Wound of the Month: Creating Close Range Bullet Entry Wounds

Time

3–5 minutes. See Figure 1.

Skill Level

Beginner

Supplies (Find supplies and more at www.moulageconcepts.com.)

Latex

Modeling wax

Red make-up wheel

Burgundy make-up wheel

Black make-up wheel

Caramel coloring, thinned

Blood gel

Equipment
Two small paint brushes

Toothpick

Technique

Use the modeling wax to create a small, approximately 1 inch x 1 inch circular pattern on the skin of the victim. The wax circle should be 1/8 inch thick, or approximately the size and depth of a nickel. Using your thumb or index finger, begin blending the wax outward, around the perimeter, to create a feathered edge that blends into the natural skin while maintaining the 1/8 inch thickness in the center. See Figure 2.

Press firmly in the center of the wax with your fingertip to create an indentation. Using the end of a toothpick, remove any wax remnants from the center of the imprint, creating a clean, defined entry point. See Figure 3A & 3B.

 Use the latex to lightly brush the surface of the bullet entry point and surrounding area, setting the wax and creating a seal. See Figure 4.

With a paint brush that has been dipped in red, then burgundy make-up, create wound depth by carefully filling the bullet entry hole, depositing the color and creating slight alternating color intensity. Using a toothpick that has been dipped in the black make-up, place a small, approximately 1/8 inch dot in the center of the entry hole, on top of the red make-up. See Figure 5.

Use a paintbrush dipped in thinned caramel to lightly coat the inside perimeter of the bullet entry hole, along the edges. See Figure 6.

Take a small paint brush dipped in red make-up and create ecchymosis by lightly applying the make-up to the surface of the latex, around the bullet entry point, with a gentle blotting motion. Alternate the intensity of color placed on the latex by the amount of pressure applied to the applicator. (Note: Latex absorbs more color then natural skin.) See Figure 7.

Use a paintbrush dipped in blood gel to lightly coat the interior surface of the bullet entry hole, taking care to not smear the black dot centered in the wound. Place a drop of blood gel inside the bullet entry wound, squeezing out enough product to create a “pool” at the entry point. Position the patient to create blood flow as appropriate to gravity. See Figure 8.

Quick Fix

Use a black make-up pencil to simulate a bullet entry hole on the victim. Using a pencil, apply a small, approximately 1/4 inch circle to the skin of victim. Carefully place a drop of blood gel on the surface, squeezing out enough gel to create a “flow.”

Dispatch

Medic 22, respond Code 3 to Gilligan’s Tap Room, report of shots fired; unknown injuries. 322 Normal Street, nearest cross street, Second Avenue. Ontario police and fire responding. 0145 hours. Dispatch clear.

On Scene

Dress the victim in a pretreated bullet entry shirt. Use scissors to cut a small hole in the abdominal area of a light colored shirt, above the belt line. Using a large paint brush dipped in fresh moulage blood, liberally apply blood mixture to the front, side and abdominal area of the shirt. Create gunshot residue around the entry hole by applying a small amount of soot powder with a paint brush. Using a make-up sponge, apply white makeup to the face of victim, blending well. Create beads of sweat on the skin by applying a light mist of premade sweat mixture to the forehead, chin and upper lip of patient. Position the victim flat on his or her back. Using congealed blood mixture, create a small pool under the back and side of the patient, near the wound site. (In areas with stain risks, create a hard barrier by applying wax paper to ground surface prior to applying congealed blood.) Apply fresh bruising, superficial abrasions, bloody noses and bruised knuckles on several “friends” of the victim to create a fight scene.

Use in conjunction with abrasions, superficial; blood, congealed; blood, fresh; bruise, fresh.

Helpful Hint

Have a patient with a latex allergy? Use clear moulage gel in place of latex to set the wound and create a seal.

Cleanup and Storage

Using a soft, clean cloth or make-up remover towelette, wipe away the make-up and sweat from the skin of the victim. Allow congealed blood to set before storing with barrier in refrigerator for future use. Treated garments can be stored together in a sealed freezer bag in your moulage box for future use.

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 Gap^TM 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 HealthySimulations.com, 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 www.moulageconcepts.com.