PROBLEM: Infrequent presentation of patients with eclampsia, leading to staff inexperienced in the condition and untested emergency systems. DESIGN: "Fire drill" programme using on-site simulation of patients with eclampsia. SETTING: Tertiary referral obstetric unit. Key measures for improvement: Successful implementation of measures to optimise management of eclampsia. Strategies for change: Rapid activation of emergency team after one call, development and dissemination of evidence based protocol for eclampsia, strategically placed "eclampsia boxes," individual staff feedback and education. Effects of change: Efficient and appropriate management of subsequent simulated patients. Lessons learnt: On-site simulation can identify and correct potential deficiencies in the care of patients with eclampsia.