But where do they come from? Well, in the case of our favourite hospital programme, they usually find their way on to set via the skills of a team which includes 29-year-old Marcus Whitney – a man often found to have blood on his hands!
I spoke to him to discover just what his job entails and what secrets he would care to reveal.
What does your job entail?
"I'm a make-up designer come prosthetic designer on Casualty. You start designing the look of the show and how you want the make-ups to look and you sit down and talk about what prosthetics are going to be in the episode - and then I end up making them."
What's your job title?
"Make-up designer."
How did you land the job?
"I'd always wanted to do it since I was young and I met a make-up designer called Sue Kneebone, who she told me what to do. I had to go to hair-dressing college for four years, and I taught myself the prosthetics. Once I'd done that, Sue gave me a job as her trainee. I shadowed her for six years and then ended up designing myself."
For anybody who's interested in pursuing this kind of career, what qualifications, if any, do you need to make all-things prosthetic?
"One of the main things that you have to do is to study hair-dressing because you won't only be having to do prosthetics all the time, you'll have to put hair up and that sort of thing. You might be shooting a wedding one day or doing gore with someone's leg chopped off the next. There are different courses which you can do - Nick Dudman and the guys that do Dr Who run specific prosthetic courses, and there are others like the London College of Fashion and Design. There are also schools in London like Greasepaint which do courses for prosthetics, too."
How long have you been with Casualty?
"This is my tenth year. It's great fun. I started on series 11 or 12. It's absolutely great fun because you never know what you're going to get in an episode. So one minute you can be doing someone with a splinter in their finger and the next minute you can be doing open-heart surgery."
How many episodes have you worked on?
"It's funny you ask that because the other day we were trying to work this out in the make-up office. I averaged about 10 episodes a year, so I reckon I've done just over 100."
Have you worked on any other shows?
"Yeh, you get calls all the time to go and do other shows. It depends for me whether there are any prosthetics in the show because that keeps it going for me. I've just finished doing a new drama for the BBC called 'Sorted' that was all about postmen. Basically it was a lot of hair cuts on all the guys, but they did give me a little bit of gore towards the end of the series where a postman got smacked in the face with a gun and lots of blood and a split down his nose. Again, it was just general make-up that we had to do for the guys.
"It was either that or a prosthetic hand being bitten off by a dog."
[Laughs]
Do you work in a team?
"On the team there's myself the designer, then I have Beverley who's my assistant and then I have another assistant as well. There are normally three or four of us on every episode of Casualty. There are two episodes filming at the same time, so there are always eight make-up people in the building and while we're not filming, there are two episodes prepping as well. So you have the designer and the assistant prepping the next episode, too. So there are normally 12 or 13 make-up designers about at the same time."
How do you cope with the pressure of everything going on at once?
"It's very busy because, as I say, the episodes vary from one to the next. I'm not the only prosthetics guy down there. There's myself and Derek and Sue who tend to do a lot of prosthetics as well. So once you're given your episodes for the series you sit down and work out what you need to do and how you're going to break down these particular scripts. And Derek and Sue will do the same because they're designers as well."
How far in advance do you see the scripts?
"Well what happens is, because it takes two weeks to film an episode, the make-up designer gets two weeks prep and within that period, I sit down and read the script on the first day and then we have medical meetings and costume and make-up meetings, where the costume designer, the make-up designer, the director, the first and the producer will sit down and decide what they want to see on the first day, which is great because then you have two weeks to actually start making that episode and ordering all the stunt-double wigs and speaking to artists and making sure they don't have any allergies to any make-ups and getting the regular artists' hairs cut and coloured."
Does it take a long time to 'prosthetic people up'?
"For instance, yesterday, I did a 14-hour day, so I was in at 6.30am and I got home at 8.45 at night. We didn't have major prosthetics, but we had a stunt that day and stunts always take ages. But if you're doing a big make-up where someone's got swollen eyes, they might need a prosthetic neck, that's all blood and gore. You'll do that on the artist at 6.30 or 7 o'clock in the morning and then you'll take it off at 8 o'clock at night. So during the day, you don't just put it on and forget about it, you have to keep going to touch up the make-up and ensure the edges aren't peeling away and making sure that the make-up looks right for camera."
What are the prosthetic injuries made from?
