OBJECTIVES: An outreach education service, Simulation Training Optimising Resuscitation for Kids (STORK) identified opportunities to use their course (Optimus PRIME) to understand and help optimise regional paediatric resuscitation. Our objective was to document challenges faced by healthcare providers in rural, remote, and regional (RRR) health centres in Queensland during a paediatric resuscitation course and ensure information reached stakeholders. METHODS: Using in situ simulation, participants were prompted to identify real-life challenges during paediatric resuscitation. Participants co-generated solutions to these specific challenges and identified local advocates. Summaries for stakeholders included service strengths and improvement opportunities. Site follow-up identified actions taken and supported ongoing challenges. RESULTS: Between March and December 2023, 40 Optimus PRIME courses were delivered. Thirty-nine course summaries were sent. Using the safety software in infusion pumps, 60% and 81% of sites were unable to correctly administer adrenaline or phenytoin, respectively. One or more pieces of paediatric oxygenation or ventilation equipment were lacking at 65% of sites. Participants working at 81% of sites were unfamiliar with the Queensland Health paediatric guidelines. CONCLUSION: We highlight challenges for healthcare providers across Queensland and demonstrate educational teams can contribute to their resolution. Many problems perceived as local were occurring statewide. Our findings inform further advocacy. Our report informs opportunities for system optimisation and highlights inconsistencies in three key areas: infusion pump safety software, access to paediatric resuscitation equipment, and access to information technology. Statewide consistency synergising with local expertise is needed to ensure every child in Queensland has access to optimal resuscitation.