So Much Moulage, So Little Time: A Guide to Performing Moulage for Mass Casualty Scenarios.

Simulation has become a central component of healthcare education. Allowing learners to experience low-frequency high-risk situations, such as a mass casualty event, in a safe learning environment is a basic tenet of simulation-based education in healthcare. Creating realistic simulations often involves advanced moulage to accurately represent illness and injury. However, providing advanced moulage for mass casualty exercises can be time-consuming, resource-intensive, and costly. Here we discuss a novel means to execute moulage for multiple victims while maintaining a high level of realism. We executed two simultaneous mass casualty exercises as part of medical student education and employed our novel 3-step moulage process. Step 1-Preparation included case development, generation of a victim list, and victim designation into "zones" within the simulation. Step 2-Creation entailed making wounds, in-house 3D printing materials, and assembling each victim's moulage bag. Step 3-Application was an assembly line method of executing all victims' moulage on the day of the simulation. This method of moulage supported the highly realistic simulation activity that learners have come to expect while decreasing time, resources, and cost.