'Hemoulage' – A Review of TrueClot Blood Simulant by Will Enfinger
With Halloween just around the corner we thought now would be a great time to review Luna Inc. ‘s TrueClot’s Blood Simulant. Simulation Technology Specialist Will Enfinger wrote this wonderful breakdown of this amazing product!
Let There Be… Simulated… Blood:
Welcome to the inaugural simulated blood-product series! My name is Will Enfinger, and I will be your guide on this magical journey through the myriad of products available to us as Simulation Professionals. I have a unique understanding of blood products, as my experience in simulation has required me to bring realism to combat medical training, OR scenarios, and traumatic mass casualty events. I have spilled many a gallon of blood in my quest to illicit realistic stares and flustering amongst participants.
Whether we call it “blood simulant”, “simulated blood”, or just “fake blood”, we all have a need for it at some point during simulation. We fill IV arms with it, pump it through the manikin, or create a trauma wound or scene. And let’s be honest: “concentrated blood” from the majority of manikin manufacturers looks like, well, Kool‑Aid.
While some simulation programs have great success with food coloring or manufacturer’s concentrated mixtures, others feel the need to step it up just a notch. Raise the bar. Add the next level of realism. Give students and learners a memorable experience. That’s where good fake blood comes into play. Hemoulage!
For the sake of this series, we are going to refer to these products as “simulated blood products” since the majority of sim programs will use them for bleeding wounds, scene creation, or realistic IV training and these events involve human whole blood (one of the blood products as recognized by the Red Cross). I will review four Key Elements for these products: Color; Viscosity; Washability; Bonus Traits.
The first product on our testing block is TrueClot™ Blood Simulant by Luna Inc. As you can imagine, the focus of simulated blood products is going to be trauma training and hemorrhage control. This is where realism plays a vital role in the development of skills and intestinal fortitude. According to the Luna website their product
“. . . is the most realistic blood simulant available today. Developed for training first responders in traumatic hemorrhage control, wound packing and the use of advanced hemostatic dressings, TrueClot™ Blood Simulant will form realistic simulated blood clots when used together with TrueClot™ Simulated Hemostatic Dressings and a suitable task trainer or manikin-based wound simulator. Moulage clots can also be created instantly by mixing TrueClot™ with our liquid Clotting Solution.
TrueClot™ accurately matches the color, opacity and flow characteristics of human blood. It is non-biological and non-hazardous, washes from skin and clothing with soap and water and is shelf-stable for six to twelve months. TrueClot™ Blood Simulant is available as a pre-mixed solution or as a concentrate designed to be diluted in water by the end user.”
I believe that is a challenge!
In the sample package I found instruction pages, a large bottle of TrueClot ™ Blood Simulant, a roll of TrueClot ™Simulated Hemostatic Gauze, and TrueClot ™Clotting Solution. The last two bits are intriguing, as shops are beginning to focus on ultra-fidelity with blood. Other than color and viscosity, what makes human blood so special? It clots. Interest piqued.
COLOR: Red water is not realistic. Appearance is everything in simulated blood. Appearance consists of a combination of color and viscosity. If the color is wrong, we know it right away and the believability suffers.
The first thing I noticed about TrueClot ™ is the color. It is surprisingly realistic. Kind of like that shade of red just this side of I-stole-it-from-a-blood-bank. So far, off to a good start! Luna actually has an image online comparing TrueClot ™ with human blood for color. I was hard-pressed to tell the difference.
I opened the bottle and immediately poured some in my hand. It looked like I really hurt myself. I was impressed. It was extremely life-like and I immediately had a flashback to one of any number of times I have sliced my hand/finger open while cooking, carving things, or just being a boy.
Then I poured some onto our Testing Surface to see how it would fare in the next test . . .
VISCOSITY: Blood is not water-thin. Neither is it syrup-thick. On a smooth surface blood runs, but slowly. It splatters, but uniformly. Have you ever rubbed it between your fingers? It’s sticky. All of this is viscosity at work.
