Instructor's Guide for Casualty Simulation Kit Device 11E10

Box MS 1375

Book

Instructor's Guide For Casualty Simulation Kit

Device IIEIO

No Blank Pages

NAVEXOS P-2709

INSTRUCTOR'S GUIDE

FOR CASUALTY SIMULATION KIT

DEVICE IIEIO

PREPARED FOR

ARMED FORCES INSTITUTE OF PATHOLOGY

THROUGH ARMY PARTICIPATION
IN

U. S. NAVAL TRAINING DEVICE CENTER
PORT WASHINGTON, NEW YORK

NOVEMBER 1964

NAVEXOS P-2709

Chapter

TABLE OF CONTENTS

Page Chapter

I Casualty Simulation in Disaster

Demonstration 1

ri Material Required for Casualty Simulation 3

III General Instructions 5

IV Preparation of Special Effects 7

Blood 7

Perspiration 7

Frothing 8

Vomitus 8

Odor 8

V Techniques of Make-Up 9

Shock 9

Burns 10

First Degree Burns 11

Second Degree Burns 11

Third Degree Burns 12

Page

Wounds 13

Abrasion . . ;. . ...''...:.. 13

Bruise or Contused Wound 14

Lacerated and Incised Wounds 15

Puncture Wound 16

Fractures or Foreign Bodies 17

Chest Wound . 19

Intestinal Evisceration

or Protruding Bowel , 20

Head Wounds 22

Eye Enucleation 24

Enucleation with Head Injury 26

Multiple Wounds 28

Amputations 29

Finger 29

Arm 30

Elbow 31

Leg 32

VI Moulages
VII Summary

33

36

NAVEXps P-2709

LIST OF ILLUSTRATIONS

Figure Page

1 Casualty in properly staged situation iv

2 Casualty Simulation Kit, Device IIEIO,

showing a number of components 2

3 Application of cold cream to face, neck,

and ears 9

4 White grease paint or liquid blended

into entire area t 10

5 Special blue make-up applied lightly

beneath the eyes, to lips, and lobes of

ears 10

6 Appearance of a patient in shock; note

drops of "perspiration" 11

7 A first degree burn can be indicated

by using cold cream and red grease

paint or lipstick 11

8 A second degree burn showing blisters 12

9 Blast injury with second degree burn

to the face showing characteristic blisters 12

10 Third degree burns showing charred

appearance and tissue destruction 13

11 A contusion results when an area is struck

with a blunt object, causing severe in-
jury to tissue and small blood vessels 14

12 A lacerated wound is characterized by torn

or jagged edges 15

ii

Figure Page

13 Incised wounds have smooth edges made by

a sharp object such as a knife, broken

glass, or bayonet 16

14 A puncture wound 16

15 Simple wound of leg 16

16 Simple wound of foot 17

17 A fracture of the leg 17

18 A fracture of the hand 18

19 A foreign body thrust through the face 18

20 A wound of the chest 19

21 An intestinal evisceration or protruding

bowel 20

22 Evisceration 21

23 A wound of the head 22

24 A wound of the head 23

25 Enucleated eye 24

26 Wound of the face with enucleated eye 25

27 An eye pad in position over normal eye,

showing surgical tape to hold the eye

patch in place 25

28 A stick-on wound moulage or make-up is

applied over an eye protected by a

sealed eye patch covered with plastalene 25

NAVEXOS
Figure Page

29 Several layers of elastic bandage are

wrapped around the head at the hairline
to keep plastalene and blood from getting
in the hair

26

30 The area around the artificial eye is

built up with plastalene 26

31 A foreign body should be inserted in the

plastalene near the eye 26

32 Coagulated blood is applied over the

gauze and plastalene 27

33 Charcoal or dirt is used to indicate dirt

and debris in certain areas 27

34 Because eye and head wounds always cause

severe shock, make-up for shock is added 27

35 The type and location of multiple wounds

of the leg and buttock must be considered
carefully 28

36 Emphysema, or swelling, should be shown in

multiple wounds of the face, neck, and
chest 28

37 Multiple wounds 29

38 Amputation of the fingers can be shown

by taping the fingers in a folded posi-
tion and forming the stumps with plasta-
lene and other materials 30

P-2709

Figure Page

39 Amputation of the arm at the shoulder can

be shown by taping the arm to the body
and building up the shoulder with plasta-
lene and other substances 30

40 Before portraying amputation of a leg at

the knee, the lower leg must be folded
beneath the upper leg, and the ankle
secured to the waist with bandage 31

41 After securing the lower leg as shown in

figure 40, the stump is molded on the
knee with plastalene and other materials 31

42 Small stick-on wound moulage 33

43 Perforated stick-on wound moulage 33

44 Small fracture stick-on wound moulage 34

45 Large fracture stick-on wound moulage 34

46 First, second, and third degree burns,

stick-on wound moulage 34

47 Open wound of head, stick-on wound

moulage 34

48 Enucleated eye, stick-on wound moulage 35

49 Chest wound, stick-on wound moulage 35

50 Jaw wound, stick-on wound moulage 35

51 Bladder wound, stick-on wound moulage 35

52 A casualty 36

Ul

NAVEXOS P-2709

Figure 1. Casualty in properly staged situation

IV

NAVEXOS P-2709

CHAPTER I
CASUALTY SIMULATION IN DISASTER DEMONSTRATION

Many individuals of the civilian and military
population have been made increasingly more
aware of the need for teaching in self-aid or
buddy care.

