EMSWorld Interviews Moulage Concepts Founder Bobbie Merica About Simulation Realism Through Makeup

EMSWorld recently interviewed Moulage expert Bobbie Merica of MoulageConcepts.com to learn how moulage makeup can improve the educational outcomes of simulation by increasing the realism for learners. Here are a couple of excerpts from the EMSWorld article entitled The Importance of Accuracy in Moulage Trainingby Valeria Amato:

What advice would you give people who are looking to implement more realistic and effective moulage into training regimens?

It’s like anything else: You need to plan and prepare. When you develop your case scenarios, decide what the takeaway is going to be. Is it triage-specific? If so, then your wounds should accurately represent wounds related to triage. A lot of the time, people will throw in the moulage piece at the end without giving it any thought. They won’t collectively decide what the full-thickness burn is going to look like, what the pediatric patient will look like and how they’re going to present it. Locate an accurate picture on the Internet of an actual case. Practice creating moulage so that everyone in your training knows what these wounds will look like.

Mostly it’s about the planning. You’d never run your training scenarios without a great deal of planning. When you’re building those scenarios, start building in those moulage components. Understand what story you want to tell. Understand what the training outcome is. Is intubation with a full-thickness burn the outcome, or is it identifying the smoke inhalation? If the training outcome is smoke inhalation, then you don’t need a full-thickness burn. It’s not difficult to clarify that a full-thickness burn in the upper airway in the chest and neck has smoke inhalation. If you really want to know if someone has smoke inhalation, bring it back and test it in multiple areas. Create that eye-reddening, some tears coming down, the reddening in the back of the throat. That little bit of hoarseness. Break it out into multiple training avenues, unless intubating the patient with a full-thickness burn is the skill set.


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That makes sense, especially going back to what you said about using moulage in less of a theatrical capacity and for mass-casualty incidents.

If it’s a mass-casualty incident, you’re going to have some people who look like those first-line-of-response people, but often a lot of those people look the same. Certainly you should assess the woman screaming and covered in blood, but you might also want to look at that person quietly dying right next to her. It’s about creating all those aspects and using this as a tool to define where those strengths are and, more important, where those weaknesses are so you know how to align future training dollars.

I think every person, every entity and every training site should have access to this level of training. Moulage doesn’t have to be expensive and time-consuming. You can have amazing moulage that tells the whole story, allowing you to spend the next six weeks accurately training your participants to meet outcomes, that will cost you pennies.

Do you have a copy of Bobbie’s Best Selling Moulage Recipe Book? Check out our review here!


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Active Shooter Moulage Training Program and Kits Now Available from MoulageConcepts + Upcoming Training Dates

active shooter moulage training program kit

Our great friends at MoulageConcepts recently launched a new active shooter training program along with specialized moulage build kit. MoulageConcepts founder Bobbie Merica is a world renown expert in healthcare simulation resources, and has written the most comprehensive moulage recipe book on the market… read our review of her book Medical Moulage here!

Upcoming Moulage Trainings:

  • Medical – Trauma Moulage Workshop Fayette MO. June 8-9, 2017
  • All Hazards/Medical Moulage Workshop Nokesville VA. May 18-19, 2017
  • All Hazards Trauma Moulage Workshop Pomona CA. June 29, 2017
  • All Hazards/Medical Moulage Workshop Folsom CA. July 20-21, 2017

More than just a moulage company, MoulageConcepts provides interactive training workshops are designed to enhance realism, scenario staging, and hazard identification. This intensive, hands-on, 16-hour workshop is regularly presented in a multi-level learner approach including:

  • Beginner, Intermediate and Advanced moulage development
  • Scenario Staging
  • Sensory Engagement
  • Core STEPS and Technique
  • Accessory Moulage & Layering
  • Wound Customization
  • Time and Budget Saving Options

These two-day workshops are developed to save you time and money upfront, exceeding your training needs, wound for wound, as an industry standard.

