Moulage

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Figure 1: Examples of moulage kits.

From Wikipedia: "Moulage (French for 'casting, moulding') is the art of applying mock injuries for the purpose of training emergency response teams and other medical, military, [or paramilitary] personnel. Moulage may be as simple as applying pre-made rubber or [gel] 'wounds' to a healthy patient's limbs, chest, head, etc., or as complex as using makeup and theatre techniques to provide elements of realism (such as blood, vomitus, open fractures, etc.) to the training simulation...

"...In modern terms, the word moulage refers to the use of "special effects makeup (SPFX) and casting or moulding techniques that replicate illnesses or wounds" in simulation based techniques. Common examples include designing diabetic wounds, creating burns or other illness effects, like dermatological rashes and gunshot wounds...

"...These illness and injury effects are applied to training manikins or simulated or standardized patients for training or other purposes. Simulation staff attend training to learn these techniques. It is argued that the use of moulage in simulation improves realism or participant buy-in. Moulage is an emerging field of research for paramedicine, radiography and medical education, with researchers exploring how moulage contributes to learning in training. Military training utilizes highly-authentic moulage techniques to desensitize to graphic wounds, prepare for battle, and treat injuries."

In Portland NET, moulage adds realism to exercises, desensitizes reactions to wounds, encourages decision-making during triage, and provides productive stress. PBEM and Portland NET does not have its own in-house moulage team. Cascadia Moulage, a Portland-area nonprofit organization, typically provides moulage services. NET volunteers routinely see moulage in exercises such as Scenario Village and Final Field Exercises.

Volunteers wearing moulage are appropriately called Survivors, Survivor Actors, or Patients (PBEM described them as "Victim Volunteers" or "VVs" at one time, but that is an outdated term). Moulage is applied by a Moulage Artist.

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What Is Moulage Made Of?

Moulage Artists from Cascadia Moulage use a gel product that contains no latex and washes/peels off, although the "blood" coloring can stain clothing and may temporarily stain your skin. Survivors should wear only clothing, shoes, etc. that can be stained and torn. Moulage is messy.

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Survivor Actor Preparations: General

If you are volunteering as a Survivor, thank you! Your presence at the training exercise will help save lives by increasing the level of realism for emergency responders. Exercises that offer the same stressors and lifelike elements are valuable in assisting responders when called upon in real emergencies.

This is also an excellent training opportunity for you. You will experience rescue and medical treatment from the patient's perspective, which will make you a better responder. For this reason, PBEM makes a shift as a Survivor part of the NET Task Book and creditable as Advanced Training for a NET's Minimum Service Contribution.

An important note: as a Survivor, you are encouraged to get moulaged but it is not usually required for participation. Not everyone is into getting made up, and that's OK. Let the Exercise Coordinator who recruited you ahead of time, if possible, and decline to be moulaged at the exercise if a Moulage Artist approaches you.

• Artists could apply moulage to any area that wouldn’t be covered by a swimsuit. Moulage to the head/hair, face, torso and/or legs is common.
• Do not wear makeup, apply lotions or bother with ‘doing’ your hair. Makeup & lotions prevent the moulage pieces from adhering to your skin. If we need to shave your arm, chest or leg, we’ll ask you about it first.
• We provide a wide range of "injuries" for these trainings, depending on the scenario - some minor, some dramatic - it all depends on what the emergency responders are learning at that event.
• Your safety is our primary concern. It is imperative that you let the Moulage Artist know of any pre-existing medical condition that may in any way affect your participation (e.g. asthma, back problems, allergies).
• When you sign up for an event, you’re committing to being there on time, and staying for the duration of the exercise. Each moulage application takes between 15-30 minutes (advanced moulage takes even longer).
• It’s important to stay on schedule so that the emergency training starts on time.
• Moulage takes time, and there is often ‘down time’ while waiting for your moulage and during the training exercise. Bring a book and/or portable game, and some water or snacks. It can be a noisy, intense environment, and a long day with breaks few and far between; patience is definitely a virtue. Lunch is always provided if it’s a full day, but we’ll seldom be able to adapt to special dietary requests; so if that’s a concern for you, please bring your own lunch.
• Dress for the weather. You may be out in the summer sun, or laying on cold/wet pavement for a while. Layers (in cool weather) are a good idea. Wear only clothing, shoes, etc. that can be stained and torn.
• Medical triage requires that emergency responders "palpate" your body, meaning they’ll ask you to let them know if you feel any pain when they press on your skin (head to toe assessment). This is a gentle pressure designed to locate any injuries that are not obviously visible and to prioritize victims.
• Please follow the specific directions given for your injury/scenario. Do not ‘ad lib’. Injuries are designed to give responders specific clues, and any changing of those clues could put you in a different category, making it difficult to assess responder performance and skill. It is extremely important that you maintain your assigned vitals, chief complaints and any additional directions you’ve been given.
• You’ll be signing in for the event, will be asked to sign a "hold harmless" agreement and likely an agreement that your photos/video can be used.
• Please return any latex moulage pieces and any "symptom cards" you may have before you leave. There’s no need to return the gel pieces...if you put them in your freezer, you can reuse them for Halloween :)

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Moulage Gallery

Coming soon! In the meantime, you can see pictures of moulage here:

https://www.friendsofportlandfire.org/moulage-images-graphic.html

https://portlandnet.tumblr.com/tagged/moulage

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Survivor Actor Preparations: Scenario Village

In addition to the general preparations described above, here are a few more details for Survivors volunteering at Scenario Village, located at 14912 NE Airport Way. The most important thing to know is this: there is nothing taking place at Scenario Village more important than your safety. If you feel unsafe at any time, or feel that something unsafe is about to happen, yell "REAL WORLD!" and that will pause all activity during the exercise. Never feel shy about speaking up if you feel unsafe.

General Tips

• Please read the Scenario Village Overview section of the wiki here (the rest of the page is optional): https://volunteerpdx.net/index.php/Scenario_Village#Scenario_Village_Exercise_Overview
• Optimal arrival time for Survivors is between 0815 and 0830 for the AM shift, and between 1245 and 1300 for the PM shift.
• When you arrive, you will enter into the lobby. The moulage room is most often the classroom immediately to your left as you walk into the lobby.
• You can expect coffee in the AM shift and some breakfast-y snacks.
• You will have restroom access both in the moulage room and in the Village.
• Players (rescuers) begin to arrive around 0830 (AM shift) or 1300 (PM shift) and will be staged in the lobby. If at all possible, please do not let them see you. If they do, they'll see the injuries they may need to treat ahead of time and that's a little like getting exam answers surreptitiously.

The Village and the Exercise

• At some point after you are moulaged, an exercise Proctor will guide you to the Village and place you in the area where the Proctors want Players to find you.
• Lighting is very poor in some areas of the Village. If you plan to bring an analog book to read during downtime, plan to bring a book light as well.
• It's not uncommon for rescuers using flashlights to not be aware they're shining them right in your face as they check you for "injuries". If this happens and it's annoying you, say "REAL WORLD" and ask them to be aware of that.
• If your "injuries" include you being non-ambulatory, Players might transport you out by carrying you using a MegaMover or by some other technique. Again, stop the exercise by saying "REAL WORLD" if you feel unsafe. Proctors will also be watching and will stop the exercise if they feel concerned about the techniques used by the Players.
• Also, Players should never transport Survivors up or down stairs. If you are being carried, the Players should place you down, walk you down the stairs, and then resume the carry.

When the Exercise ends

• You are welcome to join the hotwash discussion, and make observations of the response effort by Players.
• Please be sure to turn in your lanyard and injury card to PBEM or back to the moulage technicians.