Creating complex wounds

Quick and convincing moulage

CarolinaFireJournal - By Bobbie Merica
By Bobbie Merica
04/24/2015 -

The following is a Moulage Minute, value based training for those times when your scenario calls for quick, cost effective and convincing moulage application.


Hypothermia and Frostbite

Objective: The objective of this moulage-training scenario is to assist responders in creating moulage specific to frostbite and hypothermia; treating the symptoms associated with it and assisting educators in creating training scenarios that enable utilization of appropriate triage interventions and wound management. (See Figure 1)

Time: 5 minutes

Skill Level: Intermediate


Silifix Gel set

SIM-Safe stix, black

SIM-Safe stix, red

SIM-Safe stix, white


2 Palette knives

Make-up sponge

Blush brush

Paint brush, small

Technique: (See figure 2)

Using separate palette knives, remove a small amount (approximately the size of a pea) of Silifex gel A and B in equal portions and place on palette board to activate. Note: To ensure long term integrity of both products, use separate palette knives or utensils to remove product from each container prior to combining on palette board — using the same utensil for both materials will cause the Silifix to “seize” in the container. (See Figure 3)

Using the back of the palette knife, combine ingredients until fully mixed.

Using a paintbrush or your fingers spread a thin layer (approximately one-eighth inch thick) of Silifix over the upper fingers and knuckle joints and allow setting. (See Figure 4)

Using a blush brush that has been dipped in translucent powder, set the skin to ready it for colorant. Use your fingers to gently lift the edges of the Silifix (at the bottom of the knuckle) to create a “loose skin.” (See Figure 5)

Using a make-up sponge that has been dipped in water activated SIM-Safe red colorant, create areas of skin reddening along the upper fingers and back of the hand.

Using a small paintbrush that has been dipped in activated SIM-Safe black colorant, create areas of severe frostbite by applying the black color along the ends of the fingers and nail bed and extending upward to bottom edge of Silifix — hanging skin. (See Figure 6)

Optional: To create dying skin use a small paint brush that has been dipped in caramel coloring, lightly tint the edges of the hanging skin area (Silifix edges) to highlight areas of dying, peeling skin along the finger joints and creases between the fingers and knuckles.

Value-Based Training

In addition to being realistic in appearance and waterproof, Frostbite wounds can be easily modified to extremities and patient profiles to highlight training objectives in adults and pediatrics scenarios.

Cost Effective

Frostbite wounds are tremendously cost effective. At approximately twenty-five to seventy-five cents each (depending on the area of frostbite desired,) frostbite wounds will handle most triage applications.


When working with Silifix, the bulk of the time spent is waiting on the Silifix to set. Depending on temperatures, this may account for one to five minutes; however, a hairdryer will speed up the process. Enlist the help of your patient in holding the hairdryer while you utilize this down time to create the accessory moulage — such as skin mottling, cyanosis and blisters to ears, lips, nose, fingers and toes.


Rating: A —When combined with a scenario that includes constrictive and/or wet clothing, frostbite wounds offer a realistic training scenario that develops the responders sensory perceptions while building skill sets specific to training outcomes.


Medic 15, respond Code 3, Dry Creek Hunting Camp, missing hunters found; unknown injuries — 1322 Dry Creek Camp Grounds, nearest cross street, Dry Creek Hwy. County and City Search and Rescue on site. 1115 hrs. Dispatch clear.

On Scene

At campsite: Three adult men are being retrieved from the backcountry of Dry Creek Mountain after not arriving at their destination four days ago. Search and rescue attempts have been hampered due to rough terrain and severe weather.

Two victims are in fairly good health. Using a make-up sponge, apply white makeup to the face of victims, blending well into hairline. Using a make-up sponge, create various stages of skin mottling and cyanosis to ears, nose, lips, fingers and toes. Apply superficial abrasions and swelling to exposed skin of hands and face.

The third victim had separated from his friends during the storm and was found partially clothed several hundred feet away near a tree. Using a make-up sponge, create pronounced stages of skin mottling, cyanosis and frostbite to ears, nose, lips, fingers and exposed extremities. Apply superficial abrasions and bruising on knees, feet and hands.

Patient should exhibit:

  • Slurred speech or mumbling
  • Loss of consciousness
  • If using a simulator: Weak pulse and shallow breathing

Use in Conjunction With:

Abrasions, superficial

Bruise, fresh

Cleanup and Storage:

Carefully remove frostbite wound from skin of victim. Using your fingers to lift the wound around the edges of the silifix, gently lift in an upward motion, continuing to peel away the wound until all Silifix has released from the skin. Using a soft clean cloth or make-up remover towel, remove the make-up and any remaining product residue from the skin. Treated garments can be laundered or stored together in a sealed freezer bag in your moulage box for future use.

Bobbie Merica is a medical/trauma moulage expert, author and owner of Moulage Concepts, an international moulage company specializing in training, supplies and education. Utilizing best practice techniques, Merica’s teaching methods have simplified the complex, enabling everyone to create moulage that is quick, cost effective and convincing. Find her free tutorial blog at
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