Glossary

Acute

A fresh injury still in its inflammatory phase , colour reads bright and tissue is reactive. Used for bruises and recent contusions where the discolouration has not yet aged.

Adder

A snakebite from a UK adder (Vipera berus). Presents as two puncture marks with local swelling, bruising, and possible systemic signs. The only venomous snake native to the UK.

Angioedema

Deep swelling in the subcutaneous or submucosal tissue, most often affecting the face, lips, and throat. Distinct from urticaria in that it involves deeper tissue layers; visually dramatic and rapidly progressing.

Arterial

Bleeding from a damaged artery. Characterised by bright red, pulsatile flow under pressure. The primary visual cue in major haemorrhage scenarios requiring tourniquet or direct pressure.

Atrophic

A depressed or sunken scar where tissue loss has left a pit or indentation below the surrounding skin. Common in healed ulcers and severe acne. Requires texture building rather than raised-surface effects.

Avulsion

A fracture where a fragment of bone has been pulled away by tendon or ligament. Externally presents with localised swelling and bruising at the attachment site; the bony fragment may be palpable.

Bee/Wasp

An insect sting presenting as a small puncture with surrounding erythema and wheal. In anaphylaxis scenarios, the sting site is the entry point for the systemic cascade; local swelling is disproportionate to the wound size.

Category I

A pressure ulcer limited to non-blanchable erythema of intact skin. Skin is intact but discoloured , no break in surface, making it the most subtle staging to replicate convincingly.

Category II

Partial-thickness skin loss presenting as an open, shallow ulcer with a red-pink wound bed. May appear as an intact or ruptured blister. The first staging with visible tissue disruption.

Category III

Full-thickness skin loss exposing subcutaneous fat but not bone, tendon, or muscle. Slough may be present but does not obscure wound depth. Requires visible depth and tissue layering.

Category IV

Full-thickness tissue loss with exposed bone, tendon, or muscle visible in the wound. Often includes slough or eschar. The most severe stageable category; high clinical urgency in training scenarios.

Chemical

A burn caused by contact with a caustic substance. Appearance varies with agent type , acids produce defined, dry lesions; alkalis cause wet, progressive tissue destruction. Colour may range from pale to deep brown or black depending on concentration and exposure time.

Closed

A fracture with no break in the overlying skin. Presents with swelling, deformity, and localised bruising but no external wound. Scenarios focus on body shape and splinting cues rather than wound replication.

CO Poisoning

Carbon monoxide poisoning. Skin may present with cherry-red or pink discolouration, though this is variable in practice. Primary scenario cues are systemic , altered consciousness, headache presentation, and environmental context.

Compartment

Crush-related compartment syndrome , raised pressure within a closed muscle compartment causing ischaemia. Externally presents with a tense, shiny limb and severe pain. The key visual is a limb that appears swollen and under pressure rather than a specific wound.

Complete

A full traumatic amputation where the amputated part is entirely separated from the body. Presents as a clean or ragged terminal stump with exposed soft tissue and bone, and active haemorrhage.

Compound

An open fracture where bone fragments have broken through the skin. The defining visual is a wound with visible or palpable bony material , a high-priority injury requiring careful technique to show without implying irreversible damage.

Contact

A gunshot wound fired at close or contact range, producing muzzle blast effects including soot, stippling (powder tattooing), and sometimes stellate tearing of the skin around the entry point. Distinct from a standard entry wound by the surrounding blast evidence.

Contaminated

A wound containing visible foreign material , soil, gravel, debris, or biological matter. Used in scenarios where wound hygiene and irrigation are learning objectives. Contamination is applied to the wound bed rather than the wound margins.

Contracture

Scar tissue that has shortened and restricted movement, typically following a burn or deep laceration. Presents as tight, distorted skin pulling across a joint. Requires both texture and positional cues to convey the functional impact.

Cyanosis

Blue-grey or purple discolouration of the skin and mucous membranes caused by reduced oxygen saturation. Visible in the lips, fingertips, and nail beds. Most reliably depicted using makeup rather than silicone; blends must suit the scenario's lighting conditions.

Deep

A graze extending through the full epidermis into the dermis, producing visible ooze rather than simple surface abrasion. The wound bed may show dermal papillae and capillary bleeding. Distinguished from a superficial graze by greater depth cues and more active bleeding.

