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Moulage of a gumma in syphilis for training students, University of Tübingen
Picture showing a 'dead' OPFOR soldier with moulage

Moulage (French for 'casting' / 'moulding') is the art of applying mock injuries for the purpose of training emergency response teams and other medical and military personnel. Moulage may be as simple as applying pre-made rubber or latex "wounds" to a healthy "patient's" limbs, chest, head, etc., or as complex as using makeup and theatre techniques to provide elements of realism (such as blood, vomitus, open fractures, etc.[1]) to the training simulation. The practice dates to at least the Renaissance, when wax figures were used for this purpose.[2]

In Germany some universities and hospitals use their historical moulage collections for the training of students. The often very lifelike models are especially useful to show the students today the characteristics of rare diseases, such as skin tuberculosis or leprosy.[3]

Picture showing medical soldiers working on a training aid (dummy) with moulage

History

[edit]

Up until the 16th century, European scientists had little knowledge about human anatomy and anatomy of animals. Medical students of Bologna and Paris studied the books of Aristotle, Galen, and other Greek scholars. Four centuries after the invasion by the Arabs and the fall of Rome and Persia, many Greek books were translated into the Arabic language. European scientists then translated these Arabic books into the Latin and Greek languages. In the medical field, this led to a reliance on Galen as a medical authority in European countries. In European medical schools the professors of anatomy merely lectured from Galen, without any dissection of the human body, and Galen's books were the only way to learn anatomy.

Anatomical moulages (torso)

Andreas Vesalius (1514–1564), a Flemish anatomist, was at first a "Galenist" at the University of Paris. When he moved to Italy and entered the University of Padua, he began dissecting human bodies. He studied many details of human anatomy and found that Galen made some anatomical mistakes. For example, Galen wrote that the sternum has seven segments, but Vesalius found it has three segments. Galen wrote that the bone of the arm is the longest bone in the human body, but Vesalius found that the bone of the thigh is actually the longest bone in human body. At age 25 Vesalius realized that the anatomical knowledge of Galen was derived from animal anatomy and therefore Galen had never dissected a human body.

In 1543 Vesalius wrote an anatomical masterwork named in Latin De humani corporis fabrica libri septem ("On the fabric of the human body in seven books"), or in short De Fabrica. The book included drawings of human females and males with their skins dissected.[4] These pictures greatly influenced the creation of future anatomical wax models. The anatomical pictures of Vesalius were followed by those of Johann Vesling ("Veslingius") and Hieronymus Fabricius. By 1600 Fabricius had gathered 300 anatomical paintings and made an anatomical atlas named the Tabulae Pictae. Giulio Cesare Casseri ("Casserius"), Spighelius, and William Harvey are other followers of the pictures of Andreas Vesalius.

The Tabulae anatomicae of Bartolomeo Eustachi ("Eustachius") (1552), printed in 1714, had a major effect on the history of anatomical wax models. This work so affected Pope Benedict XIV that he ordered construction of a museum of anatomy in Bologna In 1742, named Ercole Lelli and featuring anatomical wax models. Felice Fontana made cadaveric specimens into wax models by the casting method for anatomical teaching.[5]

The history of wax models is ancient. Wax anatomical models were first made by Gaetano Giulio Zummo (1656–1701) who first worked in Naples, then Florence, and finally Paris, where he was granted monopoly right by Louis XIV. Later, Jules Baretta (1834–1923) made more than 2000 wax models in Hospital Saint-Louis, Paris, where more than 4000 wax models were collected. While wax models were being made, he made pleasant conversations with the patients, sang songs or at times played the piano. Moulages were made for the education of dermatologists around the world, but were eventually replaced by color slides.

Wax sculpture, use in moulage

[edit]

The modeling of the soft parts of dissections, teaching illustrations of anatomy, was first practiced at Florence during the Renaissance. The practice of moulage, or the depiction of human anatomy and different diseases taken from directly casting from the body using (in the early period) gelatine moulds, later alginate or silicone moulds, used wax as its primary material (later to be replaced by latex and rubber). Some moulages were directly cast from the bodies of diseased subjects, others from healthy subjects to which disease features (blisters, sores, growths, rashes) were skilfully applied with wax and pigments. During the 19th century, moulage evolved into three-dimensional, realistic representations of diseased parts of the human body. These can be seen in many European medical museums, notably the Spitzner collection currently in Brussels, the Charite Hospital museum in Berlin and the Gordon Museum of Pathology at Guy's Hospital in London UK.

