tubes by air pressure from small CO2 balloon. The flow and rhythm can be adjusted to simulate either arterial or venous bleeding. In order to better implement the treatment of shock we custom designed venous systems to allow blood withdrawal for blood tests, as well as administration of massive blood transfusion and drugs into a special drainage system. Trauma teams used information from different sources in the hospital. In order to minimize the use of different computers alien to the hospital systems we integrated lab Results, radiology tests and packs from the blood bank between the simulator’s platform and the hospital systems. In order to overcome the shortage in specific wound patches and lack of variety in premanufactured moldings, we created realistic wounds using makeup on special self manufactured add on to the manikins such as burns (burn patches), penetrating trauma objects (knife stuck in thigh), etc. The combination of all the added features discussed above, plus many more contribute to creating a vivid and realistic appearance to the simulated patient, thus enriching the atmosphere of the treatment and bring to the implementation of better drills. Results: Conclusion With little effort and money some crucial changes and adjustments have been introduced to the commercially available simulators in order to create the much needed improvements in trauma scenarios resulting in a more genuine scenario. The reactions from the participants are remarkable, acknowledging that enhanced realism makes them better cooperate with the simulation and above all deliver better treatment to real patients, as some of the realistic simulated injuries repeat later on in reality. Disclosures None.