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Full text of "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. ^ ^ 



.^