Health Services

Staying home when sick can lower the risk of spreading infections. Under routine circumstances, some illness spread among school communities is expected. In general, children with improving symptoms should be able to participate in school.

If a child’s needs while sick with an infectious illness would interfere with school staff’s ability to teach and care for other students, the child should stay home. Schools must balance the risk of infectious disease spread with educational, social, and mental health needs of children when determining when students should stay home.

Schools, parents, and caregivers often do not know what specific illness a child may have; rather, children present with symptoms. If someone has the following symptoms, they should stay home because their illness could affect their ability to participate in school and there is concern that they might spread an infection to staff and students.

When to stay home from school: 

• Fever, including a fever with a new rash.
• Vomiting more than twice in the preceding 24 hours.
• Diarrhea that causes ‘accidents’, is bloody, or results in greater than two bowel movements above what the child normally experiences in a 24-hour period.
• Skin sores that are draining fluid on an uncovered part of the body and are unable to be covered with a bandage.
• Respiratory virus symptoms that are worsening or not improving and not better explained by another cause such as seasonal allergies.

The above list describes symptoms of common illnesses experienced in school-aged children and can also apply to school staff. Schools should develop policies for common illnesses, such as strep throat and hand-foot-mouth disease, that are informed by CDC pathogen-specific guidance, with assistance from school health teams and other professionals with expertise in infectious disease management and spread. Teams can include people with child-health and infection-prevention expertise, such as school nurses, pediatricians, and health department advisors. When developing illness-specific policies, schools can reference resources from school health experts (for example, the American Academy of Pediatrics , the National Association of School Nurses, and the School-Based Health Alliance) who provide several resources that may be useful. Schools can also refer to state and local health department school health resources.

When a person can return to school depends on the nature of the illness. In general, a child returning to school should be well enough to participate in school (e.g., can adequately manage improving cough and congestion on own, not overly fatigued), and care of the returning child should not interfere with the school staff’s ability to teach or care for other students. Students and staff returning to school following an illness may still be contagious, but are likely to be less contagious as symptoms improve, depending on factors like duration and severity of illness. Parents and caregivers should consult their child’s health care providers with specific questions about their child’s condition or recovery.

When to return to school: 

• The child has not had a fever (and is not using fever-reducing medicine) for at least 24 hours.
• Fever with a new rash has been evaluated by a healthcare provider and fever has resolved.
• Uncovered skin sores are crusting, and the child is under treatment from a provider.
• Vomiting has resolved overnight and the child can hold down food / liquids in the morning.
• Diarrhea has improved, the child is no longer having accidents or is having bowel movements no more than 2 above normal per 24-hour period for the child. Bloody diarrhea should be evaluated by a healthcare provider prior to return.
• Respiratory virus symptoms are getting better overall for at least 24 hours. Students and staff returning after a respiratory illness can consider additional actions to reduce spread.

Traumatic Blood Loss / "Stop the Bleed" Protocol

(Implemented pursuant to 160.485, RSMo)

I. Purpose

The purpose of this protocol is to:

1. Provide a standardized, district-wide response to injuries involving traumatic blood loss ("life-threatening bleeding") on school property or during school-sponsored activities.

2. Implement the requirements of the Stop the Bleed Act (160.485, RSMo), including:

   • Placement and maintenance of bleeding control kits.

   • Designation and training of school personnel in bleeding control techniques.

   • Integration of bleeding control kits into district emergency plans and drills.

II. Definitions

1. Bleeding Control Kit: A first-aid response kit kept alongside all building automated external defibrillators (AEDs) that contains at least:

   • Tourniquets approved for use in battlefield trauma care by the U.S. Armed Forces

   • Bleeding control bandages

   • Latex-free gloves

   • Permanent markers

2. Traumatic Blood Loss (Life-Threatening Bleeding): Significant bleeding that may quickly result in serious injury or death if not controlled, including but not limited to:

   • Spurting or pumping blood

   • Blood flowing continuously

   • Blood pooling on the ground, soaking clothing, or quickly saturating bandages

III. Scope

This protocol applies to:

• All district school buildings, facilities, and grounds.