On the fingers, TrueClot ™ feels like water. On our Testing Surface (a laminated sheet) it beaded up and ran when tilted, just like water would. This is not a deal-breaker, but I began to have my doubts. Deduct one point from TrueClot ™. According to Luna Inc, TrueClot ™ can be used in a manikin. I haven’t gotten to that point yet, but I’ll update as soon as I do. With this thin viscosity it may be just fine. Spattered on the floor or manikin, it looked realistic despite the thinness of it.
Maybe some other properties will raise the score. . .
WASHABILITY: This is The Number One Simulation Concern. I suppose the proper word here is “cleanability”, but the idea remains the same: will it wash off? Not just from skin (ours and our learners) but from clothing (again, ours and learners) and, most importantly, from the manikin. A little known fact: the color red stains more persistently than any other (we could debate about black Sharpie on a manikin’s skin or Red Dye #5 which is probably of the devil). My general rule: If it stains me, it will never come off the manikin.
I left the sample on the Testing Surface to dry for 24hrs, a sample on the manikin for 12hrs, and my skin for about 5 minutes. The interesting thing about TrueClot ™is that it doesn’t actually dry. This is a little strange to me. Luna sells a concentrated TrueClot ™product that reconstitutes with water and I can only assume this is the case here. Once the water evaporates we are left with a concentrate.
A purple, slimy concentrate. All traces of “human blood” are now gone (See Image 3) on the Testing Surface. On my skin, I actually had staining right away (when I first opened it I spilled some and washed up immediately). But at the 5 minute mark, I was concerned. Even with soap and warm water, per instructions, I had staining (Image 4). It easily rinsed off of the Testing Surface with water alone, and I could see that it was reconstituted when the water touched the “dry” sample. On the manikin, it was a nightmare. Purple, deep-set stains that I couldn’t remove with soap, acetone, elbow grease — which was not a good sign for cleanup.
TrueClot ™ does clotting! The namesake of this product is one of the most incredible aspects of human blood. Our clotting factor keeps us from leaking like a sieve. Anyone who’s dealt with traumatic amputations, childbirth, or just simple lacerations can attest to the miracle of a little direct pressure (or a few shakes of a coagulant).
With the included TrueClot Simulated Hemostatic Gauze, a flow of TrueClot Blood Simulant will actually begin to clot in 30-60 seconds to facilitate the experience of hemorrhage control in a trauma or surgical setting. The addition of a Clotting Solution is even more impressive and more than makes up for the viscosity and washability issues. A ration of 5:1 Blood Simulant to Clotting Solution yields incredibly life-like, almost-instant, clots. So realistic, my co-worker (an experienced trauma/advanced care certified Paramedic) walked into my experiments and just stared. Pale. He turned around and walked out. Luna has a few amazing videos on their site demonstrating the clotting factor, and I really think it’s absolutely brilliant. The possibilities are frightening . . .
So, in conclusion and in summary, Luna Inc.’s TrueClot ™Blood Simulant is a life-like simulated blood product with qualities that far surpass dyed water especially when it comes to educating about clotting, but there’s still a few things to be desired. If the staining isn’t a concern to you, be my guest and try it out. But for the clotting factor, that is absolutely awesome! The price for this, and other simulated blood products, is not cheap. You truly get what you pay for (about $50/gal of the pre-made solution), and while tempra paint can do in a pinch, it’s just not the same.
To learn more visit Luna’s TrueClot Webpage!
Stay tuned, my Hardcore Hemoulage Heads! More to come next month… If you have any questions or would like to know how a simulated blood product (can we call these things SBPs?) acts in certain situations, email me!
Lance Baily, BA, EMT-B, is the Founder & CEO of HealthySimulation.com, which he started while serving as the Director of the Nevada System of Higher Education’s Clinical Simulation Center of Las Vegas back in 2010. Lance is also the Founder and acting Advisor to the Board of SimGHOSTS.org, the world’s only non-profit organization dedicated to supporting professionals operating healthcare simulation technologies. His new co-edited Book: “Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice” is available now. Lance’s background also includes serving as a Simulation Technology Specialist for the LA Community College District, EMS fire fighting, Hollywood movie production, rescue diving, and global travel. He lives with his wife Dr. Abigail Baily in Las Vegas, Nevada with their newborn daughter and two crazy dachshunds.