Deep Dermal

A burn extending into the deeper layers of the dermis, affecting hair follicles and sweat glands. Presents as a mixed appearance , pale, mottled areas with reduced sensation. Blistering may be present but broken; the wound is typically moist and may have fixed staining.

Deep Tissue Injury

A pressure ulcer presenting as a purple or maroon area of intact skin, or a blood-filled blister, caused by underlying soft-tissue damage at the bone-muscle interface. Can progress rapidly to a full-thickness wound; the surface appearance underrepresents the depth of injury.

Degloving

A severe laceration or crush injury where the skin and subcutaneous tissue are stripped away from the underlying structure, often in a rolling or avulsing motion. Results in a large exposed surface of fascia, muscle, or bone. A demanding replication requiring extended surface coverage.

Diaphoresis

Profuse, abnormal sweating , a key systemic sign in shock, hypoglycaemia, and MI presentations. Applied as surface moisture rather than a wound effect; the skin appears clammy, pallid, and glossy. Combined with pallor and mottling for high-acuity scenarios.

Dog

A bite wound caused by a dog, producing a combination of puncture marks and tearing lacerations. Bite force causes significant tissue compression and avulsion; wounds are characteristically irregular with bruising around the margins.

Early

A contusion in its early stage of development, showing acute tissue response , swelling and red-purple discolouration , before the characteristic colour shift associated with ageing bruising begins. Distinguished from Acute by a slightly more evolved colour transition.

Electrical

A burn caused by electrical current passing through the body. Entry and exit wounds are typically small, char-edged, and depressed; internal injury is disproportionate to external appearance. Scenario focus is usually the entry point with supporting systemic cues.

Embedded

Shrapnel or a foreign body lodged within soft tissue without complete penetration. The object is visible at or protruding from the skin surface. Impalement protocols apply , do not attempt removal; stabilise in place.

Entry

A penetrating wound where a projectile has entered the tissue. Typically small, round and neat, with minimal external tissue loss compared to the corresponding exit wound.

Epidermal

A superficial burn affecting only the outermost skin layer (epidermis). Skin is reddened and tender but the surface is intact, with no blistering. Equivalent to a first-degree burn.

Erythema

Widespread redness of the skin caused by capillary dilation , a key visual sign in anaphylaxis, sepsis, and allergic reactions. Applied as an area-wide colour wash rather than a localised wound; the redness should appear to spread from a focal trigger point.

Evisceration

A wound through which abdominal organs (most commonly bowel) protrude through a disruption in the abdominal wall. A high-priority visual requiring wet, textured organ replication. Organs must remain moist and covered during the scenario , a key actor brief.

Exit

The wound created where a projectile leaves the body. Typically larger, more irregular, and more destructive than the entry wound, with blown-out wound margins, tissue loss, and significant haemorrhage. Triage classification is usually more severe than entry-only injuries.

Flash

A burn caused by brief, intense heat exposure , typically from an explosion, ignited vapour, or arc flash. Produces a superficial-to-partial-thickness burn across exposed skin, with a sharp demarcation at clothing edges. Hair and eyebrows may be singed; the face is often disproportionately affected.

Flap

A laceration producing a partially detached section of skin that remains connected at one edge. The flap may be folded back to expose underlying tissue. Replication must show both the wound bed and the viable flap tissue, with the flap sitting naturally rather than rigidly.

Friction

An abrasion caused by the skin sliding across a rough surface. Capillary bleeding rather than arterial flow; often contaminated with grit or dirt depending on the surface.

Full Thickness

A burn destroying the full depth of the dermis and potentially exposing subcutaneous fat, tendon, or bone. The wound appears pale, waxy, or charred with a dry, leathery texture and no blistering. Paradoxically painless in the wound centre due to nerve destruction.

Granulating

A healing wound in which the wound bed is filling with granulation tissue , bright red, beaded, vascular tissue that is fragile and bleeds easily on contact. Indicates active healing; used in wound assessment and dressing scenarios.

Haematoma

A localised collection of blood outside vessels, forming a raised, fluctuant swelling beneath the skin. Distinguished from a simple bruise by its three-dimensional profile and the palpable sense of fluid or clot beneath the surface. Colour is typically deep purple-red.

