FORT HUNTER LIGGETT, CA - First, she peeled the skin off of
the plastic tray and glued it to the elbow stump. Next, she
added bruising and bone shards where the arm was cut off.
Finally, he covered it all in a cascade of blood.
U.S. Army Spc. Courtney Greene, a patient administration
specialist with the 4220th U.S. Army Hospital from Topeka,
KS is a member of the Warrior Exercise (WAREX) 91 14-03
moulage team. The team's goal for WAREX is to learn from the
experience while also improving the quality of training for
Soldiers participating in the events.
U.S. Army Reserve Spc. Courtney
Greene (left) of the 4204th U.S. Army Hospital from Topeka, KS
and Spc. Ethel Jarvis of the 4220th U.S. Army Hospital from
Shoreham, NY, use sponges to apply dirt mixed with clear adhesive
to a neck wound moulage at Fort Hunter Liggett, Calif., during
Warrior Exercise (WAREX) 91 14-03 July 22, 2014. Adding the dirt
makes the wound look more realistic to the Soldiers using the
mannequins. (U.S. Army Reserve photo by Pvt. Travis Terreo, 205th
Press Camp Headquarters)
“A moulage is a real-world enhancement to a medical training
mannequin or a live role player,” said Greene. “It is a way
to make the training more realistic, to really make sure
that Soldiers know what they are doing.”
construction process works to the benefit of everyone
involved. Though the moulage team is made up of Soldiers
with medical backgrounds and experience, it is a valuable
training experience for them too.
process is sometimes a learning experience for us,” said
Sgt. Leah Moberg, a medic with the 7240th Installation
Medical Support Unit from Kirksville, Missouri. “We use
pictures of real injuries and of the body parts we are
working on as a reference to make the moulage as realistic
as possible. We have to learn where the bones are and are
not, which wounds bleed a lot and which ones don't.”
The process of making the most realistic moulages possible
begins the instant the team determines the type of injury
needed. The team must then find a photo example of the wound
type so that decisions concerning coloring and materials can
To begin the actual construction of the
moulage, the team starts with large sheets of gel called Gel
Effects. These sheets come in red for blood, beige for skin,
and clear for use as an adhesive. The sheets are cut into
small rectangular pieces and stuck into plastic bottles. The
bottles are then placed into a hot water bath until they
Once the Gel Effects melt, a team member
removes them from the hot water bath and squeezes them into
small puddles on plastic sheets. These are called blanks. At
this point, a Soldier uses grease paints to change the gel's
color to any color needed, said Robert Marlin, a former Army
medic and current moulage construction instructor with
Regional Training Site-Medical out of Camp Parks in Dublin,
California. Generally, the team only changes colors to help
match skin colors.
Next, the team adds special
effects. Holes are cut for bullet wounds, aluminum pieces
are added to look like shrapnel, dirt can be added to mimic
field wounds and much more. With the add-ons in place, the
mannequins are allowed to dry.
After they dry, a
Soldier peels the wounds off of the plastic sheets and
places them on the mannequin using clear Gel Effects. A team
member then uses more Gel Effects in various colors to blend
the wound to the mannequin, and adds dirt and other foreign
matter. This is also the stage where most of the artificial
blood is added. Finally, the moulages are left alone to dry
before being stored or sent out for use in medical training.
According to Marlin, there are three different types of
moulages. There are regular mannequins, live role players
and computerized mannequins.
“The regular mannequins
allow Soldiers in training to see what wounds look like and
they make Soldiers go through the whole process,” said
Marlin. “We expect Soldiers to ask what is wrong first, but
these mannequins are not going to reply. If we throw one of
these out there with a uniform on and tell them that there
is something wrong, they have to find the problem by cutting
the clothes off or using rakes and sweeps. They have to use
Live role players are the second
type. This type allows the team to put the moulages on
people so that they can act as if they are wounded and
actually be able to display the wound. This type is not used
often, explained Marlin. They are usually only used if we
are short on time and need to produce moulages quick for a
mass casualty type training.
“The body suits are
particularly useful for surgical training,” said Spc.
Fernando Octaviani, a health care specialist with the 4005th
U.S. Army Hospital from Ellington Fields, Texas. “I can put
the suit on and it will simulate internal bleeds, bruising
or almost any kind of traumatic wounds like shrapnel or
gunshots. The advantage to the suit though is that it is all
gel, so Soldiers can cut into it and actually perform the
The final variation is the computerized
mannequin. These are the least commonly used because of the
price and the requirement that trained technicians be
available to run the computer that controls the mannequin.
“The advantages to this type of moulage is that it is
almost like working on a real patient,” said Marlin. “They
can speak, blink their eyes and move their arms. They can
even have a pulse and respiration or internal bleeding.”
Though some types of moulages are most useful in
specific situations, all moulages can be used for any
portion of the Army medical process.
the variation of moulage chosen, they can be used at all
levels of military medical care whether it is combat life
saver type buddy aid, triage, or in a military hospital,”
The Army's Combat Lifesaver (CLS)
Course teaches Soldiers the basic skills necessary to
provide potentially lifesaving aid to fellow Soldiers on the
battlefield. The team can use moulages to provide injured
patients to Soldiers who otherwise might not have had the
opportunity to practice.
Triage is the stage of care
in which large numbers of injured personnel are sorted based
on the severity of their injuries. This stage determines how
and when medical personnel will transport and treat
“Triage is an under practiced but
critical stage in the medical process,” said Spc. Octaviani.
“This stage is about doing the most good for the most
people. I have been through the training and moulages are
one of the greatest tools out there for it.”
can also be used in an Army hospital setting. During WAREX,
Soldiers stage the mannequins to simulate combat injuries.
Soldiers participating in the event then administer
CLS-style buddy aid. Medics then triage and transport the
mannequins to an Army hospital for further treatment if the
wound warrants it.
“One of the hardest parts of being
in an Army hospital as a Reserve Soldier is that we don't
get a lot of practice being a hospital,” said Greene. “We
can't set up a field hospital over the weekend for drill.
What we do on the moulage team allows the Army hospital
units here to get that experience.”
Moulages are an
invaluable tool for medical training, Octaviani explained.
Trying to practice medical aid on someone that you know
doesn't actually have an injury and getting that practice in
a chaos-free environment is not a useless exercise; but it
does not give the same value as working with moulages in the
chaotic environment provided by WAREX.
“How this all
helps Soldiers is it prepares them for experiences they may
have going into areas of operation,” said 1st Lt. Christina
Leake, the moulage team officer in charge and member of the
7231st Installation Medical Support Unit from Lubbock,
Texas. “Having been through this exercise and training, they
will know what to do. It better prepares them to take care
of Soldiers in a combat environment.”
By U.S. Army Reserve photo by Pvt. Travis Terreo
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