The Code Simulation team at University of California, San Francisco (UCSF) Benioff Childrens Hospital-San Francisco is presenting a perspective on COVID-19 related simulation in a paediatric emergency department (PED) setting. The primary focus was personal protective equipment (PPE) usage in the setting of new latent safety threats in high-risk scenarios in relation to the COVID-19 pandemic. We addressed communication challenges and trialled new workflows in relation to the COVID-19 pandemic. The perspective details the objectives, themes and lessons learnt during this process. The simulation practice occurred multiple times over multiple days with an interpersonal, interdisciplinary and inclusive approach. The results of this work were implemented into practice in the PED at UCSF Benioff Childrens Hospital-San Francisco setting and influenced hospital-wide education on PPE usage during the acute phase of the COVID-19 pandemic.