Hornet

A sting from a European hornet (Vespa crabro). Produces a more pronounced local reaction than a bee or wasp sting , significant swelling, erythema, and pain , due to the venom volume. The sting site may be visible as a small puncture at the centre of the reaction.

Human

A bite wound caused by human teeth, producing a characteristic oval or arc-shaped pattern of puncture wounds and bruising. Human bites carry a high infection risk and are associated with violent altercation scenarios; the wound pattern is distinctive and forensically significant.

Hyperthermia

Elevated body temperature presenting with hot, flushed, and dry or sweating skin. Applied as a colour and surface finish rather than a wound effect , the skin reads as visibly heated. Associated with exertional heat illness, heat stroke, and environmental exposure scenarios.

Hypothermia

Reduced core temperature presenting with pale, grey, or cyanotic skin. The casualty appears cold and mottled; extremities may show waxy pallor or mild cyanosis. Surface moisture is absent , the skin reads as cold and dry, distinct from the clammy presentation of shock.

Impaled

A stab wound in which the implement remains lodged in the wound. The protruding object must be stabilised and is never removed during first aid , a critical protocol teaching point. Replication requires a convincing impalement rig that reads as secure without contact risk.

Incised

A laceration with defined but irregular edges, typically produced when a sharp instrument applies force with a tearing or shearing component. Wound margins are uneven with tissue bridging across the wound bed , distinguished from a stellate or blunt-force tear by its relatively contained outline.

Infected

A wound showing clinical signs of infection , erythema spreading from the wound margins, warmth, oedema, purulent exudate, and possible odour cues. Used in delayed-care and wound assessment scenarios. The surrounding skin effect is as important as the wound bed in communicating infection status.

Internal

Haemorrhage occurring within a body cavity without an external wound. The key visual cues are systemic , pallor, diaphoresis, and distension , rather than a surface wound. Abdominal rigidity and guarding are actor-performed; bruising over the abdomen may indicate mechanism.

Irregular

A laceration with non-uniform, ragged wound margins produced by blunt force, crush, or tearing mechanisms. Wound edges are uneven and may include skin tags or devitalised tissue. Distinguished from Incised by the absence of any consistent directionality or sharpness.

Jaundice

Yellow discolouration of the skin and sclera caused by elevated bilirubin. A systemic presentation requiring full-skin and conjunctival colour application. The scleral yellowing is often the most diagnostically relevant visual cue for responders.

Jellyfish

A sting from a jellyfish producing a characteristic linear or streaking wheal pattern corresponding to tentacle contact. The marks are raised, erythematous, and intensely painful; the pattern across the skin is a distinctive visual identifier for the mechanism.

Junctional

A wound at a body junction , the groin, axilla, or neck , where tourniquet application is not possible. Junctional wounds are high-priority haemorrhage scenarios requiring wound packing or specialist haemostatic devices. The anatomical location is the defining feature.

Keloid

A raised, over-grown scar that extends beyond the original wound margins. Unlike a hypertrophic scar, a keloid invades surrounding tissue and does not regress. Appears as a firm, smooth, raised ridge , often darker than surrounding skin , and is common at specific anatomical sites including the chest, shoulders, and earlobes.

Late

A contusion in its late stage of resorption , the bruise is fading, transitioning from purple-blue through yellow-green as the blood breaks down. The least acute of the contusion subtypes; colour mixing must reflect the yellowish undertone of haemoglobin degradation products.

Linear

A straight, narrow cut consistent with a single stroke from a sharp edge. Distinguished from Incised by its long, even shape and uniform depth.

Localised

A crush injury confined to a specific anatomical area without extensive systemic involvement. Presents with swelling, bruising, and deformity at the site of compression. Distinguished from compartment syndrome by the absence of rising intra-compartmental pressure.

Mangled

A severely traumatised limb or extremity with combined vascular, bony, soft-tissue, and nerve damage , often from high-energy mechanisms such as blast or crush. The most demanding amputation or crush subtype to replicate; destruction is non-uniform and extensive.

Mid

A contusion at the mid-point of its colour evolution, transitioning from the initial red-purple of acute bruising toward the deeper blue-black of haemoglobin deoxygenation. The central area is typically darkest; margins may show early yellowish colour shift.

