The art behind Army medical training
July 28, 2014
FORT HUNTER LIGGETT, Calif.- First, he peeled the skin off of the plastic tray and glued it to the elbow stump. Next, he 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. Harrison Greene, a patient administration specialist with the 4220th U.S. Army Hospital from Shoreham, New York, 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.
"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."
The moulage 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.
"The construction 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 be made.
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 melt.
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 their training."
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 procedures."
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.
"Regardless of 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," explained Marlin.
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 casualties.
"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."
Moulages 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."