Importance of moulage

The use of moulage is another feature of fidelity to assist with immersion.

Moulage is the art of applying injuries for the purpose of training and is used extensively in healthcare simulations to produce realistic training to engage all the senses. 

Moulage can range in complexity from using makeup to create simple wounds, to using prosthesis with major injuries pumping blood.

There are significant benefits of using moulage for education of healthcare professionals. 

Moulage assists with the physical signs that provides clues to the patient’s condition or injuries, and supports decision making, diagnosis and the subsequent patient management. 

Conducting realistic scenarios that replicate true to life conditions also enhances assessment by increasing the sensory experiences of the participant as to what is felt, seen, heard and smelled. 

It also can provide stress inoculation by preparing healthcare professionals for what to expect at the scene of real world settings. 

There are a number of different types of moulage that may be incorporated into simulations:

• Visual – whatever the wound or injury looks like in real life, make it look like it in simulation. So when creating an injury or wound, give consideration to the colour, flow and volume of blood from the wound to make sure it is realistic and consistent with a genuine case.
• Auditory – if it is loud in real life, make it loud in simulation.  Sounds may include a vital signs monitor or pain response noises from the manikin or patient.
• Olfactory – if it smells in real life, reproduce the smell in simulation.  Smells may include bowel, maleana, vomitus, burn/smoke.  If there has been a burn, make it smell like there has been a fire.
• Environment – ensure the simulated environment looks like it would in real life.  Consider the appearance of the manikin or patient with appropriate clothes and wigs, as well as room furniture and bedside equipment to recreate hospital ward or theatre environments. 

When applying moulage, consider the physiology behind what is going on. 

• What is the age of the wound? 
• What environment did the wound occur in? 
• Is the wound infected? 
• Do bones really bend that way? 

When applying moulage to manikins, ensure they are prepared and cleaned appropriately as moulage can be difficult to remove and can cause damage if not done correctly. 

You also need to ensure that the manikin is cleaned as soon as possible after the training event.  The longer the moulage is left on, the harder it is to remove. 

Barriers may be used to protect or decrease damage to the manikin’s skin from the moulage.

Hard barriers include plastic wrap, wax paper, aluminium foil, tegaderms or clear tape.  Soft barriers may include petroleum jelly, cold cream or baby oil.

Always test new products on an inconspicuous area of the manikin prior to applying liberally on the skin. 

And never place pen on manikin skin – it can’t be removed. 

Ensure you use gentle solvents and citrus based cleaners to remove sticky residues but not cause any long term damage to the manikin skin.

CSDS has created a number of resources for you to include in your moulage tool kit. 

And there are plenty of resources available online to step you through creating all kinds of different wounds and effects.

Get creative, practice your skills and try new techniques.

Remember, if you are able to convince your mind you are somewhere, your body will react as though you are there!