Mottling

A blotchy, lace-like pattern of skin discolouration caused by irregular cutaneous blood flow , a key sign of circulatory failure, sepsis, or end-stage shock. Applied as an irregular, reticulated pattern of pallor and cyanosis rather than a uniform colour wash.

Multiple

Multiple shrapnel wounds distributed across a body area following an explosive event. Rather than a single wound, the scenario requires a pattern of entry wounds , varying in size and depth , consistent with a fragmentation spread pattern.

Necrotic

Wound tissue that has died and requires debridement. Presents as black (eschar) or yellow-grey (slough) devitalised material in or over the wound bed. Necrotic tissue is typically dry and firm (eschar) or wet and stringy (slough) , both require distinct texture replication.

Normal

A mature, fully healed scar with normal tissue architecture restored. Presents as a flat, pale or skin-coloured line with no elevation. The baseline scar presentation; used when the scenario requires a healed wound history without complication.

Oedema

Swelling caused by accumulation of fluid in the interstitial tissue. Pitting oedema , where pressure leaves a temporary indent , is the clinically relevant presentation in lower limb and cardiac scenarios. Applied as a sculptural limb effect rather than a surface wound.

Open

A fracture in which the bone has broken through the skin, creating a wound overlying or adjacent to the fracture site. The bone may or may not be visible; the primary visual is a significant wound with bruising and deformity in a mechanistically appropriate location.

Other Mammal

A bite wound from a mammal other than a dog, cat, or human , including farm animals, rodents, or exotic species. Wound morphology varies with the animal; the defining feature is a mechanism-appropriate bite pattern and the infection risk associated with mammalian saliva.

Pallor

Abnormal paleness of the skin resulting from reduced blood flow to the surface , a primary sign of haemorrhagic shock, vasovagal syncope, and cardiovascular compromise. Applied as a general skin-tone desaturation; combined with diaphoresis and mottling for full shock presentations.

Partial

An amputation in which the limb is not fully severed , some soft tissue, skin, or vascular connection remains. The extremity is devitalised but attached. Requires both wound and positional cues; the limb hangs or lies in an anatomically abnormal position.

Patterned

An abrasion that carries a recognisable imprint from the object or surface responsible , tyre tread, grille, or fabric weave. The pattern is forensically significant and should be reproduced accurately. Distinguishes impact mechanism and is a key detail in trauma assessment scenarios.

Penetrating

A wound or shrapnel fragment that has passed through the skin into underlying tissue without exiting. For shrapnel, penetrating indicates an embedded fragment; for wounds, it describes any wound with sufficient depth to enter a body cavity or organ.

Perforating

A wound with both an entry and exit point , or a shrapnel fragment that has passed entirely through tissue. Distinguishes through-and-through ballistic or fragment trajectories. Triage implications are typically more significant than isolated penetrating injuries.

Petechiae

Tiny, pinpoint haemorrhages under the skin caused by capillary rupture , appearing as flat, non-blanchable red or purple dots, typically 1–3mm in diameter. Associated with raised venous pressure, meningococcal disease, and severe sepsis. Applied individually rather than as a colour wash.

Primary

The direct tissue injury caused by the overpressure wave of an explosion , primarily affecting gas-filled organs: ears, lungs, and gastrointestinal tract. External signs may be subtle; the visual focus is on the casualty presentation and mechanism rather than a surface wound.

Puncture

A small-diameter stab wound created by a pointed implement , a knife tip, nail, or needle. The wound is deeper than it is wide; external appearance is often deceptively minor compared to internal trajectory. Used in scenarios where mechanism and depth cues must be communicated.

Purpura

Larger areas of haemorrhage into the skin , typically 3–10mm , presenting as non-blanchable purple patches. Distinguished from petechiae by size and from bruising by the absence of trauma mechanism. Associated with meningococcal disease, thrombocytopenia, and vasculitic conditions.

Pyrexia

Elevated temperature presenting with flushed, hot skin , particularly across the face and chest. The body appears visually warmer than normal; may be combined with diaphoresis in sepsis scenarios. Applied as a colour enhancement rather than a wound effect.

Quaternary

All blast injuries not accounted for by the primary, secondary, or tertiary mechanisms , including burns, crush injuries, and exacerbation of pre-existing conditions. The most clinically diverse blast category; scenarios typically combine multiple wound types rather than a single characteristic presentation.

