November 11, 2013By Lance Baily

Military Trauma Moulage Report From the Fields

Just connected with Will Enfinger, Simulation Operator/Associate at ICF International after noticing his amazing moulage work posted online last week. He gave me permission to share his email that reflects on his long week of medical simulation!

skin tite smooth on

“Hey Lance,

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This week I have had my hands FULL!   

Beginning Monday, our office was involved with a 72-hr medical exercise here at Joint Base Elmendorf-Richardson, Alaska. We were tasked with providing simulation and moulage support for the EMEDS (Expeditionary MEDical Support), or field hospital, training. 

Thursday, I presented a full-day moulage training course for the 38th Alaska EMS Symposium. 
neck moulage injury
For the EMEDS exercise, our primary focus is the creation and deployment of the “wounded and dead” for the various units across the base.  As the simulated attacks take place (complete with launches of F-22 Raptors, C-17 and C-130 aircraft, deployments of EOD teams and Security Forces) members of the Exercise Evaluation Team come and collect “bodies” to take to the areas affected by the attacks.  Once they are treated locally and triaged, the patients are routed to the EMEDS for care.  In the course of a typical exercise, it is not unusual to create around 150 patients, ranging from the sniffles and watery eyes due to a chemical exposure to amputations, penetrating injuries, lacerations, burns, and more.  Some of these patients are created to be triaged and then replaced with a manikin for the further treatment of their injuries once they arrive at the field hospital:  blast wounds/bruising on the ribs = TraumaMan for a chest tube.  Severe lacerations and hemorrhage become SimMan 3G in hypovolemic shock leading to cardiac arrest. 
We even deploy the TOMM and MATT manikins for hemorrhage control, shock-n-awe, and total team reaction assessments. Nothing makes me smile more than the blood trail these two create.  Granted, it does not make me smile when it takes responders too long to adequately tourniquet a femoral bleed . . . and that’s why we train.  To test our medical teams and expose them to the type of real-world combat injuries they will invariably see.  To prepare them.  
simulated frost bite
At the EMS Symposium I had the pleasure of sharing the benefits and simplicity of moulage in simulation and medical training to some of the areas up-and-coming trainers, including members of the world-famous “Dragon Slayers” from Aniak, AK (if you don’t know much about them, please search for them and be amazed and what they do).  I shared a brief history of moulage, the current use of the word and how it impacts our training, and then coined a beautiful phrase that I hope everyone uses, “You can’t have moulage without simulation. You CAN have simulation without moulage.  But that’s boring”.  Granted, if you have moulage without simulation it’s just a Halloween party.  I showed them how we can create visual and tactile triggers, ways to combat our worst enemy in simulation:  a poor imagination.  We discussed ideas in an open forum, creating ideas and solutions from folks who had never done this before.  It was long and I was tired of talking (yes, me) but at the end of the day, I made new friends and compatriots in this burgeoning world of medical education and opened the eyes of folks ready to shake a few cages with realistic training.
moulage gunshot
Either way you look at it, the importance of moulage in our daily activities is unquestionable. Whether we create simple bruises, the diabetic toe, inflammation of an IV site, or impaled objects and eviscerated bowels we have the ability to change training.  To expand training.  And to keep simulation always interesting!
Friday, I took a nap.
Simfully yours,
Will Enfinger (@ManikinRunner)
(on Linkedin)
Picture notes:
Hand = Skin Tite by Smooth-on and Skin Illustrator paints
Neck = Skin Tite, Skin Illustrator, Simulaids blood
Chest = Ben Nye burn wheel and scar wax, simulaids blood”
Want to share your moulage work? Email us and let us know what you are up to!

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