EMS World Expo Preview: The Art and Science of Moulage Realism

In the weeks leading up to EMS World Expo—the world’s largest EMS-dedicated event—EMS World is spotlighting select pre-conference sessions to learn more from the featured speaker on what makes their presentation timely, informative, and worthwhile. In this installment, we speak with Bobbie Merica, who will present “The Art & Science of Moulage Realism” on Tuesday, Oct. 11, 2022, in Orlando. Learn more and register at www.emsworldexpo.com

Highly regarded for her ability to think outside the box while incorporating realism into training, Bobbie Merica takes simulation-based practice to the next level by teaching just how important preparation is for wound care in the field—something that most practitioners would prefer to learn before it’s actually needed.

A conference regular and respected workshop host, Merica brings moulage to the people who need it—and more importantly, to those who think they don’t. Her medium, medical moulage, is the art of creating wounds and injuries to scale with all the properties that they would have in the field—smell included.

This hands-on course will be presented in a multi-level learner approach including scenario staging, sensory engagement, core steps and technique, accessory moulage, wound development, storage recommendations, and time and money-saving alternatives for both simulator and standardized patients.

“We are a company that trains leaders for preparedness,” Merica says.

What to Expect

What is medical moulage? Without spoiling Merica’s workshop, her techniques make it possible for learners to experience an active wound with all its properties. These are topical wounds that no longer require imagination to pretend they are there—which is how most first responders demonstrated their skill sets when they entered the job. We have always had to imagine a knife in the abdomen, third-degree burns on a face, head or neck, or even amputation. Manikins are expensive and Merica’s moulage takes into account every aspect of learning—including the integrity of the manikins. 

Those who have practiced a scenario with imaginary wounds and then had to apply treatments based on those self-created wounds know just how hard it is to focus on care when so much energy is spent with imaginary moulage. Merica believes that simulation-based practice helps reduce medical errors—and it’s hard to argue against, but if they do, she is prepared.

“I think what makes this more timely is that these are things that I've been discussing for years but were things people were not ready to hear. We provide the ability to show differential diagnosis by creating art that tells a story that sets up opportunities to learn and grow,” explains Merica. “Every time someone bounced back at me with a reason they were not upping their game, I gave them a solution.”

Merica, a pioneer in the art of medical moulage, brings forward over 20 years of experience, spending copious amounts of time studying wounds and injuries in an effort to ensure that first responders and those in the military show up prepared for events and injuries that are historically difficult to prepare for. 

“I create a moulage that can tell a story,” says Merica. “We couldn’t create stories that made any level of sense until we brought in what could be seen, heard, felt, and in some cases, smelled. We begin to learn what we thought we knew but didn't fully understand.”

The ‘Unknown Unknowns’

Merica is no stranger to mass casualty incidents. She and her family fell victim to a catastrophic 2018 fire that leveled the town of Paradise, California—her home. Merica was not in town at the time, but her partner was (who was thankfully safe), and living through that level of disaster reinforced for Merica how important it is to be prepared. Those who worked to save the town and its occupants would have never imagined their town burning to the ground, and it’s this reaction that Merica works to remedy by preparing first responders for the absolute worst.

Convincing the powers that be how important realistic training is for first responders has been an uphill battle, but the proof is in the mouths of her competition, who direct folks to her expertise when they need top-notch, realistic medical moulage for high-level preparation and training. Merica explains, “We provide the ability to show differential diagnosis in creating art that tells a story that sets up opportunities to learn and grow.”

While this is not a new approach to preparing first responders for the field, it’s becoming more timely as we deal with more mass casualty incidents that are next to impossible to prepare for beyond the old school approach of covering mock casualties in fake prop blood. Non-specific training is becoming a thing of the past and Merica’s medical moulage is guaranteed to make scenario-based learning as real as possible.

When it comes to creating each moulage, Merica analyzes the gaps, or the “unknown unknowns,” which then lead to her discovering how certain events play out that might have been previously unanticipated. 

“When I realized how all of these things linked together, it was like opening Pandora's box. I realized at that moment it’s what we had always been missing,” says Merica. She is referring to the obvious gap in training that has long been regarded as normal training practices. “We run simulations to bridge the gap between the things we do know, and what we don't know.”

“At the end of the day, every one of us who steps up to that plate is trying to make a difference. I just don't think we're investing in them the way we can to give them the skill sets they need. We come to this from the top-down perspective,” states Merica. “We come with a learner's etiquette. What it's going to take to create standardization, get people on board, save time, money, lives, all of it. And that's important.”

Sign up for this precon workshop at https://emsworldexpo.com/rates.

Leah Sobon is a freelance writer and paramedic at the Region of Peel, Ontario, Canada.