cert moulage feb 2014
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Introduction to Moulage for
Fairfax County CERT
Susy Ledgerwood Volunteer Instructor/CERT 4
2008 2008
Course Preview
● Introduction to Moulage Introduction
Basic Supplies
Working with Actors
General Guidance
● Representative Injuries
● Moulage Technique Scrapes
Bruises
Lacerations
Open Fractures
Burns
● Summary Summary
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Impalements
Cyanosis / Shock
Pre-made Wounds
Cleanup
Additional Resources
2008 2008
Course Objectives
● Understand the purpose of moulage
● Become familiar with moulage supplies
● Learn how to work with actors
● Review types of injuries appropriate to CERT exercises
● Learn and practice basic techniques for creating
“injuries”
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Introduction to Moulage for
Fairfax County CERT
Introduction
2008 2008
Introduction
● Moulage – French for “casting” or “molding”
The art of creating/using 3-dimensional replicas of injuries,
diseases, and symptoms for training medical, emergency
response, and military personnel
● Use of moulage in CERT
Increases realism in training exercises and practical exams
Gives actors an injury to act out
Gives rescuers something to triage and treat
Creates a more realistic stress level
Key challenges of CERT moulage
Lots of victims to moulage in very limited time
Limited “real estate” to work with
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2008 2008
Basic Supplies
● Materials
Creme-based makeups Color wheels (bruise, burn, trauma)
Foundations (normal flesh tones and shock)
Alcohol activated makeups/color palettes (requires 99% alcohol to activate)
Waxes (scar, bone) and gelatins
Blood (thick, gel, stage, “soaped”, powdered)
Latex
Adhesives (e.g., spirit gum) and removers
Petroleum jelly/lubricant
Glycerin (diluted 50% with water)
Powders (translucent, charcoal, ash, dirt)
Cotton balls
Styrofoam peanuts/modeling clay
Impalements (“glass” shards, wood, metal, etc.)
Duct tape and/or medical tape
● Tools
Cosmetic sponges
Stipple sponges
Powder puffs
Brushes (blush, paint)
Sculpting tools/spatulas
Scissors
Towels and paper towels
Baby and alcohol wipes
Cotton swabs
Small containers/cups
Trash bags
Gloves
Mirror
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Use your imagination!
2008 2008
Working with Actors
● Talk to the actors Let them know what you are doing as you are doing it
Most men are not used to having makeup applied to their faces!
Check for allergies/sensitivities (e.g., latex)
Can you dirty or tear their clothing?
Tell them how to act out their injury and encourage them to do so
Tell them cool water should get blood out (but no guarantees)
Let them see the result
Thank them for their time
● Avoid latex and waxes in hairy areas!
● Hygiene Use clean sponges or hands to avoid transferring germs from one
actor to another
Avoid contaminating supplies with dirty fingers or sponges Place small amount on palette or hand and use from there instead
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2008 2008
General Guidance
● Less is more
You are trying to simulate realistic injuries, not create
Halloween costumes
● Need to work quickly and confidently
We often have less than an hour to make up 50-100 victims
● Know your triage colors
You may need to assign injuries that match the actors’ colors
● Think about how the actor will be placed
Blood should drip in direction of ground when placed (not
necessarily the same as when seated in a chair)
Try to keep the actor comfortable
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Introduction to Moulage for
Fairfax County CERT
Representative Injuries
2008 2008
● Red
Symptoms
Unconscious/semi-conscious/confused (acting)
Rapid, shallow breathing (acting)
Severe bleeding
Shock
Moulage
Pale/sweaty/cyanotic for shock
Severe burns
Severe bleeding
Head injuries
Impalements and amputations (with severe bleeding)
Representative Injuries
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2008 2008
● Yellow
Symptoms
Trapped or can’t walk
Leg injuries – breaks, sprains, and strains
Moulage
Open fractures
Bruising to indicate a sprain or closed fracture
Swelling (wadded up duct tape, padding, or paper towel under
clothing works)
Mostly acting and victim placement
Trapped
Legs at awkward angles (but only as rescuers approach to prevent
actor discomfort)
Actor screams in pain when “injured” leg or foot is touched and
pretends he/she can’t walk on it
Representative Injuries
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2008 2008
● Green
Symptoms
“Walking Wounded”
Arm injuries
Minor boo-boos
Victims may be annoying or helpful
Moulage
Scrapes
Bruises
Minor lacerations
Minor burns
Broken arms, sprained wrists
“Dirtied up”
Representative Injuries
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Introduction to Moulage for
Fairfax County CERT
Moulage Technique
2008 2008
Scrapes
● Redden skin with bruise
wheel and set with
translucent powder
● Create scrapes using
stipple sponge and blood
or red foundation from
color wheel
Lightly drag sponge across
skin to create scrape
Can add additional few
drops of blood if desired
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2008 2008
Bruises - Materials
● Use bruise wheel or
alcohol activated
makeup for coloring
● Apply coloring with
Fingers
Cosmetic sponges
Stipple sponges
● Set with translucent
powder using cosmetic
puff/brush
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2008 2008
Bruises - Technique
● New bruises - apply red
as a base, then add
burgundy and purples
Use stipple or torn
cosmetic sponge to add
blotches around edges –
avoid even coloring
For darker skin tones, use
more midnight blue and
less red
Set with translucent
powder
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2008 2008
Bruises – Technique (Cont’d)
● Old bruises – blend in
green and/or yellow to
age the bruise, but don’t
overdo it
We won’t do many aged
bruises – the disaster just
happened!