Active Shooter Program and Moulage Kit

As the industry leader, MoulageConcepts understands the complexities of creating interactive training that meet your safety-preparedness needs. With an extensive knowledge of moulage wound development and scenario staging, Moulage Concepts provides a unique combination of simulation expertise to strengthen training performance, participant retention, and risk reduction. Working with both simulator and standardized patients, they provide measurable training options to meet your industry requirements.

The Active Shooter/Mass Casualty (AS/MCI) Moulage & Training Kit was developed to assist you in preparing for Active Shooter Incident Response. Including moulage specific to wound identification and treatment, this multi-training kit enables team practice of rapid assessment, airway management, and hemorrhagic response- with focused training realism and incident standardization. Utilizing interactive wounds that are quick, cost effective and most importantly, convincing- MoulageConcepts provides the visual and olfactory realism required in developing an effective Emergency Operations Response with multi-skin tones.

 

Learn more about these workshops, programs and kits on the MoulageConcepts website!

New Surgical Simulator Prototype from Nottingham Trent University

surgical simulator trent university uk

The model was created from silicone gels and fibres to help prepare trainee surgeons for the mental and physical experience of operating on chest organs. It was created using CT scans of real organs to create lifelike simulations of the heart, lungs and great vessels in the chest.

The outer skin, created by Yorkshire-based Trauma FX – uses a life-cast of an anonymous model and can be cut into with a scalpel and seamlessly resealed to allow for repeated mock surgeries.

Richard Arm, of Nottingham Trent University’s School of Art and Design, who helped create the model, said: “The aim is to allow trainee surgeons the psychological space to prepare for real life surgery using immersive environments and realistic representations of human anatomy.

Learn more at the Express UK News Website!


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MoulageConcepts.com Shares Pus Thick, Odorous, Wound Exudate Moulage Recipe

moulage odorous wound

Happy New Years Sim Champs! Today another amazing moulage recipe from Bobbie Merica of Moulage Concepts, author of the best moulage recipe book in medical simulation “Medical Moulage”.

About Bobbie Merica and MoulageConcepts.com:

Bobbie Merica is a medical/trauma moulage expert, author and CEO of Moulage Concepts, an nationwide moulage company specializing in training, supplies and education. Utilizing best practice techniques, Bobbie’s teaching methods have simplified the complex, enabling everyone to create Moulage that is quick, cost effective and convincing. Get her free tutorial blog with expert weigh-in at www.moulageconcepts.com/blog and join us in creating moulage that looks, feels, sounds, and even smells like the real thing!

Skill Level: Beginner

Time Frame: 1-2 minutes

Ingredients:

  • 2 Tbsp. waterbased lubricating gel
  • 2 tsp. of petroleum jelly (SIM-Safe) yellow, colorant (SIM-Safe) brown, colorant
  • Odor: (SIM-Safe) “Decaying matter”
  • Supplies: (Shop www.moulageconcepts.com for all your moulage needs!)

Recognize the Disguise:

MRSA Simulation Simulations should include many different presentations in which MRSA should be considered. swelling, heat apparent “spider bite” rythematous skin with red papules and central pustules single lesions on the extremities or multiple “boils” fluctuance-wavelike motion beneath the lesion when pressure is applied impetigo and necrotizing fasciitis, “track” marks (frequently among IV drug users) fever, low BP and shortness of breath (indicators of systemic infection)

Get the whole Recipe on MoulageConcepts.com today!

Hollywood Special FX Artists Help Boston Children’s Train for Pediatric Surgery

boston children's healthcare simulation surgery hollywood

From Engadget.com:

Boston Children’s Hospital has formed an odd partnership with a practical special effects company to create more realistic surgery simulator models. Santa Monica-based Fractured FX is well acquainted with human anatomy (and gore), having worked on FX’s bloody American Horror Story. It also helped recreate surgeries performed in the early 1900s on the Cinemax Series The Knick. For its part, Boston Children’s Hospital has had a surgery simulator program for quite awhile, but decided it needed to up the realism quotient and give doctors a better “haptic” feel for patient’s organs.