The Louisiana hurricane produced many
casualties who needed immediate medical as-
sistance. More recently the Alaskan earth-
quake and tidal wave and the midwest tornado,
which had the potential for producing large
numbers of casualties, has reinforced the
awareness and desire of individuals for train-
ing in basic emergency medical care.

Major portions of the population will survive
man-made or natural disaster only if they
have been properly trained to care for them-
selves, their families, friends, or co-workers.

Realism in teaching individuals the funda-
mentals of self-aid is essential. Only through

such planned realistic experiences can the
individual be conditioned to function in a
disaster. The use of make-up is one means
of obtaining this realism. The techniques of
creating casualties are comparatively simple,
requiring only a limited background or ex-
perience in the application of make-up and a
basic knowledge of the types of wounds in-
curred in a disaster.

Three factors are important in casualty
simulation :

1. Staging — The surroundings within which
the casualty may be found.

2. Acting — The ability of individuals to
portray the symptoms of such a patient.

3. Make-up — The creation of simple or com-
plex wounds which add realism to the
situation.

NAVEXOS P-2709

gs^^.--^-

^

W: ■■ '%.^^.

Figure 2. Casualty Simulation Kit, Device IIEIO, showing a number of components

NAVEXOS P-2709

CHAPTER II

MATERIAL REQUIRED FOR CASUALTY SIMULATION

Item

Quantity Item

Quantity

Tissue, facial, cellulose, white

(FSN 8540-793-5425) 1

3M Minnesota Mining Transparent No-
Ouch Surgical Tape (1'' wide, 5 yards
per roll, 12 rolls per rack) 12 rolls

Gamophen^ — Liquid surgical soap

(plastic bottle) 1

Hand cream (Hydrophilic Ointment) —
1 lb. jar cold cream (FSN 6505-153-
8703) ^ 2

Applicators, cotton tipped (100 in

package) (FSN 6515-303-8250) 1 pkg

Depressors, tongue, wood (100 in box)

(FSN 6515-324-5500)
Foaming Capsules (bottle of 20

capsules)
Glycerine — (bottle, one-half filled)
Plastalene — two, 1 lb. white bars;

one, 1 lb. dark bar
Cotton balls (1 paper bag full,

approximately 150)

1 box

1
1

Duco Cement — (Tube)

Lubricant, surgical — 4 oz. tube
(FSN 6505-153-8809)

Petrolatum, white — 1 lb. can
(FSN 6505-133-8025)

Petrolatum, liquid, heavy — 1 pt. can
(FSN 6505-133-5980)

Charcoal, Powdered (I/2 lb)

Max Factor's Theatrical Liquid Make-
up—White, 8 fl. oz. (bottle)

Max Factor's Theatrical Tube Make-
up #4A, Spec. Cream

Max Factor's Theatrical Tube Make-
up #41/2, Cream

Max Factor's Theatrical Tube Make-
up #6, Sallow

Max Factor's Theatrical Tube Make-
up #7, Spanish

Max Factor's Theatrical Tube Make-
up #8A, East Indian

Max Factor's Theatrical Tube Make-

NAVEXOS P-2709

Item

Quantity

up #15, White 1

Max Factor's Theatrical Tube Make-
up #17, Dark Negro 1
Max Factor's Theatrical Make-up,

#2231B, Gray (Compact) 1

Max Factor's Theatrical Make-up,

Moist Rouge #1 (Small tin) 2

Stein's Theatrical Make-up, #16,

Yellow (Tin) 1

Max Factor's Theatrical Make-up,

#17, Special Blue (Tin) 1

Stein's Theatrical Make-up, #19,

Green (Tin) 1

Simulated Blood (Plastic vial) (normal) 3

Formula :

FD & C Red #1 Certified Food

Color 10 grams
FD & C Red #2 Certified Food

Color 10 grams

Powdered Caramel Coloring 1 gram

Methyl Cellulose 12 grams

Sodium Benzoate 4 grams
Dissolve in 1/2 gallon hot water. When com-

pletely dissolved add sufficient cold water
to make one gallon.

Fragments:

Plaster of Paris, glass, chicken bones, and
sticks for insertion into the wound.
Clothing which can be torn or soiled.

Additional Materials:

Such as sausage casings, theatrical hair,
dirt, and other materials as desired.

WOUND MOULAGES

Small Flesh Stick-On Wound Moulage 30

Perforated Stick-On Wound Moulage 15

Small Fracture Stick-On Wound Moulage 10
Large Fracture Stick-On Wound Moulage 15
First, Second, and Third Degree Burns,

Stick-On Wound Moulage 15

Open Wound of Head, Stick-On Wound

Moulage S

Enucleated Eye, Stick-On Wound Moulage 3
Chest Wound, Stick-On Wound Moulage 3
Jaw Wound, Stick-On Wound Moulage 3

Bladder Wound, Stick-On Wound Moulage 3

NAVEXOS P-2709

CHAPTER III
GENERAL INSTRUCTIONS

SELECTION OF CASUALTIES

Individuals selected as casualties should be
of different age, varied body build, coloring,
and other physical characteristics to increase
the realism of the situation. They should have
the ability to act out the signs and symptoms
associated with their injuries. Usually, this v^^ill
take some coaching on the part of the in-
structor. Individuals allergic to cosmetics and
those with skin eruptions or abrasions should
be omitted in casualty simulation.