A comprehensive book monograph on moulages is "Diseases in Wax: the History of Medical Moulage" by Thomas Schnalke (Author) the director of the Charite Museum and Kathy Spatschek (Translator). In the 19th century moulage was taken of medical patients for educational purposes. The prepared model was painted to mimic the original disease. Nowadays anatomicals model are an important instrument of education of human anatomy in department of anatomy and biological sciences in medical schools.[6]

Modern moulage

[edit]
An actor behind-the-scenes with pre-scored "bullet holes" on his costume and squibs blowing open fake blood packets for a gunshot wound stunt.

Moulage has evolved dramatically since its original intent. In modern terms, the word moulage refers to the use of "special effects makeup (SPFX) and casting or moulding techniques that replicate illnesses or wounds"[7] in simulation based techniques. Common examples include designing diabetic wounds, creating burns or other illness effects, like dermatological rashes[8][9] and gunshot wounds.[10]

Example of moulage on a mannequin

These illness and injury effects are applied to training manikins or simulated or standardized patients for training or other purposes. Simulation staff attend training to learn these techniques. It is argued that the use of moulage in simulation improves realism or participant buy-in.[8] Moulage is an emerging field of research for paramedicine, radiography and medical education,[11][12][13] with researchers exploring how moulage contributes to learning in training. Military training utilises highly-authentic moulage techniques to desensitise to graphic wounds, prepare for battle, and treat injuries.[14] New advancements in the field include using tattooed injuries and moulage through augmented reality.[15] The level of authenticity required for moulage remains unclear.[7]

See also

[edit]

References

[edit]
[edit]
Revisions and contributorsEdit on WikipediaRead on Wikipedia

Moulage

View on Grokipedia
from Grokipedia
Moulage is a technique in and that involves creating highly realistic representations of injuries, diseases, and anatomical features using materials such as , , makeup, prosthetics, and simulated , primarily to healthcare professionals, emergency responders, and in realistic scenarios. The term derives from the French word mouler, meaning "to mold" or "to cast". Originally developed as three-dimensional models to and teach pathological conditions before the advent of , it has evolved into a key component of modern healthcare , enhancing learner immersion and skill acquisition by providing visual and tactile cues on manikins, standardized patients, or actors. The origins of moulage trace back to the late 17th century in , where anatomist Zummo (also known as Zumbo) pioneered the creation of detailed wax models depicting anatomical dissections and disease effects for educational purposes. By the early 19th century, the practice gained prominence in Europe, with figures like Franz Martens and Joseph Towne producing wax moulages for medical teaching, and Charles Lailler alongside his collaborators, including Jules Pierre François Baretta, establishing a renowned collection of approximately 4,900 dermatological models at Hôpital Saint-Louis in , initiated in 1867 and expanded through the mid-20th century. These collections, including significant holdings at the in , served as indispensable tools for illustrating skin conditions, tumors, parasites, and surgical outcomes in an era without color imaging. In contemporary applications, moulage extends beyond to trauma , mass casualty drills, and procedural , where it replicates burns, lacerations, gunshot wounds, and environmental hazards to improve , emotional preparedness, and performance under stress. Studies demonstrate that incorporating moulage leads to better retention of clinical skills and more accurate responses compared to verbal descriptions alone, particularly for complex conditions like severe trauma or infectious diseases. Emerging technologies, such as , are beginning to complement traditional methods by allowing customizable, durable replicas, while moulage kits and DIY recipes using household items like and cocoa powder make it accessible for diverse environments.

Overview

Definition and Etymology

Moulage is the art of creating realistic three-dimensional representations of injuries, diseases, or pathological conditions on or forms, typically using molds, casts, wax modeling, or specialized makeup to enhance and training simulations. This technique aims to replicate the visual, tactile, and sometimes olfactory aspects of real medical scenarios, allowing learners to practice , treatment, and response in a controlled environment. The term "moulage" derives from the French word mouler, meaning "to mold" or "to cast," reflecting its roots in the process of forming precise impressions or replicas. In medical contexts, it emerged in the early 19th century as a method for producing detailed wax models of skin lesions and other conditions, initially developed by artists such as Franz Martens in Germany and Joseph Towne in England. By the mid-19th century, French institutions like Hôpital Saint-Louis in Paris became centers for moulage production, where craftsmen like Charles Lailler and Jules Baretta created extensive collections for teaching dermatology and venereology. While moulage shares techniques with prosthetics and makeup used in , it distinguishes itself through an emphasis on anatomical accuracy and sensory tailored to realism, enabling hands-on interaction that supports acquisition rather than dramatic presentation. This focus on educational utility, often involving durable, touchable models of conditions like burns or tumors, sets it apart from applications that prioritize or fantasy elements.

