# Moulage



## EMTrainer (Jun 13, 2009)

How often do you use casualty/trauma simulation (moulage) as part of your training? I've been teaching for several years and have received a lot of good feedback from students and other instructors because we use moulage not only for MCI drills, but also frequently (on a smaller scale) during class. I'm interested in hearing the opinions of others as to its value in the classroom.


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## Ridryder911 (Jun 13, 2009)

I use moulage routinely but not in great detail. I used to use it quite a bit, and had became very good at it; but for the most part one will spend minutes to hours for a small time on a scenario that it will be destroyed on. 

I believe there is a time and place for it, and does give students at least a sense of having to pay attention to possible wounds & injuries. There is two sides, how much does one have to see a broken bone and second just telling a student you see angulation or taping a name of a injury to extremity gives how much realism? 

R/r 911


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## EMTrainer (Jun 13, 2009)

*Good Point*

I agree that moulage can be overused. It's fun to watch a student's eyes get wide when the lift a shirt to find a big evisceration or impaled object, but I find subtle moulage valuable in finding out just how well students are applying their skills. For example, if you are practicing trauma assessment and a student says "I would check the ears" and you respond "There is blood in the left ear" obviously the student is going to take the cue. From time to time I like to take a victim with long hair and put a small amount of thick blood in one ear, or give them a Battle's sign bruise. When the student says "I would check the ears" I respond "As you find them" or "Go ahead". I'm always glad to see a student pick up on these clues, and surprised how many wave a hand over the patient while reciting the skills sheet and move on without noting the sign of injury.

Other examples could be a bee-sting welt on the neck for an unconscious, non-breathing, patient (anaphylaxis) or small electrical burns on a hand and shin for a patient who fell off a metal ladder (scene safety). You can go textbook obvious for new students or throw in some twists for experienced EMS personnel for refreshers or continuing education.

Any other ideas?


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## Markhk (Jun 14, 2009)

I sometimes like to play, "hide the crunchy object", like stuffing crumpled paper into a pant leg.  When the EMT does the patient exam, we really see if they pick up on their palpation an abnormal finding. (Or, if instead they just do a light pat down.)

I'll also use tape and write down injuries and tape that onto the person on the back and stuff to see if they find it. 

Otherwise moulage is only really used for the big messy field day.


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## EMTrainer (Jun 15, 2009)

*Durable moulage*

R/r 911, you mentioned spending a couple of hours on a moulage that would be destroyed right away. This used to be a problem for me too. I still do a lot of wax buildups, creme makeup wheels, and other traditional moulage, especially for one-shot deals that I expect to be destroyed. There are some new things on the market that can last all day and be touched, splinted, bandaged, over and over and still look good. Several companies make two-part silicone that comes in flesh and blood colors. You simply mix the two parts together into a thick paste that is applied to the skin much like you would Dermawax or other traditional products. You can sculpt it with a popsicle stick or other tool into any shape cut or whatever. It cures in just 10 minutes to a soft fleshy rubber and will stick all day. You then add your blood with the same material in red and you have a wound that will last through numerous bandagings. There are also alcohol activated makeups that come in palettes like water colors, but which are reactivated by a brush dipped in alcohol. You can stipple, brush, or even drip it on. Once it's dry it is waterproof and stays put for hours. 

Here is one that I did for a recent class. This young lady had deep abrasions to her face and hands. The entire makeup was done in about 20 minutes, including curing and drying. During curing time for the silicone, I applied a sucking chest wound/knife stab to another victim. So both moulages took a total of 30 minutes. They lasted through several students treating them as if they were real. All I had to do between students is remove any bandaging and apply a little fresh corn syrup based blood. 







When you first look at silicone and AA makeup, they seem kind of expensive, but actually I only had about $2-3 into both moulages. When you compare volume to volume, some of the silicones are no more expensive than the Dermawax. I participated in a 60 victim MCI drill last summer and used both wax buildups and silicone. The partcipants were outside in a cold rain for hours. Afterward, the regular moulage was showing a lot of wear and damage but the silicone and AA stuff looked like it had just been applied. I'm also bit on safety and the silicone and AA makeups are hypoallergenic and non-toxic. They also come off easily. The silcone can be gently peeled off and the AA makeup comes of with either alcohol, or makeup remover followed by soap and water. This young lady took about 15 minutes to get cleaned up after the drill.

Here is a 3rd degree burn I did just playing around with leftovers from another project. It's could have used a bit more color, but this was 10 minutes of playing with what was left in the mixing cup. I did a full-hand burn in a similar manner but don't have a good picture.


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## TraumaFX (Jul 13, 2009)

I'm in total agreement with using many of the new materials for moulage. I, myself do MANY, MANY moulages throughout the year (it's what I do) for EMS training, MCI's, even Motion Pictures.  Heck, I even started a web site dedicated to materials for EMS moulage.
The point is: You can TELL a student what the injury is and they'll probably treat it according to textbook, but if you SHOW a student the injury, they learn quicker and retain the knowledge longer and aren't as apt to "freeze" up when confronted with their first REAL injury in the field.  And that's what I train my students for - the street, with all it's gross sights, smells and sounds.  They get it in class long before they ever have to face it in real life.  This is also how the military trains their medics, etc.  Make it real.  There's allot of research on the subject and putting on accurate, realistic scenarios is much better for a student to learn from than the easy, lazy way of just telling your students what they're seeing.
There should be no short cuts in training.


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## grandpa (Jun 16, 2010)

*get this post going again*

I do moulage many times a month and have had students tell me that moulage is a lot better then the pics, in the books. Some times its down and dirty but the best part is when i have time to work on my subject for a while and get to put in some detail. Am using a lot of gel 10 and i really like it. I would like to hear what others have to say. grandpa.


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