How Moulage Brings Realism to Training

An enhanced sensory experience improves retention, performance

Train as you fight. —The U.S. Army

How good are you at pretending? If you were instructed to care for a simulated victim with a hemorrhaging gunshot wound or open pneumothorax, could you see it in your mind? Would your pulse instinctively quicken at the thought of congealed blood pooling around the victim or bloody froth at the chest wound entry point bubbling with each exhalation? Working instinctively, would you begin putting pressure on imaginary wounds and shouting out orders, adrenaline building, propelling you into saving a life as you’ve been trained? If you’d never experienced these medical emergencies and were asked to pretend your scenario victim had them, could you do it?

French for casting or molding, moulage is the art of depicting lifelike injuries to bring realism to the training of first responders and others who may treat the real thing (military, medical staff, veterinarians, etc.). Moulage may be as simple as applying premade rubber or latex molds or as complex as using advanced three-dimensional interactive wounds, makeup and theater techniques to provide authenticity to the training scenario—incorporating wounds such as impaled objects, crush injuries, fourth-degree burns and blisters that rupture when improperly handled. The addition of moulage supports the sensory perception of a training exercise, facilitating discovery of pertinent data and assisting the responder in confirming physical signs that support their diagnosis. This improves their sensory engagement, critical thinking, evaluation knowledge and response-time performance.

Current research estimates anywhere from 50%–90% of all communication is nonverbal—thus, proper assessment and triage often depend on accurate use of four of the five senses (sight, touch, hearing and smell). Integrating moulage into an exercise creates a powerful training modality that can enhance those perceptions. The use of interactive, odorous, three-dimensional wounds such as hemorrhages improves trainee retention and helps inoculate them from stress when they face the real thing. It can also help teams identify shortfalls in patient coding and determining acuity levels and strengths involving wound recognition, stabilization, standardization and triage on both individual and team levels. It can provide lifesaving exposure of system vulnerabilities.

While you can read about injury processes in books and study symptoms in theory, you cannot fully understand what you’ve never seen or experienced. It is the interpretation of what is seen, felt, heard and smelled that allows the responder to pull together critical data and integrate this knowledge into their assessment, response and care plan. More important, the interactive experience sears this knowledge into the brain, enabling responders, teams and systems to recall and utilize it to expand on future training experiences.

This article is derived from Moulage Concepts: Bridging the Gap in Simulation. Applicable copyright laws apply.

Bobbie Merica is the author of Medical Moulage: How to Make Your Simulations Come Alive, Moulage! Bridging the Gap in Simulation and Moulage Magic! Theatrical Tricks to Bring Simulation to Life. All works are based on her popular Moulage Mastery! Bridging the GapTM in Simulation workshops. She received her certification in Moulage-The Art of Injury Simulation; Biological/Chemical/Terrorism and WMD terrorism training through TEEX. Upon discovering the absence of moulage specific to a clinical/hospital setting, she designed and implemented the first of a series of 3D clinical wounds, moulage kits and courses that she teaches all over the country. She began her career as a simulation technologist with California State University, Chico, where her collaborative work in the development of the Rural Northern California Simulation Center earned runner-up honors in Advance magazine 2009 Best Nursing Team contest. She is a contributing author for EMS World and, and medical moulage & trauma expert for the Bureau of Public Health Emergency Preparedness, AZ. She will be offering the Medical & Trauma Moulage Workshop for Simulated Clinical Experiences, August 29–31, at the Little America Hotel & Resort in Cheyenne, WY. For more information, visit

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