Moulage Concepts


‘Bridging the Gap’ in simulated training exercises

CarolinaFireJournal - Bobbie Merica
Bobbie Merica
10/10/2014 -

How good are you at pretending, at engaging and play-acting?If you were instructed to care for a simulated victim with a patient profile card that read “hemorrhaging gunshot wound” or “open pneumothorax” could you see it in your mind? Would your pulse instinctively quicken at the thought of congealed blood pooling around the victim or bloody froth at the chest wound entry point, bubbling with each exhalation? Working instinctively, would you begin putting pressure on imaginary wounds and shouting out orders, adrenaline building, propelling you into what you have been trained to do — save a life? If you had never experienced these two medical emergencies and I asked you to pretend in your scenario that your victim had them, could you do it?

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“The secret of success in the field is to be trained and ready for your time when it arrives.”
— Bobbie Merica
Medical-Trauma Moulage expert

Moulage —What Is It?

Moulage is the art of applying life-like injuries to assist in providing realism, training techniques and shock desensitization to first responders, military, medical staff, veterinarians and youth education groups alike. Moulage may be as simple as applying pre-made rubber or latex molds or as complex as using advanced three-dimensional interactive wounds, odors, and makeup and theatre techniques to provide elements of authenticity to the training scenario. The addition of moulage supports the sensory perception in a training exercise; assisting the responder in confirming the physical signs that support the diagnosis and enabling discovery of data pertinent to assess patient status while prompting responders to gather additional information relevant to the correct treatment — all of which increases knowledge and performance in response time, evaluation clues, critical thinking, realism and sensory engagement.

Moulage — Should I Be Using It?

“Train as you Fight.”

— United States Army

The addition of Moulage creates realistic field training exercises that mimic responder and victim situational responses that are specialized to training outcomes, including:

  • Pediatric specific field triage
  • Elderly and immune-compromised
  • Pathologic patient conditions
  • Veterinarians
  • Wound identification and closure

Moulage, when integrated into the simulated exercise, creates a powerful training modality that enhances live actor and human patient simulator events. The use of interactive, odorous, three-dimensional wounds such as hemorrhages, wound debridement, suturing capabilities, decontamination and realistic triage heightens the field experience by providing enhanced assessment, injury recognition, supportive decision-making, realism, and retention and stress inoculation.

“Success does not consist in never making mistakes but in never making the same one a second time.”
— George Bernard Shaw

Another reason to add moulage to the training scenario: Current research estimates anywhere from 50 to 90 percent of all communication is non-verbal, thus proper assessment, triage, acuity and training is often dependent on the accurate use of four of the five senses; that which must be seen, felt, heard and even smelled.

The addition of moulage highlights areas for growth by assisting the team in identifying shortfalls in current patient coding, acuity levels and wound staging based on individual and team assessment. Additionally, skilled use of primary and accessory moulage can illuminate areas for risk reduction through quality advancement identifiers such as highlighting strengths and weaknesses involving wound recognition, stabilization, standardization and triage management on both an individual and team building events. The addition of moulage to the training paradigm can provide life-saving exposure of system vulnerabilities creating a segue between multiple responders, systems and triage points.

“An expert is a man who has made all the mistakes which can be made, in a narrow field.”
— Niels Bohr

The use of interactive moulage will provide training opportunities that highlight field hazards to both patient and responder, including prevention and management of secondary and transport related injuries such as:

  • Eviscerations, dislodged impaled objects and compromised burn care from ruptured blisters during transport
  • Scene safety including primary and collateral injuries related to chemical, hazard and biological events
  • Initial, cross-contamination and exposure related injuries
  • Primary and tributary environmental related injuries including smoke/gas inhalation, equipment failure and system breakdowns
  • Enhances injury recognition and accurate categorization of wound severity, staging, associated risks and complications due to progression and patient deterioration while in the field

“To Moulage or not to Moulage, there is no question.”
— Lance Bailey, HealthySimulation 

Moulage — Are You Ready to Take Your Training to the Next Level?

I hope after reading this article you agree that the use of moulage techniques has the power to authenticate the training field experience, taking your simulated exercises to the next level. While you can read about injury processes in books and study symptoms in theory, you cannot fully understand that which you do not already know or experience. It is the interpretation of what is seen, felt, heard, and smelled that allows the responder to pull together critical data and integrate this knowledge into their assessment, response and care plan, but perhaps more importantly, the interactive training experience provides responders, teams and systems first person accounts of data utilization to expand on future training experiences.  

So let’s work together to “Bridge the Gap” and create powerful training modalities that engage all the senses and provide realistic scenario storylines.

Bobbie Merica is the owner of Moulage Concepts and author of several books based on her medical and moulage and trauma workshops. Visit www.moulageconcepts.comor call 530-877-2628 for more information.

(This article/photos are referenced from “MoulageConcepts — Bridging the Gap in Simulation.” Copyright and other intellectual property laws protect these materials. Reproduction or retransmission of the materials, in whole or in part, in any manner, without the prior written consent of the copyright holder, is a violation of copyright law. All subject matter must be referenced back to www.moulageconcepts.com.)
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Issue 32.4 | Fall 2018

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