"It varies, really. A lot of the prosthetics we use now are silicones. For instance, if you watch Catherine Tate when she does the old grandma that's a whole silicone - different pieces on her face. That’s what we tend to use to do a lot of the cuts. But when we're doing burns, for instance, we use gelatin – glycerin and water mixed together – that we apply directly onto the skin and it creates a fantastic burn effect. Then we add a bit of colour and a bit of blood and a bit of blackening."
What's the most gruesome injury you've had to make?
"I've done so many now. There's always one that sticks in my mind and that was a young nurse who was in the show called Anna Paul played by Zita Sattar. She had her legs crushed in a train crash and they didn't have time to amputate and I think the tunnel was going to collapse. In the end they pulled her away and ripped her from her own legs. That always stays with me. And what with the sound effects that they put on as well of the bones cracking and the skin ripping and the blood pumping out, it was absolutely gruesome. On screen, it was Harry Harper – one of our doctors in Casualty – who was pulling the legs away, but in fact, it was me."
Do you ever get chance to watch you injuries on-screen? And what do you think when you see them?
"I sometimes sit and watch it. We never sit and look at the prosthetics when they're on the actor, we always wait until we see them on screen. Sometimes I think 'I wish I'd done that slightly different' and other times you're doing make-up and you think 'that looked fantastic, that looks really good.' For instance, we just did an episode where we had a character who had rotting toes and their toes were falling off. The director wanted to shoot it from quite a wide angle, so we couldn't break the actress's real toes off. We had a false bed made where we put her whole leg through and I'd built a false leg, so you could see her toes falling off and her skin breaking. It just looked so much better doing it like that and it was great for close-up work, too. And we didn't have to keep checking it because it was there all the time ready to go."
What's been the trickiest injury to recreate?
"We always hate swellings on Casualty. That's one of the main things that people go to hospital for, if they've twisted their ankle or something like that. And they say 'oh now, they've broken their arm, so it's going to be swollen' and it's one of the most difficult things to do. It's like doing the fat suits on the Nutty Professor, so you can't see any edges at all. Any injuries on which you have blood and gore is great because you can ignore edges and you don't have to worry, but swellings, they're a nightmare!"
What's the strangest injury you've had to recreate?
"We've done snooker cues through chests, tapeworms coming out of people's legs. Helen, one of our make-up designers had a nightmare with that and I think in the end she just used pasta coming out of someone's leg and it looked great tied to a bit of invisible string. Someone covered in hot tar was another one. We just used gelatin again with black pigment and covered the guy. It looked like he'd been in a gunge tank."
Has anything ever proved to be almost impossible?
"No, normally we just come up with an idea. If you sit there and read the script and think 'oh no, how am I going to recreate that', you chat to other make-up designers and they say 'oh, we did that'. For example, we did one recently where someone got hit in the face and the character just wanted to see blood run out of his nose. I thought 'how are we going to do that?' and I thought about a false head, but then I spoke to another one of the make-up designers and she said 'oh no, cut two teats off dummies stick them upside down in the actor's nose and fill them with blood, put his head back and when his head comes forward, the blood runs out. It was perfect. Simple, cost-effective - £2 to create the effect and it worked absolutely brilliant."
So there's always a workaround then?
"Yeh, there is within reason. I mean we've got some fantastic model makers now. We've been asked to make children in the past up to about eight years old. I think we have one girl that was about eight or nine and she had to be frozen in a freezer, so we got our model maker, Lawrence, to sculpt a life-size child. It was like going to Madame Tussauds and seeing this prosthetic child which you'd wheel into ‘resus’ on a bed. It's great because when we're filming with children we have to worry about their hours, but we had a whole body made which we could use all the time."
How do the fake syringes work? And where does the liquid go?
"[Laughs] We've got two ways of doing it. If you need to see blood coming out, we'll make a prosthetic with a blood canal underneath or we've got syringes which do go back into themselves as well for quick shots and distant shots and the actors can use them as well, they're safe – they've been blunted off so you can actually touch the skin with them. The good thing is that with the syringes that go back in on themselves, there's actually no liquid in them – the material which they're made from is magnified so it looks like there's liquid in them, but normally because the camera doesn't pick it up you don't see it - tricks of the screen really."
