Adding Realism to Practical
situations: The Use of Moulage
Techniques in Athletic Training
Shawn Felton, EdD, ATC, LAT
Hugh Harling, EdD, ATC, LAT
2014 SEATA Educators’
Conference
Atlanta, GA
Using Simulated Events
Factors Needed to Have Successful
Realistic Simulation
• Plausible Environment
• Plausible Responses
• Plausible Interaction
• Familiar Equipment
• Realistic Simulator Equipment
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Seropian, M. Technology, Computing and Simulation (2003) Anesth Analg
Importance of Fidelity
• 3 Fidelities of Patient Simulation
– Equipment Fidelity
• Simulator versus real equipment
– Environment Fidelity
• Simulation of Motion, visual and other sensory
environments
– Psychological Fidelity
• How real one perceives the simulated event?
• Trying to suspend disbelief
Why Use Simulated Events
• Control for the Area of Interest, specific
learning outcomes
• Protect patients/clients
• Ensure skills are instructed for specialized
skills
– CIPs
Testing Utilizing Moulage and Simulation
• More Authentic
• Ensure Knowledge and Clinical Skill
• Ensure flow of communication
• Scenarios that are rarely encountered
– Take out the chance
Play like you Practice
• Never more true
• Learn From FBI – J Edgar Hoover
• Practicing CPR
• Need opportunity to perform without
interruption
• Moulage always for more authentic
experience
Table Discussion
• What are some of the self-identified
challenges for creating moulage and
enhancing realism?
What are your challenges ?
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Time
Funds
Space
Ideas
Moulage….
What is Moulage??
• French for casting/molding
• Art of applying mock injuries to enhance
realism, can be simple and complex
• Can be used with Standardized Patients
and/or Human Simulators
Manikin or Person
Lessons from the field (classrooms)
• Authentic
– Use of gloves
• Obvious for external injuries
– Internal Injuries
• Add Glycerin & Water to simulate sweating (Elevated
Temperature)
• Blue Watercolors on manikin to cue Hypotension – Mild
infection
Table Discussion
• What are you trying to Achieve with Moulage?
• What have you done to enhance realism?
– What were the successes and failures?
Recipes…Blood
• Ivory dish soap and
red food coloring
• Darkens as drys just
like blood
• WILL STAIN (Skin,
clothes, manikins,
…)
• One cup corn syrup
• Red food coloring
mixed with 1-3
drops of green or
blue food coloring
• Corn starch to
thicken
Recipes…More Blood
• Non-Staining
• Similar to previous
recipes
(Dishwashing
detergent) with
washable poster
paint (Red, Black,
Blue) and sugar-free
chocolate syrup
Recipes…Skin
• Liquid Latex
• Schkin
– Petroleum jelly, corn
starch, paint or
chocolate powder
Recipes…Blister / Furuncle with Pus
• Vanilla pudding with
a drop of red, green,
or yellow food
coloring
• Inject into bubble
wrap and seal with
crazy glue
• Attach to surface
and cover with “skin”
Recipes…Dilated pupils
• Place black marker
dot on old contact
and place in eye of
manikin
• Dots can vary in
size to create
aniscoria
Recipes…Drainage/Secretions
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Wound drainage presents itself
in a variety of situations; often
the drainage is as diverse as
the situation.
Prior to beginning your
moulage, consideration should
be given to volume, consistency
and odors to assist you in
authenticating the scenario you
are creating.
When crafting your wound
drainage, consider the following
factors: What type of wound is
it? Where is it located? What is
the over-all health of the
patient?
Recipes…Drainage & Secretions (Cont.)
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Purulent, odorous drainage moulage for healthcare simulation:
1 tsp. (condensed) cream of mushroom, chicken or split pea soup
2 tsp. Limburger cheese
2 drop Kimchee (Chinese seasoning)
4 drops water
Caramel food coloring; thinned
In a small bowl combine cream soup, Limburger cheese, Kimchee and 2 drops of
water. Stir mixture well for approximately 1 minute or until thoroughly combined. On
wax paper, thin 1 drop of caramel food coloring with 2 drops of water, stirring well with
small paint brush. Swirl paint brush with caramel coloring through purulent mixture to
impart coloring and add depth.
Environmental Settings:
Using a small paint brush, apply purulent drainage to 4×4 wound dressing, gauze
pads, and internal cavities and crevices of dimensional wounds. Use in conjunction
with diabetic foot ulcer and wound dressing drainage. See: MoulageConcepts.com
for more recipes.
