Back to Top Skip to main content

The art of moulage

Combat Medic Training program students at the Medical Education and Training Campus at Joint Base San Antonio-Fort Sam Houston conduct an emergency cricothyrotomy on a “casualty” during simulation training. The “wounded” manikin also presents with facial burns that were created with moulage techniques. (DoD photo by Lisa Braun) Combat Medic Training program students at the Medical Education and Training Campus at Joint Base San Antonio-Fort Sam Houston conduct an emergency cricothyrotomy on a “casualty” during simulation training. The “wounded” manikin also presents with facial burns that were created with moulage techniques. (DoD photo by Lisa Braun)

Recommended Content:

Health Readiness

JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas — The saying “train like we fight” is a common idiom in the military training spectrum. As combatants, service members must train for a variety of scenarios that will prepare them to succeed when engaged in real-life conflicts.

Simulation plays an important role in preparing enlisted medical trainees at the Medical Education and Training Campus, or METC, at Joint Base San Antonio-Fort Sam Houston to respond appropriately when faced with an actual life-or-death situation.

For the combat medic trainees in the Department of Combat Medic Training, or DCMT, program who, due to the sheer size and number of classes, will not have an opportunity to see real patients until after they graduate from the program, the realism goes a step further.

The use of high-fidelity human patient simulators that mimic actual patient encounters will prepare Soldier medics with the basic skills that will save lives – on and off the battlefield.

When the training scenario calls for treating casualties with combat wounds or injuries, however, less expensive generic manikins are incorporated and given a makeover to look the part because not many manikins have wounds already on them.

“To better simulate battlefield wounds or injuries our simulation instructors have become moulage artists to make realistic wounds and injuries that give these manikins more realism,” said Donald Parsons, DCMT program director. “This allows the students to actually see and treat wounds they will see on the battlefield, but they can also make their mistakes on the manikin without risking someone’s life.”

These realistic injuries may include an amputation, head and chest gunshot wounds, and other traumas associated with combat injuries. As the combat medic trainees, or Soldier medics as they are called in the training environment, respond to the simulated casualty they are simultaneously reinforcing the skills they learned in the classroom – from a basic injury assessment to more complex wound care.

Camille Espinoza, a civilian DCMT training instructor and simulations technician, heads the process of transforming a generic, low-fidelity manikin into a combat casualty. As an art, moulage is a process of trial and error so Espinoza is always learning new techniques. Her team offers ideas and assists with some of the moulage application.

Espinoza has had to create a way for students to apply needle chest decompressions, or NCD, on the manikins, for example. An NCD is a medical procedure that is most commonly used to treat patients suffering from a punctured or collapsed lung by inserting a needle with a catheter on the end through the chest cavity.

In the past, students would utilize a task trainer for working on specific procedures, such as a NCD, tourniquet, or wound packing among others. The students would assess the manikin first then turn to a task trainer to treat the wounds.

Espinoza modified the chests on the low-fidelity manikins, which are made out of PVC, so that the NCD insertion spots are soft enough to allow students to puncture through the manikin without causing the catheter to bend.  She also gave them trachea inserts that she carved into the manikins, and added injuries that look more realistic.

Now, students can examine and assess the “casualty,” inspect the location of the wounds and perform all of their interventions directly on the manikin itself. A set of manikins was created to use just for testing as well.

One of the biggest challenges with creating the wounds is that the manikins take a lot of abuse when students practice with them because they get moved around a lot to different outdoor locations where dirt and other elements wear down the moulage effect.

Many of the materials would break down or wear off too quickly, so experimenting with different moulage techniques and materials that make the wounds last longer is part of the process. Feedback from instructors was also an important factor in determining what works and what doesn’t.

“A lot of the stuff that special effects people do is usually a one or two time use, so it doesn’t need to last a long time,” Espinoza explained. “Unfortunately, I have students from three Whiskey teams that come down to the simulation lab so we’re running around 1,000 Soldiers through there. I had to figure out what the best materials were, the least expensive, the most effective; there was a whole lot of stuff that was going on trying to come up with the best way to apply the moulage and then hope it doesn’t break up too quickly. It’s all trial and error.”