SELECTION OF THE WOUND SITE

The selection of the wound site is considered
to be of the utmost importance. The instructor
must know the anatomical and physiological
aspects of the body in order to portray dif-
ferent types of wounds and injuries accurately
and realistically.

Selection of the wound site will usually in-
dicate the severity of the injury. A wound of
the head, chest, or abdomen is of greater

significance than a wound of similar size in
the hand or foot.

Excellent results can be obtained if fiat
smooth surfaces of the body are used. Some
difficulty may be encountered if the wound
site selected is on an extremely hairy area of
the body or one that is being consciously or
unconsciously moved by the casualty.

Extreme care must be exercised to insure
the comfort and safety of the patient and to
prevent any injury from embedded foreign
bodies in the simulated wound.

BASIC FEATURES OF ALL CASUALTIES

Casualties will have the basic characteristics
of disheveled hair, rumpled or dirty clothing,
loosened collars, belts, and possibly torn and
missing pieces of clothing. Nearly all individu-
als in accidents are usually in some state of
shock, and simulated casualties should be made
up accordingly.

Facial expressions should portray pain,

NAVEXOS P-2709

anxiety, fear, etc., in relation to the degree
and type of injury.

One of the features of casualty simulation
in structured make-up is to portray irregu-
larity of bone and jagged tissue molded into
the desired effect.

A comparatively clean skin area is funda-
mental to the creation of wounds. A very small
amount of grease paint of the desired shade

should be applied to the skin and blended into
the surrounding areas. The use of excessive
make-up should be avoided as this destroys
the illusion being presented.

The palm of the hand may be used for
mixing two colors to obtain the desired shade
of grease paint. For multiple casualties a small
square of solid plastic with a spatula may be
used as a palette, thus allowing many in-
dividuals to work from a single kit.

NAVEXOS P-2709

CHAPTER IV

PREPARATION OF SPECIAL EFFECTS

BLOOD Formula Type (as contained in Kit):

In the make up of wounds it is necessary to FD & C Red #1 Certified food

simulate blood to give a realistic effect. Dif- color ^ :« ' ,' . \q ^^^^^

ferent types of blood are used depending on FD & C Red #2 Certified food

the type and severity of the wound. Coagulated color 10 grams

blood is used within a wound to give depth. Powdered caramel colormg 1 gram

Normal blood is made for insertion into wounds Methyl cellulose 12 grams

for oozing and frank bleeding. Thin blood may Sodium benzoate 4 grams

be used on clothing to indicate extensive Dissolve above contents in one-half gallon of

hemorrhage. hot water. When material is completely dis-

PREPARATION solved, add sufficient cold water to make one

n 1 ♦ J. gallon.

Loaguiated. , ^ ^ . . Thin: Dilute the above formula with water.

Blend together equal parts of petroleum amuATmivi

jelly with red food coloring; add a drop or PERSPIRATION

two of light blue and brown food coloring. Individuals who have been subjected to

Normal: trauma are usually in some degree of shock.

Blend together liquid starch, 1 pint; red food Those casualties who are in shock break out

coloring concentrate, 10 cc's; yellow food in a sweat which is usually most predommant

coloring, 3 cc's ; blue food coloring concentrate, on the forehead, upper lip, chin, and neck.

1 drop. This condition can be simulated by using a

The "amount of coloring is approximate. It glycerine and water preparation applied to the

will depend upon the variety and concentration face and neck with an atomizer or dabs of

of the prepared food coloring used. cotton.

7

NAVEXOS P-2709

PREPARATION

Mix three parts of glycerine and one part
of water.

FROTHING

Some injuries or trauma to the body cause
an increased secretion of saliva. When tissue
is damaged around the nasopharynx the sahva
may be bloody or blood tinged, giving the
casualty the appearance of "frothing" at the
mouth. Capsules for this simulation may be
prepared in advance.

Formula :

Gelatin capsules, size 00

Tartaric acid powder or cream of tartar, 1 oz.

Bicarbonate of soda, 1 oz.

Granulated sugar, ly^ oz.

The victim holds the capsule in his or her
mouth and at the proper moment chews it,
mixing the dry powder preparation with saliva.
The saliva will then have a white, bubbly,
frothy appearance. If a blood-stained effect is
desired, add a small amount of red liquid food
coloring to another capsule, and allow the
casualty to chew the two capsules together
at the proper time.

VOMITUS

The casualty in a real disaster may lose his

stomach contents as a result of severe physical
or psychological trauma.

One must be realistic and attempt to create
the actual situation, although some potential
patients may find repulsive the vomitus simu-
lated for another casualty.