With input from Boston Children’s Hospital doctors, Fractured FX developed models “not only look real, but they feel real,” according to the hospital’s press release. They contain “artificial tissues that bleed and pulsate, man-made blood vessels that feel like the real thing when doctors insert a catheter and special gels that feel like brain tissue when an endoscope is guided through them.” The FX team need to develop new designs and materials for the models, with the doctors giving them feedback as to how realistic they felt compared to real organs.

From Children’s Hospital Website:

“A lot of us had aspirations in medicine, and have collaborated with prosthesiologists to help improve prosthetics artistically,” says Fractured FX CEO Justin Raleigh. “We wanted to take our skills in special effects to try and help people.”

One model, of the neck and upper chest, was developed in consultation with the hospital’s ECMO team, is designed to help surgeons put critically ill children on heart-lung bypass. The model includes tissues that bleed and pulsate, blood vessels and the vagus nerve, which surgeons need to avoid.

A second simulator, developed with the neurosurgical team, is helping teach surgical residents how to perform a tricky procedure called endoscopic third ventriculostomy (ETV), used to treat hydrocephalus. ETV uses an endoscope to remove tumors and bypass other blockages that prevent fluid from draining from the brain. This requires working perilously close to the basilar artery—if that artery is torn, the patient could die. The simulators, made with special gels that feel like real brain tissue, help surgeons hone their hand-eye coordination.

Learn more at Endaget.com & the Children’s Hospital Website!


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A Collection of 11 Medical Simulation “How To’s”

how to for healthcare simulation

Today we are highlighting a series of articles we have put together over the past several years covering the “How To” of medical simulation. Check out these awesome resources in a variety of domains:

These are must read articles to help your healthcare simulation program grow! Subscribe to our free monthly newsletter for more great “How To” content!

Magnum Services Provides Realistic Additions to Military and Casualty Simulations

military simulation services

Looking for Trauma Simulation Services in the US or UK? Magnum Services adds realism to Casualty Simulation (CAS SIM) training through professional amputee actors and makeup specialists. Their actors have many years of experience including being featured in film and television. By utilizing the unique combination of realistic prosthetics and expert CAS SIM effects, Magnum Services role players expertly and appropriately use their skills, experiences and simulated injuries to mimic the emotions and actions of a casualty, resulting in realistic and very definitive clinical training delivery!

Magnum Services Provides:

Moulage Makeup: We use professional, trained makeup artists who have years of experience. All our makeup is used in films and TV and is the same they use in Hollywood. It is washable so it doesn’t stain uniforms and can wash off the skin easily.

Simulation: We specialize in providing realistic military and medical training through high quality casualty simulation using trained and professional makeup artistes as well as skilled and experienced amputee actors.

Actors: All of our actors are skilled and trained in a variety of scenarios from the ‘unseen’ injuries to the traumatic amputation. They are skilled in performing both physical and emotional symptoms for each role presented.

Experience: The directors of the company have combined over 10 years of experience working with the British armed forces as well as with the German and American forces on tri-service exercises in Germany. We have also worked with emergency services over the years

Casualty Simulation Specialists:

Our capabilities of Casualty Simulation (Cas Sim) effects range from the un-obvious and not visible to the physical and traumatic injuries such as:

  • Primary health care simulation – rashes, blisters, bites and shock
  • Closed/healing wounds including lacerations, bruising and scarring Infected and necrotic wounds
  • Head and facial injuries, including avulsions and abrasions Fractures, both open and closed
  • Amputations, partial and full
  • Catastrophic hemorrhaging
  • Perineal and pelvic injuries
  • Abdominal and chest injuries; including sucking chest wounds (pneumothorax) and eviscerations
  • Blunt trauma, de-gloving injuries and entrapment injuries
  • Ballistic injuries, such as; gunshot wounds, blast injuries, fragmentation wounds and large cavity wounds
  • Burns (1st, 2nd & 3rd degree) superficial, partial and full thickness
  • Bioterrorism, such as; Chemical, Biological, radiation and nuclear (CBRN) and other toxins and plagues

Learn more about these Simulation Training Services at the Magnum Services Website!