Scald

A burn caused by hot liquid or steam. Typically presents as a superficial to partial-thickness burn with irregular, drip-pattern margins corresponding to liquid flow. The burn distribution tells a story , a pouring pattern versus an immersion pattern have different injury profiles and safeguarding implications.

Secondary

Blast injury caused by fragmentation and debris propelled by the explosion , penetrating and lacerating injuries from shrapnel. Typically produces multiple wounds distributed across exposed body surfaces. Scenario setup requires pattern of wounds consistent with a fragmentation spread.

Shock

A life-threatening state of circulatory failure presenting with pallor, diaphoresis, altered consciousness, and reduced skin perfusion. Applied as a systemic presentation , pallor, mottling, and surface moisture , rather than a discrete wound. A defining end-state for major trauma and anaphylaxis scenarios.

Spider

A spider bite presenting with a localised puncture and surrounding erythema. False widow bites , the most likely clinically significant spider encounter in the UK , produce localised pain and swelling. Necrotic arachnidism (tissue death) is possible with certain species and requires more involved wound replication.

Stapled

A closed surgical or traumatic wound approximated with skin staples rather than sutures. The wound is linear and closed, with visible metallic staple heads at regular intervals across the wound line. Requires accurate staple spacing and skin tension to read convincingly.

Stellate

A star-shaped laceration with multiple radiating tears from a central point, typically caused by blunt force over a bony prominence. The wound does not follow a single plane; the tearing pattern fans outward. Common over the scalp, brow, and shin.

Superficial

A graze limited to the outer epidermis, with capillary ooze but no dermal exposure. The wound appears as an area of raw, reddened surface without the depth or bleeding of a deep abrasion. The least complex of the graze subtypes.

Superficial Dermal

A burn extending into the superficial dermis, producing blistering with a pale pink, moist wound base. Pain is intense due to exposed sensory nerve endings. Blisters may be intact or broken; the wound base is viable and responsive to healing without grafting.

Sutured

A closed wound approximated with sutures , either interrupted or continuous. The wound line is visible but sealed; sutures are spaced at regular intervals and the skin edges are in apposition. Represents a managed wound state used in post-procedure assessment and delayed-care scenarios.

Tangential

A gunshot wound where the projectile has grazed the skin surface or passed through the superficial tissue at an oblique angle without deep penetration. Produces an elongated, channel-like wound , wider and shallower than an entry wound, with ragged margins on one or both sides.

Tertiary

Blast injury caused by the body being physically displaced by the explosion wave , producing blunt and penetrating trauma from impact with structures or the ground. Wound pattern resembles high-velocity blunt trauma; long-bone fractures and head injuries are common.

Through-and-through

A stab wound in which the implement has entered and exited the same anatomical region, producing both an entry and exit wound in close proximity. Common in scenarios involving thin body regions such as the hand, cheek, or lateral thigh.

Tick

A tick bite presenting as a small puncture, often with the tick still embedded. The characteristic expanding erythematous rash of Lyme disease (erythema migrans) may be present in delayed scenarios , a bullseye pattern radiating from the bite site.

Traumatic

A traumatic amputation caused by a high-energy external force , blast, crushing machinery, or vehicle entrapment. Distinguished from surgical amputation by the irregular, destructive quality of the terminal wound. Active haemorrhage and tissue disruption are the defining visual elements.

Unstageable

A pressure ulcer whose base is obscured by slough or eschar, making depth staging impossible. The wound base is not visible; the scenario communicates severity through wound size, surrounding skin condition, and systemic indicators rather than wound depth alone.

Urticaria

Raised, itchy, irregular wheals (hives) on the skin caused by an allergic or pseudo-allergic reaction. Used for anaphylaxis presentations where the skin sign is the visible cue to a systemic event.

Venous

Bleeding from a damaged vein. Presents as dark red, steady flow , lower pressure and volume than arterial bleeding but significant in sustained haemorrhage. Wound packing and elevation are the primary intervention cues.

Weever Fish

A sting from a weever fish spine, typically through the sole of the foot when wading in shallow water. Produces intense, immediate pain with localised swelling and erythema around a small puncture wound. First aid (hot water immersion) is the key scenario learning point.

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