A Day in the Life at UNMC

Dan Brick lays the foundation for realistic simulation

Dan Brick gives himself a hand.

Dan Brick gives himself a hand.

Dan Brick gives himself a hand.
Dan Brick gives himself a hand.

First things first.

We’re not talking about a real baby.

Let’s make that clear right away, because it looks like a real baby.

And those are not real wounds.

That’s good, because they look like real wounds. They look like a horrible dog bite. They look so realistic that medical students have turned away.

But no dog put these fake wounds on this not-real baby.

Dan Brick did.

No, Brick is not a werewolf. He’s the standardized patient coordinator in the College of Medicine’s simulation lab, and the “dog bites” on this simulated baby are the product of hours of hard work — not one second of which required fangs.

brick2Brick’s work, formally known as moulage and with a long history in medical education, helps UNMC students learn to deal with the horrific sights they may be required to face as medical professionals.

Brick has experience on both sides of simulation. As a Boy Scout, he took part in a mass casualty training – a simulated plane crash — with an emergency room.

“We showed up in the morning, and they made us up with everything from bruises to cuts and scars,” he said. “And then we were supposed to be brought in screaming and hollering about being in pain.”

Despite his early experience, Brick didn’t become interested in moulage until, as a medical educator, he was trying to create the most realistic simulations possible. Many simulation conferences have a moulage workshop or breakout session, and Brick has been to several to refine his technique.

“Even though you go to workshops to pick up new techniques, a lot of it is trial and error,” he said. “And the place you always start with is a picture. If you just Google a gunshot wound, or any kind of wound or burn or dog bite, you can access a bunch of different pictures. So you find out that looks like what your case is about, and you print it out. That’s a really good place to start.

“With moulage, we can create a realistic environment, and that’s the whole point of the simulation lab,” he said.

brick3Brick doesn’t rely totally on makeup. He also has a set of intricate prosthetics which can be attached to people or simulators – feet with broken bones jutting out, burns and scars, and even deep wounds surreptitiously lined with tubes so simulated blood can spurt out.

“If you make a wound up ahead of time and put a lot of blood on it, it’ll drip and dry,” Brick said. “With this, you can pump fresh ‘blood’ into it – it just adds to the realism.”

But when the pre-made prosthetics aren’t enough, Brick’s skills are invaluable. With the baby’s dog bite, for example, instructors specifically requested a wound across the face and neck.

This is the second year he’s created the dog bite, which he considers among his best work, along with an elaborate burn makeup he created earlier this year. A coating of “casualty wax” to simulate swelling, a few swipes with a wooden stick for the teeth marks and red coloring – the whole process takes perhaps two hours.

(Other items in Brick’s moulage set: powdered “blood,” Cover Girl makeup, Vaseline, cold cream and specialty “bruise” blush in varying shades of red, purple and green.)

But if those ingredients sound simple, the effect can be powerful — even among medical students.

“There were some people last year that came in, took one look and turned around, even though it’s all just wax and makeup,” he said. “They really can’t separate it.

“And I’ve had students look at it and say, ‘Oh, that’s horrible, I could never deal with that.’

“And I say, ‘You’re going into medicine … From time to time, you’re going to see blood.’”

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