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• 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 ?

• 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

• 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.)

• 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 built-up / 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/media_bank/Schkin-Instruction-01.pdf

• http://www.behindthesimcurtain.com/moulage/bruising

• http://www.behindthesimcurtain.com/moulage/schkin-recipe

• http://www.behindthesimcurtain.com/moulage/lacerations-variation

• http://www.popularmechanics.com/technology/digital/visual-effects/diy-halloween-tips-let-me-in

Resources

• http://www.instructables.com/id/How-to-Easy-Halloween-Prosthetics/?ALLSTEPS

• http://www.ehow.com/how_8228480_make-own-scar-putty.html

• http://www.behindthesimcurtain.com/moulage/burn-partial-thickness-of-hand

• http://www.behindthesimcurtain.com/moulage/osler-nodes

• http://collaborate.uw.edu/faculty-development/teaching-with-simulation/teaching-with-simulation.html-0

Resources

• Broken bone https://www.youtube.com/watch?v=8GNdpAKxK3o

• Bruises https://www.youtube.com/watch?v=g2G-9r6Tv98&list=PL25CCBFA4BFB21480