1. 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

2. Using Simulated Events

3. 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

4. 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

5. Why Use Simulated Events
Control for the Area of Interest, specific learning outcomes
Protect patients/clients
Ensure skills are instructed for specialized skills
CIPs

6. 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

7. 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

8. Table Discussion
What are some of the self-identified challenges for creating moulage and enhancing realism?

9. What are your challenges ?
Time
Funds
Space
Ideas

10. Moulage….

11. 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

12. Manikin or Person

13. 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

14. Table Discussion What are you trying to Achieve with Moulage?
What have you done to enhance realism?
What were the successes and failures?

15. 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

16. Recipes…More Blood Non-Staining
Similar to previous recipes (Dishwashing detergent) with washable poster paint (Red, Black, Blue) and sugar-free chocolate syrup

17. Recipes…Skin Liquid Latex Schkin
Petroleum jelly, corn starch, paint or chocolate powder

18. 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”

19. Recipes…Dilated pupils
Place black marker dot on old contact and place in eye of manikin
Dots can vary in size to create aniscoria

20. 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?

21. 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.

22. 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

23. 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

24. 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

25. Recipe…Blister Alternate
Skin built-up
Inject Vaseline under skin
Drying time issue

26. 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

27. Recipe…Burns

28. Recipe…Bursitis
Hand warmer inside Pantyhose over area (Elbow)

29. Recipe…Closed Fracture
Tape three straws together with tongue depressor
Closed cell foam or small bubble wrap
Cover with Coban, Pantyhose, or “Skin”

30. 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

31. Current Projects Suture removal Staple removal
Oral cavity & Dental injuries
Nasal Plug insertion
Top of head laceration
Corneal abrasion

32. 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

33. 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

34. Methodist University Fishing Challenge
Online Fishing Tournament
AT Programs Challenge
Most Points, Participants
Proceeds to benefit NATAREF
Register ($ 25), Fish, fish photo to win

35. Questions ???

36. Thank You !!

37. Resources Moulage for Manikins, Ridgewater College
METI Recipes for Disaster

38. Resources

39. Resources Broken bone https://www.youtube.com/watch?v=8GNdpAKxK3o
Bruises