Clean Up:
Using soft, damp cloth; wipe odorous drainage from skin of simulator. Treated
dressings, gauze pads and wounds can be stored in the freezer indefinitely. Allow
mixture to come to room temperature before proceeding to scenario. To refresh odor:
Add 1 drop of Kimchee to dressing.
Time Saving Hint:
Odorous drainage can be made ahead, stored, covered, in the freezer or
refrigerator. To reconstitute, add 2 drops tap water and stir several times.
Recipe…Simplest Laceration
• Simplest – slice
closed foam surface
or suture arm from
Life/form ($ 165)
• Slice manikin face,
arm or chest (CPR
face – 6 for $ 60)
• Add color and
texture to wound
Recipe…Laceration
• Buildup “skin”
• Slice “skin”
• Add color and
texture to wound
• If want reusable,
make wound on wax
paper and adhere to
person or manikin,
peel off after use
Recipe…Blister
• Simplest – Bubble
wrap glued to plate
(Especially if
practicing lancing and
skin removal)
• Bubble wrap injected
with Vaseline or fluid
(Seal with crazy glue)
• For either of the
above, add skin builtup / over the top
Recipe…Blister Alternate
• Skin built-up
• Inject Vaseline
under skin
• Drying time issue
Recipe…Another Blister Alternate (Burn)
• Cut a piece of red
Saran wrap in shape
and size of wound
• Adhere to site
• Apply line of liquid
latex or “skin” to
border of area and
into the burn area
• Peel and roll inside
edges
• Apply red makeup or
lipstick fading towards
the edge
Recipe…Burns
Recipe…Bursitis
• Hand warmer inside
Pantyhose over
area (Elbow)
Recipe…Closed Fracture
• Tape three straws
together with tongue
depressor
• Closed cell foam or
small bubble wrap
• Cover with Coban,
Pantyhose, or “Skin”
Recipe…Open Fracture
• Tape three straws
together with white
tape
• Cover end with dry
wall patch material
• Paint ends for marrow
• Add “skin” over the top
• Add blood and
makeup
Current Projects
• Suture removal
• Staple removal
• Oral cavity & Dental
injuries
• Nasal Plug insertion
• Top of head
laceration
• Corneal abrasion
Items to Consider (Cautions)
• There is no known issues/problems with
homemade moulage
• Sensitivity to Latex
• Shave area a day or tow before applying
liquid latex to skin
• Be careful with dishsoap use above the neck
on real person
• Use of Sugar type ingredients (Outdoors
attracts bugs in summer)
• Soaking Clogged spray bottles
Proper Cleaning Techniques for Manikins
• Mild dishwashing soap
• Citrus cleaner (plastic container only – metal
container too harsh)
• Nothing with acetone on manikins as will
desolve manikin clear coat and paint already
on manikin (Eyebrows, …)
• Wet wipes (without bleach)
• Isopropyl alcohol wipes or gauze
• Anything you would use on the inside of your
car can usually be used
Methodist University Fishing Challenge
• Online Fishing
Tournament
• AT Programs Challenge
– Most Points, Participants
• Proceeds to benefit
NATAREF
• Register ($ 25), Fish,
Email fish photo to win
Questions ???
Thank You !!
Resources
• Moulage for Manikins, Ridgewater College
• METI Recipes for Disaster
• http://www.hpsn.com/_assets/dynamic_media/m
edia_bank/Schkin-Instruction-01.pdf
• http://www.behindthesimcurtain.com/moulage/bru
ising
• http://www.behindthesimcurtain.com/moulage/sc
hkin-recipe
• http://www.behindthesimcurtain.com/moulage/lac
erations-variation
• http://www.popularmechanics.com/technology/di
gital/visual-effects/diy-halloween-tips-let-me-in
Resources
• http://www.instructables.com/id/How-to-EasyHalloween-Prosthetics/?ALLSTEPS
• http://www.ehow.com/how_8228480_makeown-scar-putty.html
• http://www.behindthesimcurtain.com/moulage
/burn-partial-thickness-of-hand
• http://www.behindthesimcurtain.com/moulage
/osler-nodes
• http://collaborate.uw.edu/facultydevelopment/teaching-withsimulation/teaching-with-simulation.html-0
Resources
• Broken bone
https://www.youtube.com/watch?v=8GNdpAK
xK3o
• Bruises
https://www.youtube.com/watch?v=g2G9r6Tv98&list=PL25CCBFA4BFB21480