Roxanne Stelmaschuk

Workshop objectives

• To understand how the use of moulage and props add to the realism of simulation

• Participants will be able to identify ways to add realism to their scenarios

Is it really fake?

What about this?

Moulage (French: casting/moulding)

• Art of applying mock injuries for the purpose of training

• Moulage may be simple or complex

• Practice dates back to at least the Renaissance, when wax figures were used for this purpose

What is Moulage?

• Crafting an authentic and credible looking victim creates a sense of realism for mass casualty and individual training sessions and evaluations

• Responders don’t have to remember which limb was broken or where there was an injury

Why use moulage?

Moulage and realism in simulation

• Increase realism to human patient simulators

• Simulate injury and disease

• Places the learner in a realistic patient care environment

• Suspension of disbelief

From Simple to Complex

• Card tied to the victim’s ankle or neck identifying wounds or the number assigned to the victim with master sheet given to command post

• Placards beside the victim

• Water mixed with food colouring for blood

• Very often at the scene of the ‘accident’ but no discernable wreckage

• Military began to use simple methods

In the 1970’s - adding:• Clothing to match circumstance

• Manikins were more available for use

• Cuts in clothing with pieces of masking tape to identify wound

Some earlier (1950’s) techniques:

• Felt with taped-on injuries

• Strap on injuries

• Simple makeup – used cosmetic makeup – Ben Nye makeup is the best

• Simulated blood – gel and fluid

• Increased use with live ‘victims’

• Further research done on realistic looking wounds

1980’s and on…

Simulating injuries for the transport of the critically ill patient

Deep bruising

Deep cuts with debris

3rd Degree

Burns

Manikins with strap-on injuries

Bruising - fresh

Bruising - older

The strap-on kit

• Halloween blood from dollar store

• Homemade recipes - Google it

• Blood concentrate to be diluted

• Wound blood vs Stage Blood

A little about blood…

• Invite particular actors/models to match scenario

• Suggest models to wear modest underclothing (bathing suits work for female models) and no jewellery

• Coach models to act appropriate to the injuries

The addition of actors/models

• Clothing to match the scenario

• Thrift stores and donated clothing keep cost low

• One use only is ok – tear, cut, soil and burn as necessary

• Burning adds the dimension of scent

Addition of clothing

Questions to ask:

• What is the purpose? Training vs Emergency Planning Practice

• What is the scope? Number of casualties, location and incident

• What is my budget?

• What resources are readily available? Location, kits purchased already, free actors

• How many artists are coming to help?

• How big of an area do you have to set up?

• How much time do you have to set up?

• Do you have lead time to make injuries prior to the exercise?

Getting Started

• Scenario written out with details about each victim

• Allow enough time between injury creation and moulage artists

• Identify clothing for each victim

• Burn clothing (if necessary) ahead of time

MCI - Putting it all together…

• Make cards for each victim

• Use table to guide moulage session on training day for MCIs

…Putting it all together….

Example of MCI – Moulage Template

• Active bleeds

• Creating vomitus

• Broken teeth

• A&B blood

• Embedded objects

• Oral bleeding

• Coffee ground emesis

• Sucking chest wound

• Subcutaneous Emphysema

• Eviscerated bowel

Some other techniques

Smallpox

Electrical burn - entry

Heat burn

2nd and 3rd Degree Burn

Avulsion

Poison Ivy

Extruded eyeball ready to be applied

Ring avulsion

Eviscerated bowel ready to be applied

Amputation – ready to be applied

Finished product in the field

Open fracture – ready to be applied

Gunshot wound