To simulate vomitus, a tablespoon of cooked
oatmeal and water can be held in the mouth
by the individual until the proper moment for
vomiting. Crumbled graham crackers in a
watery state may be utilized in the same
manner. If desired, a small amount of yellow
food coloring may be added to the mixture
to represent bile.

ODOR

In many instances it is desirable to have a
pungent odor near the patient. Some of the
materials that can be used to give these odors
and to make a more effective presentation are :

Scraps of burned material
Deteriorating pieces of bone
Soured milk
Partially burned charcoal briquets

Compounds of this nature may also be
purchased, as for example smoke powder or
liquid.

NAVEXOS P-2709

CHAPTER V
TECHNIQUES OF MAKE-UP

SHOCK

Shock is a condition resulting from inter-
ference with the circulation of blood in the
body. This condition may be due to psycho-
logical or physiological reasons. In early shock
the casualty is listless, and the skin is pale;
but as the condition becomes more serious,
severe shock will be accompanied by grayish
skin color, sighing respirations, and uncon-
sciousness. Perspiration increases until there
is a marked reduction in body fluid. Casualty
simulators must insure that the degree of
shock parallels the extent of the injury.

PREPARATION:

1. To prepare the casualty a very thin
layer of cold cream should be applied to the
face, neck, ears, and other exposed parts.

2. A thin layer of liquid or grease paint
slightly whiter than the normal skin of the
individual is applied. The white grease paint
must be blended into the entire area so that

Figure 3. Application of cold cream to face, neck,
and ears

there are no lines of demarcation. Great care
must be exercised to prevent presenting a

9

NAVEXOS P-2709

"clown" effect by a heavy, thick white layer
of grease paint.

3. A very slight amount of blue grease
paint should be applied to the areas beneath
the eyes, on the eyelids, lips, and lobes of
the ears.

4. Depending on the degree of shock, the
fingernails are given a bluish color with a
blue grease paint.

Figure 4. White grease paint or liquid blended into
entire area

Figure 5. Special blue make-up applied lightly beneath
the eyes, to lips, and lobes of ears

5. Cover the exposed area of the body
with a light layer of gray pancake powder.

6. To simulate perspiration spray on or
apply with cotton the glycerine preparation
to the forehead and upper lip.

BURNS

Bums are caused by several agents and
result in the destruction of tissue.

The degree or depth of the burn determines
the coloring one must apply to the selected
area.

10

NAVEXOS P-2709

Material Required

Cold cream
Moist Rouge #1
Cleansing tissue
Lubricating jelly
Smokeless candle
Charcoal

Figure 6. Appearance of a patient in shock; note
drops of "perspiration"

FIRST DEGREE BURNS

1. Apply cold cream to the simulated burn
area.

2. Using red grease paint or lipstick, shade
to appear like sunburn (a very light red).

SECOND DEGREE BURNS

1. Apply cold cream to the area followed
by red grease paint or lipstick.

2. Over the selected burn area place a
single thickness of cleansing tissue.

Figure 7. A first degree burn can be indicated by
using cold cream and red grease paint or lipstick

NAVEXOS P-2709

3. Place small dabs of household cement or
lubricating jelly on the cleansing tissue, which
covers the area of the body, to create blisters.
When dry, the cement may be raised using an
applicator to give the effect of blisters.

4. The tissue, with the exception of the
area over the blisters, should be slightly
wrinkled or have rough edges.

5. Further blisters may be added by drip-

Figure 8. A second degree burn showing blisters
12

Figure 9. Blast injury with second degree bum to
the face showing characteristic blisters

ping a smokeless candle over the area covered
by the cleansing tissue.

THIRD DEGREE BURNS

A third degree burn has the basic appear-
ance of a second degree burn, but the ex-
tensive destruction of tissue has given the

NAVEXOS P-2709

area a charred appearance. The addition of
charcoal powder to skin edges or in the center
of the wound will give this charred appearance.
Consideration should be given to casualties
with large and/or circumferential burns, to
insure that the teaching is not limited to
minor burns.

Figure 10. Third degree burns showing charred ap-
pearance and tissue destruction

WOUNDS

A wound is any disruption by injury of the
normal structure in a specific anatomical site.
Injury to tissue may cause mild to severe
bleeding into the surrounding tissue. This is
called a bruise or contused wound. If the tissue
had been injured to the extent that a small
or large amount of bleeding is evident, the
wound may be an abrasion, lacerated, incised,
or punctured wound. The amount of hemor-
rhage is dependent upon the location and
nature of the wound associated with internal
involvement.

Material Required

Plastalene

Cold cream

Cream-base flesh-tone make-up

Moist Rouge #1 make-up

Yellow #16 make-up

Special blue #17 make-up

Wooden applicator

Blood (3 types)

Charcoal powder or cigarette ashes

ABRASION

An abrasion is a wound in which the outer
layers of skin have been scraped off or
scratched. An abrasion results when a rough
object is rubbed forcibly along the skin.

