Moulage — Complex Wounds Simplified

CarolinaFireJournal - Bobbie Merica
Bobbie Merica
08/07/2015 -

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

Cerebrospinal Fluid Leak

Rescue at the Rock Quarry

Time: 1 minute

Skill Level: Beginner



3 cc lubricating jelly

1 tsp. distilled water


Small paintbrush




The objective of this moulage training scenario is to assist responders in creating moulage specific to a cerebrospinal fluid leak; recognizing the symptoms associated with it and assisting responders in creating training scenarios that enable utilization of appropriate triage interventions, wound management and difficult terrain responses.


In a small bowl, combine lubricating jelly and water, mixing well with palette knife or utensil to combine.

Value-based training: In addition to being realistic in appearance and non-staining, cerebrospinal fluid leak secretions can be easily adapted to create multi-demographic patient profiles to highlight training objectives in adults, juveniles and pediatrics scenarios. 

Cost effective: Cerebrospinal fluid leak secretions are tremendously cost effective. At approximately one to two cents a training, secretions may be color modified to include additional wound profiles and training outcomes including frothy-white for RSV, yellow for measles and blood tinged for wound exudate.

Quick: Secretions can be made in advance, tinted to wound profiles and stored in the refrigerator indefinitely. Secretions can be labeled and stored in a capped 20 cc syringe for ease of use during application and storage.  


Rating: A

When combined with a scenario that includes hematoma, abrasions, and neurotrauma, the addition of clear secretions offers a realistic training scenario that develops the responder’s sensory perceptions while building skill sets specific to training outcomes. 


Medic 3, respond Code 3, Granite Creek Rock Quarry, unknown injuries. 102 Quarry Road, nearest cross street, Pentz Hwy 5.  Fire and police on site.  2230 hrs. Dispatch clear.

On Scene:

Police and fire personnel are gathered around gate entrance and close to quarry edge. Several frightened looking teenagers are speaking with police personnel and not meeting eye contact. At quarry edge several police officers are yelling down to fourth teenager who is lying on a rock “ledge” about 25 feet down. There are several bottles of open liquor on the ground near the quarry edge.

Supporting Staff:

Three teenagers speaking with police: Using a cotton swab that has been coated with red cream based make-up, create eye reddening by applying a small amount of colorant to upper and lower lash line and blotting lightly with tissue. (Repeat process with a new swab for each person.) Using a spray bottle, mix one-half cup of Isopropyl alcohol with one cup of water and shake gently; apply to clothing to create an “alcohol” odor.

Rescue Victim:

Using a make-up sponge or fingers, liberally apply white make-up to face of simulator, blending well into hairline. Create beads of sweat on skin by apply a light mist of pre-made sweat mixture to forehead, chin and upper lip of simulator. Create eye reddening, abrasions and bruising on face, neck, chest and hands.

Using a spray bottle, mix one-half cup of Isopropyl alcohol with one cup of water and shake gently; apply to clothing to create an alcohol odor. Adjust victim to raise the head of the patient to 30 degrees.

Using a pre-filled 20 cc syringe of clear secretions, apply a small pool to one-third of lower nostril, at the entry of the nares and allow pooled secretions drain from the nose and down toward upper lip. Tear a cotton ball into four small pieces and wad up each individual piece tightly. Using your finger or toothpick, place cotton piece into ear canal and pushing into cavity until it is no longer visible but still reachable. Apply a small pool to cavity of ear, outside the eardrum.  Do not fill internal ear cavity with drainage; simulate draining up to orifice. 

If using a glucose oxidase reagent strips to distinguish cerebrospinal fluid:  Dissolve a glucose tablet into a glass of warm water; dip a glucose reagent stick into cup to show an abnormal test result of glucose positive. 

Patient should exhibit:

  • Slurred speech or mumbling
  • Loss of consciousness

Use in Conjunction With:




Bruise, fresh

Cleanup and Storage:

Using a soft dry cloth, wipe secretions from nose and ears of simulator.  Use a dry cotton swab to clean and absorb secretions from nose and ear orifices where excess secretions may have deposited. Remove cotton from ear canal with tweezers or fingers if reachable. Using a soft cloth lightly sprayed with a citrus-oil based cleaner and solvent, remove make-up and sweat from face of simulator. Wipe away secretion mixture from surface of treated glucose reagent stick with a paper towel and place in Moulage box for future use.   

Bobbie Merica is a medical/trauma moulage expert, author and owner of Moulage Concepts, a nationwide 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. Get her free tutorial blog with expert weigh-in at are referenced from “Medical Moulage — Making Your Simulations Come Alive” by Bobbie Merica, publisher: FA Davis, 2011.
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