‘Hemoulage’ – A Review of TrueClot Blood Simulant by Will Enfinger

luna inc

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.

trueclot

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 . . .


Sponsored Advertisement:


trueclot2

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. . .

simulated blood clotting

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.

simulated blood stain

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.

CLOTTING:

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 . . .

CONCLUSION:

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!


Sponsored Advertisement:


Theatrical Blood Effects Part 4 – From MilitaryMoulage.com

medical simulation squib

Part 4 of MilitaryMoulage.com’s article on Theatrical Blood Effects for Realistic Casualty Simulation has been released! Written by Suzanne Patterson, Curriculum Development Specialist / Instructor at Military Moulage, this is the next installment after part 3 covered covered some important elements to keep in mind for maintaining high realism results when selecting and using theatrical bloods in your casualty simulation event or training exercise. In part 4, Suzanne shares a few extra tips, tricks, and techniques we have employed and that you might find useful for your own active bleeding scenario requirements, including how to “release” effects at the right time using Squibs and pumps.

“Active bleeding is arguably central in creating a believable injury simulation psyche, from drips to flows, and there are a number of ways to rig blood loss from small areas all the way to significant hemorrhaging. For instance, blood trickles or drips from the mouth can be easily achieved from pre-filled gelatin-based blood capsules held in the mouth until bitten to give a slow bloody drip effect. We like to rig a small cut piece of cell-like sponge soaked in edible theatrical blood, and when placed in the mouth next to the lips it mixes with the saliva to make a nice dripping consistency. When ready to drip it out the actor simply inserts the sponge and manipulates it a bit with the teeth. For nosebleeds we also use specially made reticulated sponges prepared with edible blood that, when inserted in the nostrils, will “bleed” automatically upon the actor breathing through the nose. If you need a semi-drying dripped blood look from the ears, mouth corners, or nose that needs to be more stationary, we use blood colored gelatin to which some blood paste or additional glycerin has been added for a slightly wet effect. Our favorite trick is to use a scar making material mixed with some theatrical blood product. This method gives very high realism for film and TV use, and the best part is it’s durable and waterproof in wear.

Squibs and pump assemblies are great to use when you need a more significant amount of blood flow, such as from gunshots, impalement (stabbing), amputations, etc. Blood squibs are small sealed bags of liquid blood that are hidden under clothing, and that can be pyrotechnically rigged to explode, mechanically operated to flow by pneumatic liquid means, or simply break open upon surface impact. Pyrotechnic blood squibs involve electrical charges that trigger a ballistic action to spatter the blood bag, and that can be very dangerous or fatal if not done by a professionally trained and licensed technician. We prefer to use mechanically rigged squibs and pump assemblies because most often on a training exercise these have to be operated directly by the role player portraying the injury. One type of safe squib we make is from a dissolvable plasticized material containing blood powder, and rigged with a fast acting dissolving fluid that creates a gravity blood flow. This works great under clothing for gunshots or impalements. You can make your own blood squib bags to size from many kinds of pneumatic capable or collapsible containments, such as litre bottles, plastic zip close food bags, and even small cut off fingers of disposable gloves. They can be custom rigged to flow or release theatrical blood in a variety of ways and in the manner you need them to flow.”

Read the full 4-part series on MilitaryMoulage.com!

Theatrical Blood Effects for Realistic Casualty Simulation: Part 2

military moulage

MilitaryMoulage.com Curriculum Development Specialist & Instructor Suzanne Patterson shared Part 2 of her article on Theatrical Blood Effects for Realistic Casualty Simulation! MilitaryMoulage.com (or MMCIS™) provides “the highest quality moulage training workshops for military and civilian casualty simulation personnel, regardless of their skill level, which helps companies or individuals achieve the greatest value for training investment dollars.”

bleeding headwound moulage

Excerpt from the article:

“High fidelity blood simulation is a pivotal component in creating true-to-life bleeding traumas for accurate response in training, so there are some physiology facts to keep in mind about it when you are planning blood loss in your scenarios.  First of all, the human body contains roughly a gallon plus a quart of blood, about 168 ounces, and depending on the body size.  Clinical symptoms of hypovolemia (shock due to blood loss) becomes apparent after about 20% or 1/5th of whole-blood volume has been compromised, so be aware of this detail when assigning large blood loss type of injuries. 

Blood color is also an important factor because there are two distinct types of blood that circulate throughout the body.  Artery blood is oxygenated as it moves away from the heart and lungs, so it is a lighter or brighter red looking blood. Venous blood is a darker red hue because it is oxygen depleted and high in carbon dioxide as it travels back to the heart.  You’ll need to determine how much theatrical blood of both colors will be needed to portray active bleeding through the flowing, dripping, or oozing from compromised veins and arteries portrayed, as well as any splashing, splattering, or smearing resulting from contact or an impact.”

You can read Part 1 of Theatrical Blood Effects through here, and also be sure to visit MilitaryMoulage.com for more great content!

blood splatter moulage

 


Sponsored Advertisement: