Fake wounds bring reality to training scenarios through moulage

MALMSTROM AIR FORCE BASE, Mont. -- Airmen walking around with pale skin, blue lips, blood pouring down their faces, shrapnel protruding from their limbs... Is this a bad horror movie? A scene from a war film? A costume party? 

Actually, this is a common sight in exercises where Airmen have been dressed up with plastic molds, fake blood and makeup to simulate the appearance of real injuries . Doing so helps aid in the training for medical technicians and first responders.

During exercise scenarios, members of the 341st Medical Group prepare volunteer Airmen with wounds simulating injuries that may be sustained in real-world incidents. Moulage is the art of applying these fake wounds.

"Moulage began in the 19th century and is a French word that means casting or molding," said Staff Sgt. Amy Lacy, 341st Medical Support Squadron readiness technician. "The purpose of moulage is to create realistic wounds that medics or first responders can identify or observe visually."

In the past, emergency evaluation teams simply gave the patient a card to role-play what was wrong with them. The card method was effective in a sense, but took away an important aspect of patient care, which is assessment.

"Assessing or determining what is wrong and to what extent is usually much more difficult than treating an injury," agreed Sergeant Lacy and Tech. Sgt. Sara Edwards, 341st Medical Operations Squadron medical technician. "Our goal in moulaging patients is to make the injuries appear more realistic for the best possible training."

By simulating these injuries, not only do the medical responders get put in a more realistic situation, but it also helps them get used to the injuries they may see in a real-world situation.

"There are many benefits to moulage," Sergeant Lacy said. "Most importantly, it allows medics to assess the situation, come up with an immediate, definitive diagnosis of the injury, and the required treatment on their own. It also prepares the medics and first responders for what to expect at the scene of a real-world trauma situation. "

The process of moulage is an art in itself, as much preparation and skill goes into creating each mock-injury.

To begin with, explained Sergeants Lacy and Edwards, getting volunteers is vital. Then they determine which moulage injury would suit the individual volunteers. For example, an individual with little to no hair would be best suited for a head injury, or if the wound is pre-made, such as an open fracture with a large bone sticking out, they would try to find someone with the same frame and bone structure as the pre-made mold. Matching skin coloration is also important and sometimes very challenging, they said.

"There are many different ways to attempt to match the skin color - that is where the 'art' of moulage comes into play," Sergeant Edwards said. "Abdominal wounds are some of the coolest to see, however the hardest to find volunteers for. It requires someone who is not too shy and doesn't mind displaying part of their stomach."

One of the most important aspects of moulage is knowing the scenario and ensuring the injuries are consistent with the scenario, Sergeants Edward and Lacy agreed. If the exercise involves a roll-over, patients would likely have secondary injuries. If the scenario is a fire, the moulage would consist of burns, and not necessarily amputations or fractures.

Another important part of moulage is briefing and coaching volunteers on how to act, they said. Typically two cards are given to each patient. The first card describes how to act and the second card has vitals respective to the patient's injury. Once medics or first responders initiate taking the vital signs, the patient will hand them the card to aid in appropriate diagnosis and treatment.

Many people in the clinic are trained or have experience with moulage, but it is primarily the responsibility of the 341st MDG EET to provide moulage for the base and community. 

"I started off just winging it when it came to moulage," Sergeant Edwards said. "I'd think about how an injury would look and create it with the supplies we had. I would use chicken bones, Vaseline, glue and Kleenex."

Since Sergeant Edwards began, though, many new techniques and supplies have evolved to allow moulage artists to create very realistic wounds and injuries that not only look real, but feel real as well.

Many different things can be used to create moulage. The bulk of most moulage is created from a solid gel that, when heated, turns to a liquid to create skin pieces. Then, items such as latex, dirt, charcoal, makeup wheels, Vaseline, Elmer's glue, metal, wood, fake body parts and much more can be used to create a realistic-looking wound.

"When the wound looks realistic, it actually helps desensitize new Airmen to trauma and prepare them for seeing blood - even if it is fake," said Sergeant Lacy. "I had two Airmen who were being moulaged get dizzy and close to fainting just by seeing the moulage on themselves."

"Moulage is actually a lot of fun and kind of like an art class," Sergeant Lacy said. "I had no experience, however, I volunteered to help out for a downtown exercise about a year ago and just watched and listened to the others who taught me. I became a member of the Medical Group EET and was fortunate enough to attend a week-long training course with Sergeant Edwards and have since done a couple of big exercises. I really enjoy it and hope to continue doing it."

Over the course of the exercises they've been involved in, Sergeants Lacy and Edwards have observed people react differently to moulage.

"The women seem to really enjoy being moulaged," Sergeant Lacy said. "The warm gel that is applied on their skin to glue to the pieces to them kind of mirrors a day at the spa. They continuously volunteer to be moulaged again. The men complain sometimes when we remove the pieces, as it tends to pull off some hair."

But in reality, they agreed, most people really enjoy it and often ask others to take pictures of them all made up.

"We have found the acting is much better for the volunteers when the moulage is done well," they said. "They can see what it looks like and it helps them imagine how much it hurts. It's funny to see how people react to someone who is moulaged when they don't realize it's fake. All in all, it is a lot of fun to moulage patients and be part of the exercises from start to finish."

All fun aside, moulaging is an important part of readiness, exercise participation and education for medics and first responders to better equip them to do their jobs and save lives in real-world scenarios.

"The more realistic we can make the moulage, the better chance they have of saving lives in real-world situations," Sergeant Lacy said. "I think training is the most important part of everyone's job and we just want o provide the best training possible."

"It is sometimes difficult to train for medical situations because when someone is in front of you bleeding out or going into shock, that isn't the best time to 'learn' what to do, so we have to simulate that in moulage," Sergeant Edwards said. "It is also difficult to train in a small clinic for medical emergencies as we don't have an emergency department or intensive care unit."

Sergeants Lacy and Edwards agree that is why it is much more important to moulage as much as possible here, as we are deploying medics to Iraq and Afghanistan and it is imperative we send them out the door as capable and mission ready as we can.