Semper Praepartus Bene

Translation: Always Prepare Well

I was a cherry during my first weeks at the Army Academy of Health Sciences. Even though I had a college degree in Biology and was freshly pinned on butter bars ( I was a newly minted Second Lieutenant), I knew nothing. I certainly wasn’t experienced with the blood and gore associated with combat.

Sure, we were shown some ultra graphic footage taken at MEDEVAC (medical evacuation) casualty collection points, Battalion Aid Stations, and Mortuary affairs. There was no solemn music, no narration, no attempt at production values—only a film depicting raw carnage and death with the occasional hacksaw amputation. I felt a way I had never felt before. I grew up ten years in the short time the films ran. This sh*t was real, and this would be our future.

Cut to one of my first medical classes; it looked like absolute carnage. Heads were split open, exposing gray matter, shiny intestines were spilling out of bloody abdomens, and faces were shredded seemingly beyond repair. Had I not known it was all fake, I would have been horrified. However, the instructors I was learning from had seen the carnage, and they knew how to replicate it extremely realistically using the art and science of moulage.

Simulated shoulder wound. I thought I’d spare you the gory stuff in case you were eating or something. Image Credit: moulagesciences.com

mou·lage (noun\mü-ˈläzh\):
The art of applying mock injuries for the purpose of simulating real-world experience for emergency medical training.

We train like we fight, and realism is critical to all aspects of military training, including medical care. When rounds start to find their mark on the battlefield, doc (what we call our medics in the Army) is suddenly the most popular person around.

Severe medical trauma creates significant challenges for military & civilian first responders. Traditional classroom training is essential but no substitute for actual experience in the field. Bridging the gap is moulage, the art of applying mock injuries for the purpose of simulating real-world experience for emergency medical training.

In use for centuries, moulage ranges in complexity from simple wax models to hyper-realistic prostheses with pumping blood and simulated odors. Yes, odors. Certain wounds have a particular smell. As you might imagine, it’s not always pleasant.

Sometimes professional effects teams get in on the action. Video courtesy of YouTube and AFN Wiesbaden

Major Deanna Jensen is a clinical nurse with the 934th Aeromedical Staging Squadron (ASTS) and an expert in the art of moulage. She was recruited to do all the moulage at an exercise called Heavy METL (coolest exercise name ever) in Alpena Combat Readiness Training Center.  Jensen said the easiest wounds to create are burns and lacerations. Today, however,  she’s looking forward to crafting her first compound fracture and adding realism to a sucking chest wound.

Says Jensen:

“We want to add Alka-Seltzer to a sucking chest wound. The Alka-Seltzer with a little water makes the wound bubble.” 

It’s that extra realism that makes all the difference in the world. We would train with fresh pig’s blood to get a feel for the look and metallic odor of the real thing. As you might have experienced, real blood is quite slippery, and one has to account for that during treatment.

Tech. Sgt. Julia Matthews, a 934th ASTS medical case manager, says the moulage at Heavy METL is amazing because it takes the reality level of the exercise to the next level.

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She says:

“When we have moulage it helps significantly because we can go right to the patient and see what’s going on instead of us talking to them and asking them what their pain card says.”

If they ever have to put their training to work in a real-world environment, the skills these Airmen are learning are absolutely invaluable.

Cpt. Kyle Wall, a clinical nurse with the 934th Aeromedical Staging Squadron, has a mockup of a penetrating glass wound on his neck on April 7, 2022, at Volk Field Air National Guard Base, Wis. Wall and other Airmen had moulage applied to them for a simulated mass casualty training exercise supporting Viking Shield. (U.S. Air Force photo by Chris Farley)