13

NAVEXOS P-2709

Material Required

Plastalene

Cream-base flesh-tone make-up

Moist Rouge #1

Charcoal

Toothbrush

Procedure

1. Mix a small amount of plastalene and
flesh-tone cream-base make-up and apply to
the selected wound site.

2. Draw applicator stick or toothbrush
across the plastalene to show scratches or
roughened area.

3. To the base make-up add a very light
shade of red make-up.

4. A light coating of charcoal may be used
around the wound edges to show contact with
dirt.

BRUISE OR CONTUSED WOUND

A bruise or contused wound is caused by the
impact from a blunt object, resulting in severe
injury to tissue and smaller blood vessels. The
skin is unbroken. The area is first red and
swollen, then later has a dark blue-green or
black discoloration.

Procedure

1. Apply a thin coat of cold cream to the
bruised area.

2. Using the red and blue make-up and
charcoal, dot lightly over the area.

3. With the tips of the fingers, blend these

'%^*

Figure 11. A contusion results when an area is

struck with a blunt object, causing severe injury to

tissue and small blood vessels

14

NAVEXOS P-2709

colors together until the area has an appear-
ance of an early bruise. Add a Tery small
amount of green make-up around the edges
of the bruise.

4. To give the appearance of age to the
bruise, use touches of yellow make-up.

To produce a satisfactory bruise and to
achieve the desired effect, considerable practice
is necessary.

Figure 12. A lacerated wound is characterized by
torn or jagged edges

LACERATED AND INCISED WOUNDS

A lacerated wound is a wound that is ir-
regular or torn with jagged edges. An incised
wound is a cut with smooth edges made by a
sharp object such as a knife, broken glass,
or bayonet. The placement of these wounds
will determine the amount and kind of hemor-
rhage. The amount of shock will depend upon
the site and position of the wound as well as
the amount of blood lost.

Procedure

1. Blend a shade of flesh-colored make-up
with a small amount of plastalene.

2. Apply the plastalene to the selected site.
This should be thicker in the center where the
incision or cut is to be made, and thinner
near the edges.

3. Blend the edges well with the skin.

4. For an incised wound, make an incision
into the thicker portion of the plastalene. The
incision should extend down to but not into
the skin surface. A lacerated wound can be
made by carefully distorting the edges of the
incised wound to make them as jagged as
those found in torn flesh.

5. Into the base of the incision apply co-
agulated blood.

15

NAVEXOS P-2709

Figure 13. Incised woiinds have smcmth edges made

by a sharp object such as a knife, broken glass, on

a bayonet

Figure 14. A ^fl^.in^twre wound

Figure 15. Simple wound of leg

6. Around the edges of the wound, mix
with the blood a minute amount of charcoal
powder to present a dirty appearance to the
wound. Cigarette ashes may be used in lieu
of charcoal.

7. Depending on the severity of the wound,
apply some thin blood to the surrounding skin
area and clothing,

PUNCTURE WOUND

A puncture wpund is one made by a sharp
or pointed object such as a nail. Even though
the wounding object is removed the possibility
of infection is great. As in all wounds, the

NAVEXOS P-2709

Figure 16, Simple wound of foot

Figure 17. A fracture* of the leg

site and depth determines the seriousness of
the puncture wound. The diameter of the
wound is small but swelling or edema indicates
possible serious internal damage.

The puncture wound is made using the same
procedure as for an incised wound but keeping
the opening very small.

FRACTURES OR FOREIGN BODIES

A fracture is a break in the skin usually
causing a distortion of the normal bone align-

ment. The ends of the broken bone and the
force causing the fracture frequently produce
considerable bruising and damage to the sur-
rounding tissue. External wounds resulting in
a break in the skin with protruding bones are
known as compound fractures. Pain, swelling,
loss of function are associated with simple
and compound fractures. Mild shock is present
except in instances where the fracture is com-
pound or considerable tissue damage is present,
then the shock is severe.

17

NAVEXOS P-2709

Figure 18. A fracture of the hand

Material Required

Plastalene

Cream-base skin-color make-up

Pieces of bone or plaster of Paris

Animal or chicken bones

Blood

Foreign bodies — glass, sticks, dirt, etc.

Figure 19. A foreign body thrust through the face

Procedure

1. Select the site for the fracture.

2. Mold a piece of plastalene and place on
the selected site. The plastalene should be
thicker toward the center than the sides.

3. Blend and smooth out the edges.

4. Make a regular incision into the plasta-
lene.

18

NAVEXOS P-2709

5. Insert bone or foreign bodies into the
incision.

6. The area around the fracture should
show some bruising and swelling. This is done
by applying red and blue make-up to the
plastalene. Blend the red and blue make-up
and use small amounts of charcoal around the
edges to show dirt, etc.

Figure 20. A wound of the chest

7. Around the bone or foreign body, add
coagulated blood.

8. Dirt should be applied to the skin and
clothing surrounding the injury.

CHEST WOUND

A chest wound is an opening from the out-
side through the chest wall into the chest
cavity. Many times the object will have
penetrated the lung and chest cavity and left
an exit wound. From the chest wound and
nasopharynx, the casualty may have a bright
red, frothy, sputtering-type hemorrhage. The
patient usually experiences great distress in
breathing and will move quite restlessly in
his hunger for air. Casualties with chest in-
juries may be in mild to severe shock.