Types and Variations

Moulage can be broadly classified into historical and modern types, each tailored to distinct educational purposes. Historical moulage primarily consists of permanent casts created to replicate pathological conditions, such as skin diseases and anatomical anomalies, for long-term use in medical teaching collections. These models, developed from the late onward, served as durable teaching aids in and , allowing detailed study without reliance on cadavers or live patients. In contrast, modern moulage emphasizes temporary, realistic injury simulations using flexible materials like to facilitate hands-on training in clinical scenarios. These simulations, often applied to mannequins or standardized patients, recreate acute conditions such as wounds, burns, or rashes to enhance immersion in simulation-based . Variations in modern moulage techniques include 3D-printed molds and hand-applied makeup, which differ in precision and application speed. 3D-printed molds enable the production of customizable prosthetics, such as embedded shrapnel or exposed bones, by into printed negative forms for repeatable use in trauma scenarios. Hand-applied makeup, involving layered and textures, allows for quick, on-site creation of superficial effects like abrasions or aging, ideal for dynamic training sessions. Niche applications further diversify these variations, with dermatological replicas focusing on chronic lesions for diagnostic practice, while trauma wounds simulate acute injuries for procedural skills. Silicone-based dermatological models, for instance, provide tactile replicas of lesions like or to improve visual recognition among learners. Trauma simulations, conversely, prioritize deformable elements to mimic or tissue damage in response drills. A key distinction among types lies in and reusability: historical wax casts offer museum-grade permanence, enduring for decades in archival settings, whereas modern disposable kits, often made from or low-cost , are designed for single-use or limited cycles to maintain and realism in high-volume . This trade-off balances archival preservation with practical, scenario-specific adaptability in contemporary .

Historical Development

Origins in Medical Wax Modeling

While the roots of medical wax modeling trace back to the late 17th century with Italian anatomist Gaetano Zummo, moulage as three-dimensional wax replicas of pathological conditions emerged prominently in 19th-century as a vital tool for and documentation, particularly in the fields of and . In , the practice traces its roots to the early 1800s, with Franz Heinrich Martens (1778–1805) credited as the pioneer who created the first dermatologic moulages while practicing medicine in , producing detailed wax models of skin diseases to aid in teaching and diagnosis before the widespread availability of . These early efforts were driven by the need to preserve visual records of transient or rare afflictions, allowing physicians to study and share examples across institutions without relying on live patients. In , the tradition gained momentum in the mid-19th century, centered at institutions like Hôpital Saint-Louis in , where dermatologist Charles Lailler (1822–1893) advanced the technique starting around 1863 by collaborating with skilled moulageurs to replicate skin pathologies with unprecedented realism. Lailler's work, influenced by the growing specialization in , emphasized moulages as enduring teaching aids, particularly for venereal diseases like , which were prevalent and stigmatized at the time. Similarly, in and , figures such as Anton Elfinger (1821–1864) in contributed to the proliferation of these models, establishing workshops that supplied medical schools and hospitals throughout . Pathology museums played a crucial role in institutionalizing moulage, serving as repositories for documenting rare conditions that were difficult to preserve otherwise. The Josephinum collection in , initiated in the 1780s under Emperor Joseph II, exemplifies this early application, featuring over 1,100 anatomical wax models commissioned from Florentine artisans to illustrate human and for military medical training, predating photographic documentation by nearly a century. These museums not only archived specimens but also facilitated comparative studies, with moulages of lesions from or enabling educators to demonstrate disease progression in a tangible, non-perishable form. The creation of these early moulages involved meticulous life-casting techniques, where impressions were taken directly from affected patients using plaster molds, followed by layering and sculpting colored waxes to mimic skin textures, hues, and pathological features such as ulcerations or eruptions. Artisans blended pigments into beeswax bases—often incorporating resins for durability—to achieve lifelike representations, ensuring the models captured subtle details like vascular patterns or scaling that were essential for instructional accuracy. This labor-intensive process, refined in European ateliers, underscored moulage's value as a bridge between artistic craftsmanship and scientific inquiry in pre-photographic medical visualization.