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Simulation Moulage — Should You Be Using It?

burn moulage

“Train as you Fight.” — United States Army

Today comes an article from Moulage Expert Bobbie Merica on Carolina’s Fire Journal on the introduction and reasons behind utilizing moulage in your medical simulations. You can use such an article to help demonstrate to other clinical educators or administrators why they should invest in your moulage training! Check out the link to Bobbie’s Moulage Recipe book which is a MUST-HAVE for every medical simulation library.

 

The addition of Moulage creates realistic field training exercises that mimic responder and victim situational responses that are specialized to training outcomes, including:

  • Pediatric specific field triage
  • Elderly and immune-compromised
  • Pathologic patient conditions
  • Veterinarians
  • Wound identification and closure

Moulage, when integrated into the simulated exercise, creates a powerful training modality that enhances live actor and human patient simulator events. The use of interactive, odorous, three-dimensional wounds such as hemorrhages, wound debridement, suturing capabilities, decontamination and realistic triage heightens the field experience by providing enhanced assessment, injury recognition, supportive decision-making, realism, and retention and stress inoculation.

“Success does not consist in never making mistakes but in never making the same one a second time.”— George Bernard Shaw

Another reason to add moulage to the training scenario: Current research estimates anywhere from 50 to 90 percent of all communication is non-verbal, thus proper assessment, triage, acuity and training is often dependent on the accurate use of four of the five senses; that which must be seen, felt, heard and even smelled.

The addition of moulage highlights areas for growth by assisting the team in identifying shortfalls in current patient coding, acuity levels and wound staging based on individual and team assessment. Additionally, skilled use of primary and accessory moulage can illuminate areas for risk reduction through quality advancement identifiers such as highlighting strengths and weaknesses involving wound recognition, stabilization, standardization and triage management on both an individual and team building events. The addition of moulage to the training paradigm can provide life-saving exposure of system vulnerabilities creating a segue between multiple responders, systems and triage points.

Read my review of Bobbie’s Medical Moulage Recipe Book and Read the rest of this article on the CarolinaFireJournal.com website!

‘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 . . .

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!

Moulage Concepts Announces Debut of SIM-Safe EMS/Nursing Product Line

sim safe moulage

This summer MoulageConcepts.com, an international medical trauma moulage company specializing in nursing, trauma, hospital, mass casualty and pre-hospital moulage training, supply and certification announced the debut of their new SIM-Safe EMS/Nursing moulage product line!

Designed for the pre-hospital/simulation suite training scenario, the SIM-Safe series features realistic, non-staining, non-food based make-up, secretions, bodily fluids and three dimensional wounds that can be used to creating authentic training scenarios on both simulators and standardized patients. With focus to detail, all SIM-Safe products visually and tactually replicate natural bodily processes to ensure your moulage meets your training needs. Large 4 oz. containers for multi-scenario options!

SIM-Safe EMS Set includes:

  • Fresh blood
  • Clotted blood
  • Bloody emesis
  • Bile • Blister
  • 10 make-up colors
  • Instaburn Set
    • Dermacurl
    • Dermascorch
    • Dermaflame
    • Dermachar

SIM-Safe Nursing Set includes:

  • Fresh blood
  • Clotted blood
  • Coffee ground emesis
  • Feces
  • Bile
  • Vomitus
  • 10 make-up colors
  • Secretion Set:
    • Clear
    • Frothy-white
    • Blood-tinged
  • Pus Set:
    • Yellow
    • Green
    • Amber

Moulage Concepts, a nationwide company, provides moulage products, training and services to the simulated nursing, military, EMS, field and MCI training sectors. With attention to detail, Moulage Concepts interactive wounds can be triaged, drained, sutured, debided and even ruptured if handled aggressively. With product lines specific to training fields, their customizable line of moulage kits has won them the EMS World Innovation award 2013 for their ability to provide moulage products and training that could be customized to scenario outcomes.

Be sure to check out Bobbie’s amazing Medical Moulage Recipe Book and check the schedule of her upcoming training courses to help you  create training scenarios that look, feel, sound and smell like the real thing!

Get your Sim-Safe Moulage Products at MoulageConcepts.com!