In health sciences education, there is growing evidence that simulation improves learners’ safety, competence, and skills, especially when compared to traditional didactic methods or no simulation training. However, this approach to simulation becomes difficult when students are studying at a distance, leading to the need to develop simulations that suit this pedagogical problem and the logistics of this intervention method. This paper describes the use of a design-based research (DBR) methodology, combined with a new model for putting ‘pedagogy before technology’ when approaching these types of education problems, to develop a mixed reality education solution. This combined model is used to analyse a classroom learning problem in paramedic health sciences with respect to student evidence, assisting the educational designer to identify a solution, and subsequently develop a technology-based mixed reality simulation via a mobile phone application and three-dimensional (3D) printed tools to provide an analogue approximation for an on-campus simulation experience. The developed intervention was tested with students and refined through a repeat of the process, showing that a DBR process, supported by a model that puts ‘pedagogy before technology’, can produce over several iterations a much-improved simulation that results in a simulation that satisfies student pedagogical needs.