Evolution to Modern Simulation

The transition from static wax moulages, initially developed in the for anatomical teaching, to dynamic simulation tools accelerated in the as medical training emphasized practical, hands-on scenarios. Building on earlier passive models, moulage evolved to incorporate materials like and for simulating injuries in real-time exercises, particularly in contexts where realism was critical for preparing personnel for conditions. During and II, military forces adopted moulage for and casualty care training, marking a pivotal shift toward interactive applications. In the U.S. Army during the , collaboration between the Surgical Consultants Division and the Army Medical Museum produced moulage models of war wounds using plaster casts to graphically depict anatomical damage from battle injuries, aiding in lectures and orientation courses for medics on wound management and prioritization. These simulations, often applied to live role players or mannequins, helped train personnel to sort casualties into transportable and non-transportable categories under simulated mass casualty conditions, enhancing decision-making in high-stress environments. Post-World War II, moulage advanced through integration of Hollywood special effects techniques, introducing flexible latex molds, stage blood, and makeup for more lifelike and versatile injury representations. This influence from film industry artists improved realism in depicting burns, lacerations, and dermatological conditions, transitioning moulage from rigid displays to portable, reusable tools for broader training. By the 1980s, these developments led to the creation of standardized moulage kits, which combined pre-molded prosthetics with applicators for consistent simulation across programs. A key milestone in civilian adoption occurred in the , when U.S. medical schools established dedicated moulage laboratories to support simulation-based , drawing on special effects expertise to produce custom models for teaching complex pathologies. These labs, such as those at institutions integrating visual aids into curricula, facilitated immersive training that bridged theoretical knowledge with practical skills, setting the stage for moulage's role in modern interactive simulations.

Techniques and Materials

Materials Used in Moulage

Traditional materials in moulage primarily consist of waxes such as and paraffin, which provide a moldable base for creating rigid or semi-rigid injury simulations like fractures or casts, often layered with plasters for in early techniques. Gels, particularly gelatin-based formulations mixed with glycerin and , are used for simulating blisters or soft tissue effects due to their ability to form translucent, peelable layers that mimic skin separation. These materials draw from historical practices in wax modeling, where was employed to replicate anatomical pathologies with high detail. Modern alternatives have shifted toward more flexible and durable substances to achieve skin-like textures and reusability in simulation settings. , valued for its properties and , is commonly used to fabricate prosthetic wounds that withstand repeated handling and application. offers elasticity for dynamic effects like peeling burns or rashes, though its use requires caution due to potential latex allergies among participants. provides a versatile option for simulating soft tissues and organs, with formulations that can be translucent or rigid to replicate realistic tactile feedback in training scenarios. To enhance realism, various additives are incorporated into these base materials. Pigments such as red and yellow iron oxides are applied to simulate bruising progression, blending shades like purple, blue, and green from bruise wheels or eyeshadows to depict varying stages of ecchymosis. Coagulants, including gelatin or corn syrup mixed with food coloring, create clotted fake blood that mimics hemorrhage and drying effects without mess. Adhesives like spirit gum or Pros-Aide secure prosthetics and layers, ensuring secure attachment during extended simulations. Safety is paramount in moulage material selection, with formulations prioritizing and non-toxic compositions to prevent irritation or allergic reactions in standardized patients and trainees. Materials like medical-grade provide a baseline compliance with FDA standards under 21 CFR 177.2600 for safe material use and additionally undergo biocompatibility testing per , including tests for , , and systemic toxicity. Patch testing for adhesives and is recommended, and all products should adhere to infection control guidelines, using disposable tools to maintain hygiene in educational environments.

