When Bobbie Merica worked in nursing schools setting up medical simulators—sophisticated computerized mannequins that can bleed, vomit and even talk back when asked questions—the students complained to Merica that something was missing. “They were dissuaded by the technology,” she says. “They said it didn’t feel real.”

Merica began studying wounds, burns and other physical signs of trauma and disease in medical texts and figuring out how to re-create them using theatrical makeup and other materials. Today, Merica is an expert in moulage; French for impression or cast, the term originally referred to wax models of the human body used by medical students to learn anatomy, and is now enjoying a renaissance in the form of makeup and prosthetics applied to mannequins and humans as teaching aids.

With her Moulage Concepts business in Paradise, Calif., Merica teaches educators how to make their simulators look more realistically injured or sick. She also teaches emergency-preparedness coordinators how to apply moulage and is frequently hired to make up volunteer victims at mock disasters.

Demand for moulage artistry is often influenced by current events. “Whenever a tragedy happens in our culture, I get a lot of calls,” says Merica. “People want to re-create that type of scene so they can be prepared for it.” She has been hired, for instance, by communities to help train emergency responders for mass shootings in schools or other public places.

Like Merica, Marilyn Smith-Stoner—a professor of nursing at California State University in San Bernardino, Calif., who uses a simulator to train doctors and nurses—is a stickler for detail. “You want to match the moulage to the patient profile,” she says. When she creates a bruise, for example, she thinks not only about how large and severe it should be, but how long ago it might have formed. Her boss once took a terrible fall and ended up with several nasty contusions. Smith-Stoner politely asked whether she might photograph the bruises and proceeded to snap new shots every three days to capture how the colors changed over time. She uses these and other photos as a reference guide.

Why go to these lengths? Why not just tell doctors, nurses or EMTs in training that a patient has a gunshot wound in the upper chest and evaluate how they treat the pretend patient? “Simulation training is all about getting as close to reality as possible,” says Smith-Stoner. “If you just have a three-by-five card on the simulator that says bleeding or bruise, you can’t hold the student to the higher standard of clinical decision-making.” Smith-Stoner often has trainees practice moulage on one another. “That forces them to think about which color matches which physiological process, for example,” she says. “If an arterial blood vessel breaks, what does that look like? If it’s a venous vessel, what does that look like? It’s an awesome critical thinking activity.”

As Merica puts it: “Every wound tells a story.” Here are a few tools of her trade—and the lifelike results.


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