Materia! Required

Plastalene

Moist Rouge #1 make-up
Special blue #17 make-up
Blood — coagulated and normal
Liquid white make-up
Wooden applicator

Procedure

1. Use a piece of plastalene to cover the
selected site and blend the edges onto the skin.

19

Figure 21. An intestinal evisceration or protruding
bowel

m

2. Make a hole in the plastalene with a
small round instrument and open out the edges
of the wound with an applicator.

3. Apply a small amount of coagulated
blood to the base of the wound to give the
appearance of depth.

4. Inject thick liquid blood into the wound.
Allow a small amount to run over the sides
of the wound. Remember, usually only a small
amount of bleeding is associated with wounds
of the chest unless there is a massive destruc-
tion of tissue,

5. To give the appearance of splattering
found in a ''sucking wound," dip the fingers
into blood and fleck the blood over the im-
mediate area of the wound.

6. The casualty may have brought his
hands involuntarily to the chest at the time
of the injury. This will call for some traces
of blood on the hands and chest.

7. Face, neck, ears, and fingernails should
be given a light bluish color of make-up for
severe shock.

INTESTINAL EVISCERATION
OR PROTRUDING BOWEL

This intestine is a membranous tube that
extends from the stomach to the anus. The

NAVEXOS F-2709

first 20 feet of the intestine is small in caliber
but becomes larger in size the last five feet.
When a wound has been made into the ab-
dominal cavity, a portion of the bowel may
protrude. The amount protruding will depend
upon the size and depth of the wound.

Material Required

Those Hsted under wounds plus:

Sausage casing (4 to 6 inches)

String

Syringe (30 cc)

Petrolatum jelly

Procedure

1. Decide the nature of the wound and
how it was acquired.

2. Select a person whose skin is fairly
hairless and very firm.

3. Select a flat area in mid-abdomen if
possible.

4. Select the proper basic make-up color
for skin of the casualty and mix with plasta-
lene.

5. Apply plastalene to the selected area and
blend the edges with the skin. Difficulties
may be encountered due to the continuous
movement of the muscles in the area.

6. The plastalene should be thick enough
in the center to make the incision and also
thick enough to retain the strings of the
sausage casing.

7. With the applicator make an irregular
incision into the thicker portion of the plasta-
lene.

8. Carefully distort the edges of the wound
with the applicator.

Figure 22. Evisceration

NAVEXOS P-2709

9. Blend the skin-colored plastalene edges
with the skin.

10. Apply coagulated blood to the floor and
sides of the incision.

11. Cut a piece of sausage casing four to
six inches in length. The length of each string
should be about six inches. Tie off one end of
the sausage casing. Loop the string, ready for
tying, around the other end of the sausage
casing. Using a 30 cc syringe, fill the casing
with bloody liquid and air. The sausage casing
should not be blown up too full as simulated
intestines should look gelatinous and pliable.
Close the free end of the sausage casing. The
strings, after tying, should be three inches
or more in length.

12. Secure the strings from the sausage
casing beneath the basic plastalene, allowing
the intestines to fall into place.

13. Place a small amount of petrolatum jelly
on top of the casings to present the shiny
glossy appearance of bowel.

14. Inject thin liquid blood beneath the
intestines and allow it to overflow onto the
abdomen,

15. The hands and clothing are likely to be
bloody and dirty.

16. The casualty will be in severe shock.

22

Figure 23. A wound of the head

HEAD WOUNDS

Head wounds can be from a simple scalp
wound to one which includes injury to the
scalp, skull, brain, and sometimes exposure
of the brain. Since the brain is adjacent to the
eyes, ears, and nose, these organs may also be
involved. Depending upon the area and the
extent of the injury to the skull and brain,
the area around the eye may be black and blue
and swollen and there may be a bloody drain-
age from the ears and nose. Scalp wounds will
bleed much more profusely than other wounds
of similar size and depth.

In selecting individuals for this type of

Figure 24. A wound of the head

wound, consideration should be given to those
who have an area on the head which is free
of hair.

NAVEXOS P-2709

Material Required

Plastalene

Theatrical tube make-up #15, white

Dental adherent

Theatrical hair

Blood — coagulated and normal

Procedure

1. Mix a small amount of white grease
paint with a quantity of dental adherent.

2. Add a slight amount of water until
mixture becomes rubbery.

3. Apply a rather large piece of plastalene
to the designated area of the head.

4. Make a wide incision into the basic
plastalene wound area of the skull.

5. Insert the rubbery mixture of grease
paint and dental adherent into the incision
of the plastalene. Small pieces of white bone
or chalk may also be inserted into the incision.
(This gives the appearance of a compound
comminuted fracture, exposing the brain
tissue.)

6. The rubbery mixture should show
through as gray matter but the surrounding
area should have an application of coagulated
blood. Then allow normal blood to run down

23

NAVEXOS P-2709

the face and side of the head. Scalp wounds
usually bleed quite profusely.

7. Make up the casualty for shock.

EYE ENUCLEATION

In an enucleation, the eye as a whole is re-
moved partially or fully from the socket.

It may be caused by a severe blow to the
head or trauma to the eye. The casualty will
be in severe shock.