• All students, staff, volunteers, and visitors present on district property.

• All district-sponsored events, both on and off campus, where feasible.

IV. Responsibilities

A. Superintendent or District Administration Designee

1. Ensure district compliance with the 160.485, RSMo traumatic blood loss protocol.

2. Maintain documentation of:

   • Bleeding kit locations

   • Annual training rosters and certifications

   • Inspection and restocking records

3. Ensure information regarding the traumatic blood loss protocol and the national Stop the Bleed campaign is posted and maintained on the district website as required by 160.485, RSMo.

B. Building Administrators

1. Implement this protocol within their assigned building.

2. Maintain an up-to-date record of:

   • Bleeding control kit locations

   • Trained personnel in the building

3. Ensure the integration of bleeding control response into:

   • Building emergency operations plans

   • Relevant crisis drills

C. School Nurses / Health Services Coordinator

1. Serve as the primary point of contact for medical readiness and Stop the Bleed kits in each building.

2. Assist with:

   • Training coordination

   • Kit inspection, maintenance, and restocking

   • Staff education and drill planning

   • Recordkeeping for kit inspections and trained personnel

3. Complete annual training in the use of bleeding control kits (along with designated staff), covering:

   • Proper application of direct pressure to stop bleeding

   • Proper application of dressings and bandages

   • Proper application of tourniquets

   • Response protocols for suspected traumatic blood loss incidents

   • Collaboration with EMS personnel upon their arrival

D. All Staff

All staff members should:

1. Be able to recognize indicators of traumatic blood loss (life-threatening bleeding).

2. Immediately notify the nurse, main office, and administration (using the notification phrase: "CERT Team Bleeding").

3. Request a bleeding control kit, and if trained and safe to do so, apply firm, direct pressure to the wound until trained responders arrive.

V. Emergency Response Procedure for Traumatic Blood Loss

Step 1: Check

1. Ensure the scene is safe, then evaluate the injured individual.

2. Determine if the bleeding is life-threatening (spurting, pooling, or flowing continuously).

Step 2: Call

1. Call for internal support immediately: notify the office, nurse, administrator, and announce "CERT Team Bleeding."

2. The main office will dial 911, dispatch staff to meet EMS responders, and guide them directly to the scene.

Step 3: Care

1. Apply Direct Pressure: Use latex-free gloves if available. Apply firm, steady, and continuous pressure directly to the wound to halt blood flow.

2. Apply Dressings: When available, place a clean bandage directly on the wound and continue pressing firmly without lifting.

3. Select Method of Control:

   • Direct Pressure: Used to control life-threatening bleeding on the head, neck, or torso/trunk. Also used for non-life-threatening bleeding.

   • Tourniquet: Used to control life-threatening bleeding on arms or legs. Continue holding direct pressure until the tourniquet is secured and fully tightened.

4. Tourniquet Application:

   • Apply the tourniquet 2 to 3 inches above the wound (never place directly over a joint). Tighten until bleeding stops completely.

   • If bleeding is not controlled, a second tourniquet may be applied directly above the first tourniquet.

5. Record Time: Using a permanent marker, write the exact time of application directly on the tourniquet time strap, an attached tag, or the individual's skin.

6. Monitor: Stay with the individual, maintain wound intervention, monitor responsiveness and breathing, and provide reassurance until EMS personnel take over.

7. Do Not Remove: Never loosen or remove a tourniquet once applied. Removal must be performed solely by an emergency room physician.

(A visual reference guide is placed inside every district bleeding control kit.)

References: 
American Red Cross

Missouri Revisor of Statutes (.gov)

Developed 12/2/2025 Tamara Smith-Hinchey BSN,RN, NSCN