Nurse draws on decades in ICU to bring grisly wounds to life

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Nurse draws on decades in ICU to bring grisly wounds to life

Creating faux bullet holes, road rash and other injuries is part of her job educating trauma- and burn-care providers
Brian Donohue

In a one-hour window at Harborview Medical Center, Maria Paulsen moves between gurneys of five people with apparently serious wounds – from a motorcycle crash, a car crash, a gunshot, a stabbing and a burn.

She’s not providing lifesaving care, but giving instruction and applying theatrical makeup to create the unsettlingly vivid injuries. 

Maria Paulsen
Paulsen's son Patrick, helping out after a volunteer canceled at the last minute, portrayed a patient with bullet wounds at a trauma-care class.
Paulsen's teen son, helping out after a volunteer canceled at the last minute, portrayed a patient with bullet wounds to the neck and abdomen.

The seeming victims are volunteers, mostly medical and nursing students, who role-play in 10 classes a year that Paulsen runs for physicians.

“We’re teaching Advanced Trauma Life Support. It’s a course required every four years for any physician who works in an emergency room or who might treat trauma patients at a smaller hospital,” said Paulsen, a registered nurse.

The job she took five years ago, Trauma Outreach Education Coordinator, came with bags of body paint, powdery rouges, topical glue-ons and applicators. Paulsen was unfamiliar with moulage, the art of creating mock injuries, but took to it with zeal and with decades of hands-on experience with the real thing.

“After working in the ICU for 25 years, I know what wounds look like,” she said. “It bothers me if moulage does not look real. My predecessor had left a bunch of grease-based makeup that was hard to get on and off and I didn’t like the effect of it. So I went to a costume and display store and asked them what I needed.

“I’ve evolved and now I like my effect. It’s pretty good,” she allowed. 

Brian Donohue
Paulsen displays a faux palm injury, one of the rubber products in her moulage kit.
Picture of Maria Paulsen showing a fake hand injury made of rubber

With three shades of rouge, Paulsen can buff up a convincing bruise in a minute. Her go-to product is "Fresh Scab," a quick-drying purplish gelatin that, sprayed with a little fake blood, makes a disturbingly real laceration. She mostly eschews putties and formed latex “skins” with bones and whatnot protruding. They look terrific but require more prep time than she typically has. 

Part of the life-support classes involves physicians, one at a time, being graded on their responsiveness at individual skills stations – the five mock patients. An instructor briefly introduces a scenario, for instance: “Your patient was in a car accident and thrown through the windshield and just brought here by the medics. You have no surgeon and no CT scan.”

As Paulsen described, the physician walks into the room and “it’s like they’re in the ER. The moulage patient is on the gurney and he’s got a cervical collar on and oxygen going and we spray his face with glycerin water so it looks like he’s sweating. There are injuries, some visible and some not, and the physician must survey the patient appropriately and begin care.” 

Clare McLean
Paulsen makes up Evan and Drew Blakeley, who portrayed patients in a photo shoot for a Harborview publication.
picture of Maria Paulsen applying makeup to two children

Mock patients are not only made up, they also have been instructed to add physical behaviors if the physician overlooks an injury or is too slow. For example, someone with a bullet wound to the neck might start gasping if airway isn’t quickly secured. 

In a storage closet where Paulsen keeps her kit, she nods to a medical mannequin. Today’s mannequins are high-tech, remotely operated marvels that can simulate giving birth and other extraordinary effects.

Yet moulage on a wheezing or writhing person, she said, makes for an experience that no mannequin can match.

“The thing about the moulage victims is, the more realistic they are, the more real the situation is for the physician being tested. It brings physicians into the experience.”

Paulsen coordinates courses for advanced burn and advanced trauma care. Interested physicians should email herHarborview and Airlift Northwest will host a trauma conference for healthcare professionals in September 2015.