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2008 2008
Bruises – Technique (Cont’d)
● Add dimensionality by
Accentuating shadows
around bones with
burgundy, purple, or
midnight blue
Highlighting bones with
yellow (e.g., cheekbones,
brows, wrists)
● Think about shapes of
bruises – they should
match the cause of the
bruise
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2008 2008
Scrapes and Bruises
● Hands on Exercise:
Work in pairs to create scrapes and
bruises on each other
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2008 2008
● Scar/modeling wax or gelatin
● Spirit gum and cotton balls (optional)
● Spirit gum remover, baby oil, or coconut oil
● Color wheels or palettes
● Foundation colors
● Setting powder
● Blood – thick, gel, stage
● Stipple sponge
● Brushes, puffs, and cosmetic sponges
Lacerations - Materials
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2008 2008
Lacerations – Technique
● Apply to clean skin
Wax adheres better on firm/bony
areas than fleshy areas
● Can use spirit gum and cotton ball for
better adhesion
Apply spirit gum to skin and tap with
finger until it gets tacky
Dab spirit gum with cotton ball to give
wax something to adhere to
DON’T use spirit gum on hairy areas!
● Create a “snake roll” of wax and apply
to skin (or spirit gum and cotton);
press wax to adhere firmly
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2008 2008
Lacerations – Technique (Cont’d)
● Using finger or modeling tool,
smear edges of wax out,
leaving a center ridge
● Use baby oil or spirit gum
remover to smooth out wax
and blend it into skin
● Use a stipple sponge or torn
cosmetic sponge to create
“pores” and remove
smoothness in the wax
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2008 2008
Lacerations – Technique (Cont’d)
● Lightly apply skin color
foundation with sponge and
blend into skin
● Use colors from bruise
wheel to lightly bruise up
laceration site
● Apply setting powder
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2008 2008
Lacerations – Technique (Cont’d)
● Use sculpting tool to create
laceration in wax
● Paint coral color from burn
wheel into inside edges of
wound
● Paint purple or dark blue
color into center of
laceration to provide depth
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2008 2008
Lacerations – Technique (Cont’d)
● Apply blood
Use thick blood for clotted
areas
“Soap” stage blood with a
few drops of baby
shampoo or dishwashing
liquid for better adhesion
over waxes and makeup
(avoid eyes and mouth!)
Think about direction of
drip
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2008 2008
Lacerations – Alternate Technique
● Can also use gelatin to create wounds
Heat bottle in very hot water to melt/liquefy
the gelatin
Test temperature before applying to skin to
avoid burns!
Apply directly to skin and sculpt as it cools
to create the wound, or use molds to create
prosthetic appliances that can be applied
with spirit gum
Color and apply blood
Keep gelatin in bowl of hot water to keep it
liquefied while working
Powder gelatin prosthetics to keep them
from sticking to themselves
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2008 2008
Open Fractures
● Same general technique
as laceration but create a
jagged hole for the bone
● Insert small “bone” into
the hole
Packing peanuts
Cotton padding
Plastic tubing
Modeling clay
Be creative!
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2008 2008
Lacerations
● Hands on Exercise:
Work in pairs to create lacerations
on each other
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2008 2008
Burns – Materials
● Burn color wheel
● Paint brushes
● Cosmetic sponges
● Stipple sponges
● Petroleum Jelly
(e.g., Vaseline)
● Lubricant
● Tissues
● Latex
● Charcoal and ash powders
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2008 2008
Burns - Technique
● Superficial (1st degree)
Redden area using colors
on burn wheel
Be sure to get in all
creases in skin
Blend well to edges of burn
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2008 2008
Burns – Technique (Cont’d)
● Partial Thickness (2nd degree)
Start with red as a base color
Mottle with purple and salmon,
especially around blood vessels
Create blisters using blobs of
petroleum jelly
Cover with a single ply of tissue
torn with ragged edges and
saturate with lubricant to adhere,
or
Cover with latex
Can burst a few of the blisters
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2008 2008
Burns – Technique (Cont’d)
● Full Thickness (3rd degree)
Same general approach as
partial thickness burn, but:
Darken centers and highlight
sides of major blood vessels
Apply black cream foundation
and/or charcoal as charring,
pushing up edges of
tissue/latex as you do to
slough up the burned skin
Can also “burn” clothing, add
smoke inhalation marks to
nose/mouth using charcoal
Can add “liquid smoke” to
simulate burning smell
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2008 2008
Burns – Alternate Technique
● Can also create burns using latex Apply color (and petroleum jelly
blisters if desired)
Apply thin layer of latex with torn cosmetic sponge
After latex has dried, pull up in places to create blisters
Apply additional color or charcoal as desired
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Remember to check for latex
allergies before using this technique!
