Educator's Corner: Recipes For Emergencies: Moulage


Author: Philip L Hayes, EMT, EMS-I, FO

Moulage Overview

Courtesy of Image Perspectives

When I started teaching EMT courses 14 years ago, I noticed a big problem with students being able to take what they learned in the classroom and being able to apply it when caring for patients in the street. I spent the first several years of my teaching career learning the basic instructor trade. The State EMS instructor program did little to prepare me for my teaching career. I soon began teaching so much that it became close to a second full-time job... and I LOVED IT! I became deeply interested in learning how to take my teaching abilities to the next level. So, I began taking several courses that focused in on the learning methodology of adults and how to teach them so they actually learned something - and remembered it.

Every March we have an annual Northeastern EMS Educational Conference that takes place here in Connecticut and I sat in on a seminar being taught by Montana EMS' Training Coordinator Ken Threet. Ken is a well known lecturer on the subject of moulage. While I had some basic knowledge about moulage, Ken's hands-on seminar helped spark an interest in casualty simulation that changed my teaching technique forever.

In the seminar, Ken demonstrated some very quick and basic casualty simulations using simple make-up to create burns, and fractured ankles and wrists. I was amazed at the realistic looks he was able to create in only a few short minutes. Previous instructors who I had worked with had simply glued prosthetics onto a "victim", dropped some simulated blood over it, and that was it. But the results of that were marginal when compared to the impact the simulated injuries I learned how to create had on the students!

I was hooked on reality-based training from then on and immediately began using moulage in my next EMT practical session. I went out and bought my own supplies from several manufacturers and stocked them in an old 747 Plano box we once used as our 'first in box' on the ambulance. From then on, I used as much moulage and reality-based training techniques in the teaching process as possible. Students had more fun. I had more fun. But must importantly, the students learned! They learned so well, by the end of course practical exam pass rate skyrocketed.

Casualty Simulation, the next step

Courtesy of Simulaids

Casualty simulation combines realistic make-up of injuries or conditions (moulage) with a victim playing the roll of the patient. Including a simulated or realistic environment is also very important. Not only should the simulated injury or condition be treated appropriately and efficiently by the student, his or her natural feelings and reactions to stressful situations should be tested.

Many students enter the EMS field without a true grasp of what to expect once they graduate. Many find themselves unprepared to handle the sobering sights and sounds that can accompany a serious medical case or major trauma. Usually, this is because they have not seen or experienced anything like it before. Seeing blood slowing dripping from an simulated open fracture and hearing the screams of pain of the victim as the student tries to stabilize the fracture certainly makes more of an impression than if the victim calmly says, "I fractured my left femur and it hurts bad." By preparing our students for these more stressfull situations in the classroom under controlled circumstances, they are better trained and more emotionally prepared to take the necessary emergency actions quickly and confidently.

Casualty simulation provides the student with the experience needed for making quick assessments of injuries, handling and prioritizing the patients, and becoming familiar with many medical and traumatic injuries so that the students assessments and treatments become second nature. So what can we simulate? You name it.... heart attacks, shock, burns, impaled objects, avulsions, shortness of breath, choking and childbirth. Based on my experiences, these types of simulations will help to maintain the interest in the learning process, foster teamwork and keep things exciting for the instructors.

 About Simulation Kits

The Ben Nye Casualty Simulation Kit

Casualty simulation kits and moulage supplies can be purchased through several companies that I will list at the bottom of this article. Some of these kits can be quite elaborate with enough material to moulage an army invasion or mass disaster. Generally speaking, these larger kits are not necessary for the standard EMT / Paramedic program. I found that making my own kit worked the best, albeit that it may be a little more expensive. And, when the budget was tight, I found ways to improvise with cheaper supplies.

The commercial casualty simulation kits generally include an assortment of vinyl wounds that can be glued on the victim for a realistic scenario. The typical injuries included are abrasions, lacerations, puncture wounds, burns, and small open fractures with bones protruding. If you have a fat budget, you can really go crazy and buy blood reservoirs and pumps that will ooze blood slowly or spurt like a severed artery. These devices can be controlled to stop flowing when compress bandages are applied or a pressure point is used.

Moulage supplies can also be found at theatrical supply or costume stores. In fact, the best people to learn the tricks of the trade from are people in the movie or theatrical business. I found a local theatrical store that had everything I needed.

All moulage kits should be customized with some household supplies that will even further enhance your students learning experience. Using a little imagination, bones, fractures and bone parts can be created with Plaster of Paris and a little wire. Your imagination is the limit!

Remember, the more realistic the simulation, the greater the student's learning experience.

In the coming months we will be present an exciting new Educator's Corner feature "how to" series entitled 'Recipes For Emergencies'. Each month we will present a technique for simulating a prehospital emergency. We'll start with suggestions on simulating environmental factors and providing you "how to" instructions to moulage necessary 'victims'. We'll also include essential information on properly preparing students and your volunteer "victims" for practicing with simulated injuries and reality-based training.

Suggested Supplies:

Here are some of the basics you should include in your Casualty Simulation Kit:

Bloods

  • Stage Blood (ingestable)
  • Thick Blood
  • Fresh Scab
  • Bulk Blood Powder

Foundations

  • Cyanotic Blue
  • Vermillion
  • Red
  • Dark blue
  • Black
  • Light blue
  • White
  • Purple
  • Yellow
  • Flesh
  • Brown
  • Green
  • Grey

Powders

  • Simulated Charcoal Powder
  • Ashes
  • Black
  • Light

Modeling Clay

  • White
  • Brown
  • Flesh

Tools

  • Palette knife
  • Spritzer Applicator / Spray bottles
  • Modeling Tools
  • Scissors
  • Professional brushes
  • Bulb syringe

Make-up Applicators

  • Make-up Sponge / Wedges
  • Q-Tips
  • Stipple Sponge
  • Cotton Balls
  • Dropper bottles

Adhesives, Removers & Latex*

  • Spirit Gum
  • Spirit Gum Remover
  • Latex Slip
  • Prosthetic Adhesive
  • Castor Sealer

Jellies& Creams:

  • Neutral Set Face Powder
  • Lubricating Jelly
  • Petroleum Jelly
  • Cold cream (large jar)
  • Petroleum jelly
  • Hand cleaner

Miscellaneous

  • Bones (dried chicken bones)
  • Fake Nails
  • Glycerin
  • Kleenex
  • Tooth picks
  • Condoms
  • Thread
  • Plastic cups
  • Detergent
  • Eyebrow pencils
  • IV bags
  • Apron
  • Drop cloth
  • Tongue depressors
  • Cork
  • Juicy Fruit Gum
  • Duo, A Surgical Adhesive
  • Medic Alert Bracelets

Glue-Ons Simulations

  • Slit Throat
  • Bullet Holes
  • Exit Wound
  • Open Fracture
  • Jagged Cut
  • Deep Laceration
  • Avulsed Eye
  • Torn Cheek

*Purchase latex free supplies whenever possible to prevent latex allergies. Always ask about latex allergies before using any prodcut on any person.

Resources:

Please Note: Ben-Nye is the manufacturer of some great make-up products for EMS but
they do not yet have a web site. Some of the resources listed above sell their products.