Material Required

Sheep's, pig's, or artificial eye

Eye pads

Surgical tape

Plastalene

Blood — coagulated and normal

Cream-base skin-color make-up

Special blue #17 make-up

Procedure

1. Apply a thin coat of cold cream to the
casualty's face, ear, and neck. Remove cold
cream from area about the eye.

2. Place the eye pad over the closed eye
and seal the eye pad with tape. (Care must be
taken that the eye is not traumatized by any
of the materials used.)

Figure 25. Enucleated eye

3. Using plastalene, cover the eye pad and
surrounding area.

4. Place the artificial eye in the plastalene
so that the eye hangs below the normal posi-
tion or is embedded in the plastalene to indicate
edema of adjacent tissue.

5. The face and brow will have the ap-
pearance of swelling from the application of
plastalene. Apply make-up to the plastalene to
resemble inflammation and bruising.

6. Make-up for shock should be applied to
the chin, lips, ear lobes.

m

Figure 27. An eye pad in position over normal eye,
showing surgical tape to hold the eye patch in place

Figure 26. Wound of the face with enucleated eye

7, Add coagulated blood around the eye and
on the plastalene.

8, Some charcoal added to the area will
give the appearance of dirt and soot.

9, There should be some thin blood stream-
ing down the face.

10. The casualty should have blood on his
hands as if he had tried to locate the wound.

Figure 28. A stick-on wound moulage or make-up is

applied over an eye protected by a sealed eye patch

covered with plastalene

Figure 29. Several layers of elastic bandage are „. „^ _, j ^i. ^-c • i > ^ -i*

wrapped around the head at the hairline to keep F>g"e 30. The area around the artificial eye is bmlt

plastalene and blood from getting in the hair

up with plastalene

Figure 31. A foreign body should be inserted in the
plastalene near the eye

ENUCLEATION WITH HEAD INJURY

Material Required

Sheep's, pig's, or artificial eye

Eye pad

Surgical tape

Plastalene

Blood — coagulated and normal

Cream-base skin-color make-up

Special blue #17 make-up

Gauze

Elastic bandage

26

NAVEXOS P-2709

Procedure

1. Apply a thin coat of cold cream to the
casualty's face, ear lobes, and neck. Remove
from the area of the eye.

2. Place the eye pad over the closed eye
and seal with tape to prevent any foreign
objects from penetrating the eye.

3. Build up the socket of the eye with
plastalene over the eye patch.

4. Place and secure the artificial eye over
the plastalene.

5. Using elastic bandage, wrap several lay-

ers around and across the head to prevent the
plastalene and blood from getting into the hair.
Make sure the hair is adequately covered by
the bandage.

6. Build up the area around the artificial
eye with plastalene.

7. Unfold a square of gauze over the elas-
tic bandage covering the head.

8. Above or to the left of the injured eye,
attach a foreign object with plastalene.

9. Over the entire area (injured part of
face and head) put coagulated blood.

Figure 32. Coagulated blood

is applied over the gauze and

plastalene

Figure 33. Charcoal or dirt is used to
indicate dirt and debris in certain areas

Figure 34. Because eye and

head wounds always cause

severe shock, make-up for shock

is added

Figure 35. The type and location of multiple wounds
of the leg and buttock must be considered carefully

Figure 36. Emphysema, or swelling, should be shown
in multiple wounds of the face, neck, and chest

10. Add charcoal to certain areas to indicate
dirt or debris.

11. Casualties with eye and head wounds
will be in severe shock.

MULTIPLE WOUNDS

In disaster situations, casualties usually have
more than one type of wound. Every oppor-
tunity should be given to the learner to use
judgment as to what, how, and in what order
the injuries and injured should be treated.

Patients with multiple wounds are the most

difficult to care for, and one must consider the
total patient under such circumstances. It is
a coordination of all previous learning ex-
periences brought together in a single care
plan.

It is the responsibility ox the instructor to
consider carefully the types and location of
wounds so that the learner will gain con-
fidence and experience, and will learn to prac-
tice with safety the principles of emergency
medical care, which may be used in a real
disaster.

28

^»*^'j^"^5L«Sf. •;■ ^■m^Kl"ll'<ms «¥»aaiS'.^-5'^

Figure 37. Multiple wounds

AMPUTATIONS

An amputation is the loss of an appendage
or extremity of the body. In disaster situa-
tions, appendages or extremities are amputated
by missiles or other objects. Consequently,
the tissue is traumatized and the stumps may
have exposed nerves, bones, and blood vessels.
The casualty may have considerable loss of
blood and be in varying degrees of shock.

Material Required

Gauze of desired width
Tape

NAVEXOS P-2709

Plastalene

Cream-base flesh-tone make-up

Moist Rouge #1 make-up

Blood — coagulated, normal, and thin

Charcoal powder

Bones

FINGER

Procedure

1. Select the finger or part of the finger
to be amputated.

Figure 38, Amputation of the fingers can be shown

by taping the fingers in a folded position and forming

the stumps with plastalene and other materials

NAVEXOS P-2709

2. Bind the finger to the palm with gauze
and tape to prevent motion. Check to make
sure there is adequate circulation in the fin-
gers. If desired, all fingers may be taped.