Creation and Application Methods

The creation of moulage prosthetics typically begins with sculpting a prototype using oil-based clay to form the desired shape, such as a laceration or abrasion, allowing for detailed anatomical accuracy before permanent . This clay model serves as a positive form, which is then used to create a negative mold, often with alginate, a skin-safe material mixed with water to capture fine details without harming the model or . Once the alginate sets—usually within 3-5 minutes—the mold is demolded carefully to avoid tears, and the material, such as (e.g., Dragon Skin or Ecoflex) or , is poured into the negative to produce the flexible prosthetic. Curing times vary by material; for example, room-temperature vulcanizing silicones typically cure in 10-30 minutes. This results in a reusable, realistic piece that mimics tissue texture and movement. Application methods for moulage integrate both 2D makeup effects and 3D prosthetics to achieve immersive realism on manikins or standardized patients. For 2D effects like bruises, layering starts with a base of or greasepaint in tones, followed by darker shades (e.g., and eyeshadow or greasepaint) using a to simulate ecchymosis depth and irregular edges, then sealing with translucent powder to prevent smudging. Wet elements, such as stage blood or simulated fluids, are added last in controlled layers to avoid runoff, often using droppers for precision. For 3D prosthetics, attachment involves applying medical-grade (e.g., skin-safe adhesive or liquid latex) to the back of the piece and the target surface, pressing firmly for 1-2 minutes to secure, followed by blending the edges with contour makeup or airbrushed tones to match surrounding and eliminate visible seams. This blending step ensures tactile and visual continuity, with tools like airbrushes providing even coverage for larger areas such as burns or widespread contusions. Customization in moulage creation and application balances efficiency with scenario-specific needs, often choosing between pre-made kits and on-site improvisation. Pre-made kits, containing ready-cast prosthetics, standardized makeup palettes, and adhesives, enable rapid deployment in high-volume simulations like mass casualty drills, reducing preparation time to under 5 minutes per victim when organized in assembly-line stations. In contrast, on-site improvisation adapts household or basic supplies—such as layered with for burns or Q-tips coated in for exposed tendons—to create effects without prior molding, ideal for low-resource settings but requiring skilled applicators to maintain realism. Hybrid approaches combine both, using airbrushes from kits for base coloring and improvised elements for unique details, ensuring adaptability while leveraging material properties like flexibility and durability for repeated use.

Applications

In Medical Education and Training

Moulage plays a central role in and medical schools by enabling scenario-based learning, where realistic simulations of injuries such as burns or lacerations allow students to practice assessment, dressing, and care techniques on standardized patients or manikins. This approach replicates clinical environments, fostering hands-on experience in controlled settings without risking . For instance, in undergraduate programs, multi-purpose trauma moulage has been integrated into training modules to simulate complex scenarios, helping learners apply theoretical knowledge to practical interventions like bleeding control and . In education, moulage facilitates the creation of disease replicas, such as prosthetic models of lesions or rashes, which students examine to develop skills. These replicas, applied using basic makeup or silicone techniques, provide tactile and visual cues that mimic conditions like drug-induced eruptions or . Similarly, in drills, moulage supports multi-trauma setups by depicting compound injuries across body regions, enabling teams to prioritize care and coordinate responses in simulated high-acuity scenarios. The benefits of moulage in these contexts include enhanced toward patients, as realistic depictions prepare learners for emotionally challenging encounters, such as severe burns that evoke distress. It also improves diagnostic skills by increasing confidence in identifying and managing simulated conditions, with studies showing higher satisfaction rates when using moulage-augmented standardized patients compared to paper-based cases. Regarding retention, moulage boosts and , leading to better recall in follow-up assessments, though for long-term clinical gains remains mixed. Overall, these outcomes underscore moulage's value in bridging the gap between classroom theory and bedside practice in civilian healthcare training.

In Military and Emergency Response

Moulage plays a critical role in exercises by simulating realistic injuries to train combat medics in high-stress environments. has incorporated casualty standards that include moulage techniques to enhance the fidelity of (TCCC) training, allowing personnel to practice interventions on simulated like shrapnel lacerations and . These simulations replicate the chaos of combat scenarios, enabling medics to assess and treat under conditions that mimic real operations, as evidenced by comparative studies of simulation modalities that highlight moulage's effectiveness in building procedural skills for hemorrhage control and . For instance, hybrid simulators combining actors with moulage have been used to train on catastrophic external hemorrhage, a common , improving response times and in joint drills. In civilian emergency response, moulage is extensively employed in disaster drills and courses to prepare teams for mass casualty events. The U.S. Federal Emergency Management Agency's (FEMA) Center for Domestic Preparedness (CDP) has utilized moulage for over a decade to create immersive scenarios involving 130 to 250 simulated patients, depicting injuries from such as earthquakes, , and fires, as well as man-made incidents like explosions and hazardous material releases. This approach trains (EMS) personnel and other responders in and during large-scale events, with moulage applied to both manikins and role players to simulate conditions like burns, amputations, and lacerations. Such fosters interdisciplinary coordination, as demonstrated in evaluations of preparedness that emphasize moulage's contribution to realistic victim assessment in drills. To ensure realism in operational settings, moulage adaptations include weather-resistant materials suitable for outdoor simulations and designs that allow for scalable injury severity to support practice. Silicone-based moulage, valued for its durability, UV resistance, and ability to withstand extreme temperatures and moisture, is commonly used in outdoor exercises to maintain integrity during prolonged field training, such as evisceration or simulations exposed to environmental elements. For , moulage kits enable the creation of varying injury levels—from minor contusions to severe multi-trauma—applied efficiently to multiple victims in assembly-line processes, allowing responders to practice prioritization algorithms like START (Simple Triage and Rapid Treatment) in mass casualty scenarios. This scalability, often achieved with pre-made molds and low-cost materials totaling around $6.75 per victim, enhances training efficiency without compromising anatomical accuracy.

