TissueDB/Simulators/Hemorrhage Control Simulator (Malik)

The Hemorrhage Control Simulator (Malik) is a low-cost bleeding-leg simulator developed by Malik and Chhapra at the Patients' Aid Foundation, Jinnah Postgraduate Medical Center, Karachi, Pakistan, to teach hemorrhage control techniques (manual pressure, tourniquet placement, bleeding-source identification) to civilians, new nurses, and Operating Room technicians in resource-limited settings. It uses a goat or lamb hind leg with IV tubing tunneled through stab wounds, connected to red-dyed saline bags, to simulate active venous and arterial bleeding.^[1]

1. Defrost the goat or lamb hind leg partially.
2. Wrap the leg in cling film (saran wrap).

1. Make a simple stab wound on one side of the leg with the knife.
2. Make a deeper or larger wound on the other side of the leg.

1. Detach the plastic connector from one length of IV tubing and connect the open end to the tunneler.
2. Puncture the meat with the tunneler a few inches proximal to the first wound, create a tunnel through the meat to the wound site, and pull the IV tubing through the tunnel.
3. Detach the tubing from the tunneler when the tunneler exits at the wound, then retract the tubing slightly so the open end is hidden inside the tunnel.
4. Repeat the proximal-puncture, tunnel, and retract steps for the second wound on the opposite side of the leg.

1. Attach each IV tubing line to a saline bag or bottle filled with fluid that has been mixed with red food coloring or other red dye.
2. Place clothing (shirt, tights, or pants) on the leg if a clothed scenario is desired (optional).

1. Control the rate and amount of bleeding using the roller-clamp on each IV tubing line.
2. Compress the IV fluid bag manually in a pulsatile manner to simulate arterial bleeding.

Goat and lamb are acceptable in halal and kosher diets when properly sourced; operators serving these audiences should confirm halal or kosher provenance with the supplier, because the source paper does not address slaughter method.

For vegan, Hindu, Buddhist, or Jain audiences, an animal-tissue substrate is not acceptable. The following non-animal substitutes are TissueDB suggestions and are not in the source paper; treat them as cost and accessibility trade-offs and validate locally before use:

• Konjac slab or large gelatin block with embedded IV tubing — approximates leg-tissue resistance and bleeds through the embedded tubing in the same way as the animal substrate.
• Compressed wet sponge with embedded IV tubing — lighter; lower tactile match but accessible where konjac or gelatin are unavailable.
• Commercial silicone leg from a mannequin parts supplier — higher cost (typically several hundred US dollars) but reusable across multiple sessions.

The simulator was shown to five attending-level surgeons and five emergency medicine residents (n = 10) before classroom use. On a 1–5 Likert scale (1 = unrealistic, 5 = life-like) covering bleeding response, tactile feel, response to intervention, and applicability to real-life scenarios, the model was consistently rated as "nearly real" to "life like" by all physicians and surgeons.^[1]

The simulator was subsequently used in three civilian training sessions and one combined session with new nurses and Operating Room technicians. Participants reported improved confidence in life-threatening hemorrhage control both in and out of the hospital, based on the "Until Help Arrives" Post-Course Survey.^[1]

Limitations stated by the authors: the effectiveness evaluation was semi-quantitative and has not been shown to improve real-world outcomes; the number of medically trained reviewers was limited.

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