3. Mold the plastalene to cover the hand
and fingers.

4. Chicken bones may be embedded in the
plastalene to simulate protrusion of the ends
of bone.

5. Apply skin- and red-colored make-up to
the areas of the hand, blending carefully,

6. Using the applicator stick, carefully
distort the plastalene to convey the appearance
of jagged tissue.

7. Coagulated blood should be added to the
stump. Generally amputations bleed freely. To
the hand, add normal blood and allow it to run
down the wrist and arm onto the clothing.

8. The degree of shock shown by the casu-
alty will depend on the extremity amputated
and the amount of blood lost.

Fingers can be simulated as amputated by
wrapping the bent fingers in gauze and secur-
ing the gauze with tape. In wrapping, allow
the gauze to extend beyond the bent fingers
a few inches. The gauze is then clipped at
right angles to the stump. Then steps 3, and

30

Figure 39. Amputation of the arm at the shoulder

can be shown by taping the arm to the body and

building up the shoulder with plastalene and other

substances

5 through 8 of the previous procedure should
be followed.

ARM

An amputation of the arm at the shoulder
can be demonstrated by:

NAVEXOS P-2709

Procedure

1. Bend the arm at the elbow and bind the
upper and lower arnci to the body with ace
bandages. Check to make sure the casualty is
in a comfortable position and there is adequate
circulation in the arm.

2. Mold the plastalene to cover the shoulder.

3. Steps 4 through 6 of the finger amputa-
tion procedure should be followed.

4. Allow torn jacket sleeve to hang loose.

5. Then add coagulated blood to the stump
and clothing around the stump, and normal
blood to the sleeve.

ELBOW

Procedure

1. Bend the arm at the elbow and bind it
to the upper arm.

2. Mold the plastalene to the elbow.

Figure ^u. Beiore punraying amputation of a leg

at the knee, the lower leg must be folded beneath

the upper leg, and the ankle secured to the waist

with bandage

Figure 41. After securing the lower leg as shown

in figure 40, the stump is molded on the knee with

plastalene and other materials

31

NAVEXOS P.2709

3. Follow steps 3 through 5, listed under
shoulder amputation.

LEG

Procedure

Disarticulation of the leg at the hip cannot
be demonstrated, but amputations of the leg
at the knee can easily be simulated as follows:

1. Bend the lower leg beneath the upper
leg or secure it by a bandage around the ankle
to the waist. The leg can also be concealed by
placing the lower portion of the leg in a pre-
dug hole or through a slit in the stretcher.

2. Mold the plastalene to the knee.

3. Follow steps 3 and 5, listed under shoul-
der amputations.

32

NAVEXOS P-2709

CHAPTER VI
MOULAGES

Several wound moulages are contained in
the casualty simulation kit. Use as follows:

1. Attach to the skin with tape extending
over the edge of the moulage.

2. Build up the area around the moulage
with plastalene. Smooth and blend until the
moulage appears to be part of the skin.

3. Apply skin-colored grease make-up to
the plastalene.

4. Area around the moulage should be

given a reddened appearance by adding red
make-up.

5. Depending on the severity of the wound,
add coagulated, normal, or thin blood to the
moulage, skin area, and clothing.

6. To give a touch of realism add charcoal
and dirt to the surrounding areas and clothing.
The addition of a small amount of lubricating
jelly on the moulage gives the appearance of
a fresh wound.

Figure 42. Small stick-on wound moulage

Figure 43. Perforated stick-on wound moulage

NAVEXOS P-2709

■"^m

Figure 44. Small fracture stick-on wound moulage Figure 45. Large fracture stick-on wound moulage

Figure 46. First, second, and third degree burns. Figure 47. Open wound of head, stick-on wound
stick-on wound moulage moulage

I
I

Figure 48. Enucleated eye, stick-an wound moulage Figure 49, Chest wound, stick-on wound moulage

Figure 50. Jaw wound, stick-on wound moulage

Figure 51. Bladder wound, stieli-oia \v®i;iikdi /tt^GEisge

35

NAVEXOS P-2709

CHAPTER VII
SUMMARY

Realistic casualty simulation requires a
knowledge of basic anatomy and physiology.
However, no specific rules apply to the tech-
niques of make-up in simulating casualties. In-
dividuals practicing these techniques should be
allowed to demonstrate their ingenuity in the
creation of specific effects. In addition to the
make-up, the instructor must be certain to
teach the casualty the type of symptoms he or
she is to demonstrate, and the appropriate time
the symptoms should be demonstrated.

Although a combination of psychological and
physiological casualties may be present within
a demonstration, a limited number of psycho-
logical casualties should be included to aid the
trainee in the care of these patients.

As has been stated, application of make-up
is only a portion of the total picture in simu-
lating a disaster situation. The most difficult
portion of the entire program may be the co-
ordination of the make-up, staging effects, and
acting, to portray the proper type "patients" at

36

the appropriate time and to provide an effective
practice in emergency medical care.

Casualty simulation is limited only by the
lack of ingenuity and experience of the in-
structors and other individuals participating
in the exercise.

Figure 52. A casualty

n. ^ ^

.^