During surgery when a 'chest' is cut open, is that prosthetic then rendered 'used'? If there has to be another take, do you create another one for backup?
"The same one's normally used. This episode that we're doing at the moment involves open heart surgery and we've got one where the side's already split open. We do tend to keep these things in stock, too, so we can use them again. The prosthetic is draped in surgical greens so you don't see edges and that sort of thing and so you can actually get your hands in there. But if you're doing a scene where someone's splitting skin with a scalpel, I'll always have a few of those prepared. I might say to the director 'you've got two or three goes at this and that's all you've got'. It might work perfectly first time, but there might be a hitch with the lighting so you have to do it all again."
How's the blood made?
"We actually buy the blood in from different companies. There are so many different types of blood that you can buy. You can get dry blood, congealed blood, fresh blood, artery blood, different vein blood, blood for the eyes, blood for the mouth – edible bloods that come in different flavours such as vanilla, chocolate, any flavour made up that you want really."
How do you recreate a heart pumping in a chest during surgery?
"It's either puppeteered so you can stick three fingers in and make it move or on Holby - because we don't really get chance to see many of the hearts pumping on Casualty - they have air pumps that go into the prosthetics which blow up and deflate. The fake babies are done with valves and pumps. Lawrence, the guy who makes all of our prosthetic babies, can spend two weeks making one. We had one baby that had to have an epileptic fit and that was absolutely superb. That was done with puppetry again."
Do you work on Holby as well?
"Yes, we've done quite a few cross-over episodes on Holby, normally around the Christmas episodes, so either they'll come down and work with us or we'll go up to Holby and work."
Is there another Casualty @ Holby planned for this year?
"I don't think there is actually, not that I've heard of at the moment. But you never know. I might pick up my next script and read it and 'oh, we're off to Holby'."
Do you have a room in your house where you keep your best prosthetics on show?
"[Laughs] I used to in my old house. I had a pile of chopped off hands in the hallway, but not any more. I thought I can't do this any more. Too many people would walk in and walk straight back out again so I got rid of them. Now, when the prosthetic room gets filled up, a lot of our prosthetics we use on the show get given to charity to auction off."
Did you go out to Cambodia to film for the 20th anniversary episodes?
"Yes, I did. We went out there a few months back now. It was exciting and extremely hard work working in the heat and those conditions, with the prosthetics as well. I wasn't sure how different things would cope, especially with the blood; I found that a nightmare. When applying blood to people that were sweating, the blood would just spread instead of just sitting on the skin like it does over here. But we found ways round it. We'd always mop them up and keep applying fresh blood all the time. You can't go all the way to Cambodia with Casualty without any blood!"
What injuries did you recreate out there?
"For the 20th we've got a bit of brain surgery going on and we've got a quite severe double-decker bus crash. It's the first time it's ever happened on British television."
Is there anything you've not been asked to do that you'd love to recreate?
"No is the simple answer to that [laughs]. Since a couple of years ago, I'd always wanted to do an amputation and it seemed like every other designer was getting amputations and I wasn't – I'd always end up with chest strains. Then finally I got legs being ripped of and I've just done another amputation in my most recent episode."
Have you ever played any pranks on anyone with your creations?
"I used to when I was younger all the time. My mum and dad gave me this thing called a Hollywood Horrors Kit where you could turn yourself into a zombie and create different wounds and I was always doing it when I was about 15 or 16 but no, not any more. I always get asked to do fancy dress parties and Halloween.
"On set, lunchtime's the worst when you sit across from people with half of their face hanging off and I have to eat my lasagna while they're sitting there. For the actors that come in, they sometimes find it a little hard to look at the faces and they just find people staring at them all the time as well. A new thing that's started happening is that when actors sit in the chair and they're being made up, they always get their camera phones out and take a picture of their makeup when they're all bloody and gory and send it to their friends."
Do you think Casualty's got longevity to stay on screen for another 20 years?
"I think as long as Casualty writers keep coming up with the stories and the viewers enjoy watching it, then yes. There's always something that scares people about hospitals, they never want to go into hospital themselves, but they're quite happy watching it on the screen seeing other people go through the trauma and the injuries. Fingers crossed, you never know."
Well, thanks for all that, Marcus. I was just going for a snack, but I don’t think I’ll bother now… pass the bucket, someone…