2008 2008
Burns – Alternate Techniques
● Can also create burns using:
TraumaSkin FX™ DermaBurn
Plastic wrap type material that can be activated and sculpted to
create burns
Lay down base colors first; apply DermaBurn; spray lightly with
water, sculpt, add blood powder, charcoal, and/or ash powder to
finish
Gelatin
Heat container of gelatin in hot water until liquefied
(be sure to test temperature before applying on actor)
Lay down base colors first; apply gelatin; allow to cool until it can be
sculpted, add blood powder, charcoal, and/or ash powder to finish
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2008 2008
Burns
● Hands on Exercise:
Work in pairs to create burns
on each other
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2008 2008
Impalements
● Insert small impalements
(e.g., “glass”) in a laceration
Can create “glass” shards by heating
pieces of #6 plastic in a 350 oven for a
few minutes (“shrinky dink”)
● Affix larger impalements to a
cardboard base with duct tape
Hide in pocket, waistband, or hole in
clothing
Add plenty of blood!
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Be aware of actor and rescuer
safety – avoid sharp ends/edges
2008 2008
Cyanosis / Shock
● Use creme makeup to make actor pale
Cover all areas (face, eyelids, ears, hands, etc.) and
blend very well – victim should be pale, not white
Use Cyanotic Blue, Corpse Flesh, Blythe Spirit, or Frankie
Gray, or a very thin application of clown white makeup
May mix with flesh tone foundation for better coloring
Use purple or dark blue from bruise wheel to darken
eye sockets, temples, under cheekbones, sunken
parts of neck, lips, earlobes, nail beds (wherever
there isn’t bone)
Can put a narrow line of red under eyes with brush
Can add thick blood for bleeding from ears or nose
Can spray 50% glycerin/water for “perspiration”
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2008 2008
Using Pre-made Wounds
● Strap-on wounds Reusable
Good for “quick and dirty”
moulage
Apply blood as needed
Be sure to get wounds
back after use!
● Latex, silicone, or gelatin
wounds May or may not be reusable
Apply with spirit gum
Apply latex at edges to blend
into skin (use torn sponge)
Blend in with foundation
Add blood and coloring as
needed
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2008 2008
Cleanup
● Keep trash bags handy and use them as you go!
● Cover tables with plastic bags or sheeting for easy cleanup
● Have makeup removal supplies available for actors
Cream makeups – use makeup remover, soap and water, and/or
baby wipes
Blood – use soap and water
Wax – remove majority with dental floss, then rest with makeup
remover, coconut oil, and/or soap and water
Spirit gum or adhesives – use spirit gum remover or other adhesive
removers
● Clean brushes, stipple sponges, tools, and makeup
containers before long term storage
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Introduction to Moulage for
Fairfax County CERT
Summary
2008 2008
Summary
● Use moulage to add realism to exercises
● Need to balance detail vs. time
● Acting complements moulage – don’t forget to coach
your actors!
● Practice makes perfect - As the “final exam” for this
course, students are encouraged to assist with moulage
at a future CERT Final Exercise (next one is 3/22/14)
● Other potential moulage opportunities
Capital Shield exercise (October 2014)
CERTCon exercise
EMT practical exams
Firefighter classes
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2008 2008
Additional Resources
● Search online images for pictures of real-world and moulaged injuries
● Websites with additional moulage tips, techniques, and recipes:
http://www.fairfaxcert.com/userresources.php
http://www.cert-la.com/education/moulage.htm
http://www.vdh.state.va.us/OEMS/Training/ResourceCD/Moulage.htm
http://casualtysim.webs.com/casualty_simulation_techniques.pdf
http://www.inquiry.net/outdoor/skills/instruction/simulations.htm
http://ebookbrowse.com/step-by-step-moulage-ppt-d144532915
http://www.whatcomcountyems.com/pdfs/CE%20Instructors/ BASIC%20MOULAGE.pdf
Don’t forget to check Google and YouTube!
● Supplies
Halloween and party stores
http://www.fxwarehouse.info
https://www.paintandpowderstore.com
http://www.ptsonline.biz/
And many more!
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