Celebrating 80 Years Of Casualty Simulation

For many ‘80’ is just a number, yet for the charity Casualties Union, 80 means an opportunity to celebrate. Since 1942 volunteers across the UK have devoted their time to provide realistic casualty simulation. This article is not just an acknowledgement of where Casualties Union is now but also a celebration of its founding years and long past. Without Eric Claxton’s thoughts and the determination of the first 120 inaugural members, there may have been many hundreds of emergency response teams, first aiders and companies who would have missed out on realistic emergency training.

Peacetime is not a period of safety. It is true that shell, bombs, mines and other hazards of war are not present, but even so, 1000 persons are injured every day in this country. Such a state of affairs presents a challenge which the [Casualties] Union cannot escape. A people that has struggled so bravely through total war, as has this nation, deserves the best protection from accidents that can be given and the best care and attention when, in spite of that protection, accidents occur.

–  Eric Claxton – ‘Notes For The Guidance Of Members’ – 1945

The ideology of casualty simulation and rescue training was already in Eric Claxton’s mind when he was on the search for a real bombed building as a location for his rescue school. In 1941, Hillfield, a large house that formed part of St. Andrews Convent in Leatherhead, Surrey was partly destroyed by a landmine that was dropped by parachute. Despite the destruction of the building, only one Nun was harmed; all other boarders and Nuns sheltering at the Convent at the time were uninjured. Hearing this news, and with the ruins now unusable by the convent, Eric Claxton set out to develop his training school; it was from this location that Casualties Union was founded.

But after the war the efforts to provide realistic casualty simulation did not cease. Instead, the understanding and knowledge that the skills of casualty care and rescue training could help more than just the military meant that the use of the charity’s volunteers increased. As each year passed the charity grew, emergency response teams and first aid groups began to realise the benefits of realistic training. In 1970 it was noted in the Casualty Simulation Journal that “it has been the year of the Major Disaster Exercise… so much have these exercises caught on that they seem to be taking a place of increasing importance as an extended form of training”.

The Early Years

In the early years there was some emphasis on the ‘make do and mend’ attitude with costs of moulage kept low through the use of hand and home-made makeup products and prosthetics. Flicking back through the charity’s Casualty Simulation journal and magazine archive (dating back to 1946) it’s amazing to read the efforts that many individuals went to to create the simulated injuries required. Interesting examples include:

• For a burn or scald which produces a small group of blisters (Spring 1947): “The use of ‘pear drop’ or balsar wood cement.”
• To show a blood transfusion being given (Late Summer 1952). “You will need:
  • A well padded flat bottle… with a metal cap at the neck
  • A length of plastic tubing
  • One french needle
  • One piece of Jaconet (approximately 4in x 6in)
  • A sticking plaster
  • Plasticine to match patients colouring
  • Blue liner
  • Flesh coloured powder
  • Length of roller bandage”

• To create sugar based liquid blood (May 1949).
  • “½lb sugar
  • ¼ pint of water
  • Edecol
  • Milk of magnesia”

Aside from training, first aid competitions were also extremely popular and renowned for being challenging and realistic; with one year over 160 competition teams vying for Casualties Union’s Buxton Trophy being whittled down to a small group of finalists through run-off competitions. Whilst we no longer run first aid competitions, there are many who remember their scenarios and the awards of being part of a top first aid competition team in the UK. Those individuals talk fondly of the detailed scenarios and the effort taken to make it so. For some first aid competitions, upwards of 30 Casualties Union volunteers were needed to ensure they ran smoothly and were fair to those who were participating.

Modern Day Casualty Simulation

Modern day casualty simulation has changed somewhat. Volunteers have seen advances in makeup techniques such as silicone instead of homemade ‘false tissue’. Some of the ‘recipes’ devised back in 1942 are still used today. False tissue and fake blood are frequently used because of their cost effectiveness during training and for the makeup of larger injuries. Additionally, they enable members to practise key skills such as colour and edge blending and they promote the creation of unique simulated injuries (not precast). However, with silicone and gelatine becoming more widely available, volunteers are opting to create simulated injuries that are flexible yet able to withstand multiple treatments, for example at competitions or for ATLS (Advanced Trauma Life Support) assessments.

The injuries that our volunteers are required to portray have also significantly changed. Car travel, especially during the 1940s and 1950s, was not as heavy as it is today. Yet despite the lower numbers of vehicles on the roads back then, the injuries from road traffic collisions were different. Air bags for vehicles had not yet been invented and cars were also not designed to absorb shock. As a result, the forces transmitted from the vehicle to the driver and/or passengers resulted in occupants often being ejected from the car. Injuries such as ‘stove in chest’ (a multiple rib injury from impact with a steering wheel), lacerations from glass and significant head injuries were commonplace. Furthermore the exercises have become more complex with scenarios involving multiple casualties such as aircraft accidents, high-rise building evacuations and multi-vehicle collisions in tunnels. Each of these exercises involve a significant amount of planning but enable the emergency response teams to test their interoperability and communications.

Casualty simulation nowadays is also a lot safer! With the increased emphasis on health and safety, exercises are often kept out of public areas, safety observers keep watch and the processes behind the rescue of casualties has the casualty at the forefront. Looking back to several decades ago there would be less oversight on health and safety with volunteers being cut out of cars without any form of personal protective equipment, being rescued from building ruins without the rubble being shored up or simulated train incidents held near towns and villages without prior notice!

Outside of Casualties Union, social media has brought special effects makeup into the spotlight with individuals and special effects makeup artists creating tutorials and videos on how to create highly detailed and realistic injuries. However, the makeup is not accompanied by hours of research and learning the ins and outs of how a casualty would react to an injury, emotionally and medically. Instead, for those who do attempt casualty simulation using only their makeup skills, they find that they will scream out in pain from smaller injuries and not act or react appropriately to the injuries they are required to portray or their handling. Casualties Union members still to this day focus on learning the core acting skills, alongside staging and makeup, to ensure that the casualties portrayed are as real as they would have been 80 years ago.

Key Achievements

Although the past 80 years has meant a lot has disappeared into history, Casualties Union still exists. The old site of Hillfield can no longer be seen as it is covered over and used as a playing field. Yet the statue that once was displayed prominently in front of the building is now located next to the nearby St. Andrews Catholic School and the pond that once existed can just about still be seen. Today, 300 volunteers located across the country still continue to devote their time for the purposes of rescue training and casualty care within 23 Units. The charity is fortunate that so many volunteers devote so much of their lives towards this purpose, it is not uncommon to see that some of the charity’s members have volunteered for more than 50 years!

But answering the question ‘what can be described as Casualties Union’s greatest achievement in its 80 years of existence?’ is difficult. Perhaps it’s been the persuasion of those who teach rescue, first aid, medicine and allied subjects that learning theoretical knowledge and skills is never complete until it can be put into practice using observations, communication and hands-on experience. The simulation of trauma or medical emergencies by skilled, trained actors who specialise in this field presents the practitioners with the nearest thing to reality so that they can make errors and learn from them without risking harm to true victims.

Find out more

The charity Casualties Union has been helping training providers make their first aid simulations more realistic for the past eighty years! You can learn about what Casualties Union do, request their assistance for your first aid training or make an enquiry about volunteering by visiting here or calling 08700 780 590. Don’t forget to explore our social media accounts for all the latest news about our volunteering.