Wound of the Month: Evisceration with Bloody Drainage

Time

2–5 minutes (not including drying time). See Figures 1–1b.

Skill Level

Beginner

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

Wax paper

Spray paint: pink, purple-pink and/or red

Construction-grade gap filler (Brand name: Great Stuff)

1/8 tsp. blood powder

1/4 cup baby oil

Blood gel

Equipment

12″ x 12″ sheet of wax paper

Tape

Two small paint brushes

Technique

Using tape, adhere the corners of the wax paper to a flat, outdoor surface to create a work station. Vigorously shake the can of gap filler for several minutes, or according to manufacturer directions. Using your fingers, gently apply pressure to applicator nozzle, dispensing the filler on the wax paper in a looping or figure eight-type pattern. Working quickly, create loops of varying size, width and depths by controlling the pressure on the dispensing nozzle, then allowing the gap filler to curl. Allow the gap filler to set for several minutes (between 2–10 minutes depending on outside temperature) or until “intestines” become firm enough to create an outer shell and are no longer sticky. Working in the opposite direction, apply a secondary loop over the first to create visual height and intestinal depth. Allow intestines to air dry until completely set—approximately 1–2 hours, or as indicated per manufacturer directions. Carefully peel away the wax paper from the back of the intestines. See Figure 2.

Using pink, purple or a combination of the two, thoroughly coat the surface of the intestines with spray paint, applying additional coats of paint as needed to ensure all folds and creases are saturated with color. Allow the paint to fully dry before applying drainage. See Figure 3.

Bloody Drainage

Solvents, such as glycerin, baby oil & K-Y jelly, can be used alone or lightly tinted with blood powder to create realistic wound drainage, bodily fluid or secretions that mimic the body’s natural viscosity. See Figure 4.

In a small bowl combine the solvent and blood powder, stirring well to blend. Using a small paint brush, liberally apply bloody drainage to the wound surface, folds and crevices of intestines. Gently blot the surface with a tissue or napkin.

Quick Fix

Intestines of varying sizes, shapes and colors can be made in advance, stored in your moulage box and reused indefinitely.

Training Scenario

Dispatch: Medic 31, respond Code 3 to Brasen High School, report of altercation, unknown injuries. 322 Normal St., nearest cross street, Spicer Ave. Chico police and fire responding. 0820 hours. Dispatch clear.

On Scene: Dress victim in a pre-treated stabbing victim shirt. To create shirt: Using scissors, create a large gash in the side of a light colored shirt, above the belt line. Using a large paint brush that has been dipped in fresh moulage blood, liberally apply the blood mixture to the front, side and back of shirt.

Using a make-up sponge, liberally apply white make-up to the face and lips of the victim, blending well along the hair line. Create beads of sweat on the skin by applying a light mist of pre-made sweat mixture to the forehead, chin and upper lip of patient. Position the victim flat on his or her back. Using rubber cement or spirit gum, adhere intestines to the abdomen of the victim (underneath the shirt), positioned to align with the gash in the shirt. Using congealed blood mixture, create a large pool of blood and bloody drainage 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.) Using blood gel, apply blood to the top and sides of the intestines, along the seam, where the abdomen skin and intestines meet. Instruct the victim to shiver and complain of feeling very cold.

Use in conjunction with congealed or fresh blood.

Helpful Hint

“Proper dressing” of the abdominal evisceration is a key concept and imperative to the patient’s care. When creating a scenario, consider having both normal saline (correct procedure) and sterile water available to ensure skill components and competency are met.

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. Carefully peel away the intestines from the skin of the victim (if using spirit gum, work a small amount of spirit gum remover under the intestines, continuing to add remover and lift intestines until fully removed. Do not attempt to peel the intestines from skin without remover.) Treated garments and intestines may be stored together in a sealed freezer bag in your moulage box for future use.

Allow congealed blood to set before storing it with a barrier in your refrigerator for future use.

Visit Moulage Concepts at www.moulageconcepts.com for all your moulage supplies and training needs. Recipes are referenced from Medical Moulage—How to Make Your Simulations Come Alive by Bobbie Merica.

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.