Through the process of trial and error, Espinoza discovered that silicone-based material helps the moulage stay on longer. If it gets worn out it can easily be cleaned up and redone. The manikins can potentially be used hundreds of times before the moulage wears down, depending on the type of injury.

Some wounds, like amputations, don’t last as long because the manikins are being dragged continuously through the dirt during training. Facial wounds, though, tend to last longer because the face does not make contact with hard surfaces.

Modifying a manikin may take two or three days, depending on the wound being depicted. Some injuries needs to be created in steps and can be time consuming, so an assembly line process is ideal.

Espinoza and her team can line up three to five manikins, start working on one then move on to the next one while the previous one is drying, solidifying or cooling from having to heat the plastic to soften it for an effect.

The most important factor is making sure that the manikin is dry before moving on to the next step. Rushing through a modification may result in the moulage not staying on.

Depicting a shrapnel wound, for example, means that Espinoza will need to cut into the manikin. In order to do this, the area on the manikin where the wound will be created is heated in order to soften it so it can be cut and manipulated to form a wound. Then it will be painted to look realistic and set to dry.

If it’s possible to make use of materials already on hand, Espinoza will find a way to incorporate them into her design as well.

“We don’t want to use more than what we need or waste more than what we have,” she said.

Espinoza has used the popcorn material used for packing boxes to stuff the lower portion of manikin legs where a wound is depicted before adding foam to the area so students could learn how to pack the wound and practice applying tourniquets.  Prior to that, the foam would crack and fall apart.

“We just had to modify a lot of the stuff that we did in order to find the best way to do it.” 

Espinoza takes great pains to ensure she creates as realistic a product as possible.

“I want the students to get that shock and awe when they see the injuries without having that reaction the first time seeing it on a person, on a Soldier, on their battle buddy,” she added. “I would rather they have something as realistic as possible in these manikins without having somebody actually injured." 

A fellow instructor of Espinoza’s, who is now retired, once told her that what they’re doing now is saving lives through other people's hands. Those words have always stuck with her.

“I can do my job through these medics. If I can make something as real as possible so they can get that, ‘oh my god, this is for real!’ reaction and it makes sense, that’s all I really care about. I can get in their head and make them understand that what they’re doing makes a difference.”

To Espinoza, making mistakes on the manikins is the point of the training.

“You have to make mistakes to learn. If the students do it wrong here they can learn from it. I want them to do it wrong, because if they always do it right then what are they going to learn?"

“That’s exactly what I’ve done with these manikins,” she added. “I’ve had to make mistakes to learn how to make them better for the students to make their mistakes so they can get better. I’d much rather they do that here then on the battlefield.”

Disclaimer: Re-published content may be edited for length and clarity. Read original post.

You also may be interested in...

MHS Minute September 2018

Video
9/21/2018
MHS Minute September 2018

Interested in hearing about some exciting events that took place around the Military Health System last month? Tune in to the MHS Minute to learn more!

Recommended Content:

Health Readiness

Patriot Warrior 2017 - Moulage

Video
10/5/2017
U.S. Air Force Master Sgt. Rose Jane Schoenwandt, 349th Aeromedical Staging Squadron, Travis Air Force Base, California, and Staff Sgt. Caleb Boles, 445th Aeromedical Staging Squadron, Wright-Patterson AFB, Ohio, discuss the importance of moulage during Patriot Warrior.

U.S. Air Force Master Sgt. Rose Jane Schoenwandt, 349th Aeromedical Staging Squadron, Travis Air Force Base, California, and Staff Sgt. Caleb Boles, 445th Aeromedical Staging Squadron, Wright-Patterson AFB, Ohio, discuss the importance of moulage during Patriot Warrior.

Recommended Content:

Health Readiness

USNS Mercy: Deployable Medical Center

Video
4/11/2017
U.S. Navy Sailors and Military Sealift Command civilian mariners explain the mission of the USNS Mercy and its capabilities.

U.S. Navy Sailors and Military Sealift Command civilian mariners explain the mission of the USNS Mercy and its capabilities.

Recommended Content:

Health Readiness | Access to Health Care

Trauma Innovations

Video
3/23/2017
Hemorrhage is responsible for 91.5 percent of potentially survivable battlefield deaths. From 2001 to 2011, an estimated 24 percent of combat deaths occurred before patients reached a treatment facility; the major cause of death was blood loss. Battlefield trauma innovations like the occlusion balloon catheter and freeze-dried plasma will enhance the Joint Forces' current capabilities.