Advancements and Challenges

Technological Integrations

Since the , has revolutionized moulage by enabling the rapid prototyping of custom prosthetics and patient-specific injury models, allowing for highly accurate representations tailored to individual clinical scenarios. This technology utilizes polymers, resins, and other biocompatible materials to fabricate realistic skin lesions, wounds, and anatomical anomalies directly from patient imaging data, such as CT or MRI scans, improving production efficiency and enhancing simulation fidelity. For instance, 3D-printed models of dermatological conditions like or have been developed to mimic texture and depth, providing haptic feedback during training while minimizing material waste compared to traditional molding techniques. Recent studies as of 2025 indicate that 3D wound moulages enhance nursing students' engagement in wound care simulations compared to high-quality 2D paper replications. Integration of moulage with virtual reality (VR) and augmented reality (AR) has created hybrid simulations that overlay digital elements onto physical models, offering interactive feedback and immersive training experiences. In these setups, physical moulage applied to manikins or standardized patients is enhanced by AR glasses or VR headsets that project dynamic physiological responses, such as bleeding progression or vital sign changes, allowing learners to practice procedures in a controlled yet realistic environment. Recent advancements include the use of temporary tattoos to represent injuries during VR training, increasing realism. This approach has been particularly effective in trauma and surgical training, where AR annotations guide users through wound assessment and intervention on moulage-enhanced models, improving decision-making without the risks of live patients. Studies indicate that such hybrid systems increase learner engagement and retention by combining tactile realism with customizable digital scenarios. In the 2020s, AI-assisted design software has emerged to generate realistic scenarios by analyzing medical datasets, including and clinical records. AI tools support the development of evidence-based scenarios for educational programs, streamlining the design process for creators. For example, AI algorithms can produce patient-specific models based on clinical data, ensuring anatomical accuracy and enabling scalable production for . This integration accelerates development and supports predictive modeling of treatment outcomes in educational contexts.

Current Challenges and Future Directions

One significant challenge in the application of moulage is its time-intensive preparation, which often involves logistical coordination for equipment gathering and application, limiting its frequent use in simulation scenarios. Standardization across moulage kits remains difficult due to variations in techniques and materials, potentially affecting consistency in learner experiences and competence assessment, though workshops and online resources can promote uniformity. Ethical concerns arise from the realistic depiction of trauma, as highly authentic moulage can induce psychological distress or distraction among trainees, necessitating careful consideration of participant comfort and preparation to mitigate emotional impacts. Cost barriers pose a major obstacle, particularly in low-resource settings, where high-quality moulage materials and professional application are often prohibitively expensive, restricting access to advanced . Maintenance issues further complicate use, as certain perishable materials like grease-based makeup can stain mannequins or expire, requiring regular product checks and compatibility testing to ensure durability and safety. Looking ahead, efforts toward sustainable and biodegradable materials in moulage production are gaining traction, driven by environmental awareness to reduce waste from non-toxic, eco-friendly alternatives that maintain realism without long-term disposal challenges. Global standardization is advancing through updated guidelines from the International Nursing Association for Clinical and Learning (INACSL), such as the 2025 revised Healthcare Standards of , which recommend appropriate use of moulage to enhance situation while ensuring ethical and effective integration. Emerging potential for AI-driven automated application could streamline preparation by generating customized injury , though further research is needed to validate its impact on engagement and outcomes.

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  53. https://www.researchgate.net/publication/354461480_Low-cost_moulage_in_Healthcare_Simulation_Review_of_Its_Use_Utility_and_Perceptions
  54. https://blog.tangent.com/Resources/NViA0z/0OK008/medical-moulage__how_to_make_your__simulations_come_alive.pdf
  55. https://www.inacsl.org/healthcare-simulation-standards-of-best-practice-
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