Hemorrhage is responsible for 91.5 percent of potentially survivable battlefield deaths. From 2001 to 2011, an estimated 24 percent of combat deaths occurred before patients reached a treatment facility; the major cause of death was blood loss. Battlefield trauma innovations like the occlusion balloon catheter and freeze-dried plasma will enhance the Joint Forces' current capabilities.

Recommended Content:

Health Readiness

Air Force Nurse Key Asset to Army Medevac

Video
3/22/2017
U.S. Air Force Maj. Sandra Nestor, tactical critical care evacuation team nurse, is assigned to the 3rd Platoon, C Company, 2-149 General Support Aviation Battalion Medevac. Medevac teams specialize in moving and treating U.S. and coalition forces who are injured and risk dying without immediate emergency care.

U.S. Air Force Maj. Sandra Nestor, tactical critical care evacuation team nurse, is assigned to the 3rd Platoon, C Company, 2-149 General Support Aviation Battalion Medevac. Medevac teams specialize in moving and treating U.S. and coalition forces who are injured and risk dying without immediate emergency care.

Recommended Content:

Health Readiness

Ophthalmology Medical Readiness Training Exercise

Video
3/7/2017
The Ophthalmology Medical Readiness Training Exercise (MEDRETE) team is comprised of 26 U.S. military personnel and several host nation physicians who have partnered together to train medical teams in preparation for deployment. During the MEDRETE, the teams are able to improve the eyesight of more than 250 Panamanian patients during the two-week training exercise. The goal is to provide medical care that benefits the people of Panama, while building relationships with the accompanying Panamanian medical professionals.

The Ophthalmology Medical Readiness Training Exercise (MEDRETE) team is comprised of 26 U.S. military personnel and several host nation physicians who have partnered together to train medical teams in preparation for deployment. During the MEDRETE, the teams are able to improve the eyesight of more than 250 Panamanian patients during the two-week training exercise. The goal is to provide medical care that benefits the people of Panama, while building relationships with the accompanying Panamanian medical professionals.

Recommended Content:

Health Readiness | Vision Loss

Exercise Immediate Response 16

Video
1/13/2017
Soldiers and Airmen practice combat trauma care with allied and partner nation medical service members at Cerklje ob Krki, Slovenia, as part of exercise Immediate Response.

Soldiers and Airmen practice combat trauma care with allied and partner nation medical service members at Cerklje ob Krki, Slovenia, as part of exercise Immediate Response.

Recommended Content:

Health Readiness | Global Health Engagement

Any clime and place: Sailors bring hospital knowledge to the field

Video
5/19/2016
Sailors with 2nd Medical Battalion got out of their comfort zone and conducted a week-long training exercise at Camp Lejeune, North Carolina. The aim of the training is to teach Sailors the basic skillset and gear familiarization of shock trauma platoon in a deployed environment.

Sailors with 2nd Medical Battalion got out of their comfort zone and conducted a week-long training exercise known as a Health Service Augmentation Program at Camp Lejeune, N.C., April 18-22, 2016.

Recommended Content:

Health Readiness

Racing to save lives at Steel Knight

Video
12/28/2015
Hospital corpsmen and Marines check a simulated casualty and remove their body armor during Exercise Steel Night’s mass casualty drill at Marine Corps Air Ground Combat Center Twentynine Palms, Calif., Dec. 12, 2015. The drill tested the 1st Marine Division’s ability to react to a large influx of injuries and wounds from battling the enemy. Steel Knight provides tough, realistic training for the Marines and sailors of 1st Marine Division.

Corpsmen and Marines rehearsed life-saving skills during Exercise Steel Knight’s mass casualty drill, Dec. 12, 2015. Steel Knight provides tough, realistic training for the Marines and sailors of 1st Marine Division.

Recommended Content:

Health Readiness

Global Medic 2015

Video
10/28/2015
Global Medic 2015

U.S. Army, Air Force, Navy and British Army Reserve Soldiers participate in one of the largest medical exercises of its kind.

Recommended Content:

Health Readiness
Showing results 1 - 10 Page 1 of 1

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.