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 that contains at least:

·       Tourniquets that are:  Approved for use in battlefield trauma care by the U.S. armed forces

·       Bleeding control bandages

·       Latex-free gloves

·       Permanent markers

·       These kits will be kept with all building AEDs

3.      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 that is flowing continuously

      * Blood pooling on the ground or soaking clothing or bandages quickly

      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, on or off campus, where feasible.

IV. Responsibilities

A.     Superintendent or District Administration Designee

1.      Ensure district compliance with 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 about:

·       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 in their building

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

·       Bleeding control kit locations

·       Trained personnel in the building

3.      Ensure the integration of bleeding control response into:

·       Building emergency operations plans

·       Relevant drills

C.    School Nurses/Health Services Coordinator

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

2.      Assist with:

·       Training coordination

·       Kit inspection and restocking

·       Staff education and drill planning

·       Keeping record of inspection and restocking

·       Keeping a record of trained staff

3.      The school nurse/ and other designated staff will receive annual training in the use of a bleeding control kit, including:

·       Proper application of pressure to stop bleeding

·       Proper application of dressings or bandages.

·       Proper application of tourniquets

·       Respond to suspected traumatic blood loss incidents

·       Collaboration with EMS upon their arrival

D.    All Staff

All staff should:

1.      Be able to identify traumatic blood loss incidents (life threatening bleeding)

2.      Immediately notify the nurse/office/admin- You can use the “CERT team Bleeding”

3.      Request a bleeding control kit, and if trained and safe to do so, begin basic measures by holding direct pressure on the wound until the trained personnel arrive

V.  Emergency Response Procedure for Traumatic Blood Loss

     A. Step 1- Check

              1. Ensure the scene is safe and check the person who is bleeding.

              2. Is bleeding life threatening? Spurting, pooling, or flowing quickly?

    B.  Step 2- Call

              1. Call for help- CERT team bleeding, office, nurse, administrator

              2. Office to call 911 and wait for EMS and lead to the scene

  C.    Step 3-Care

1. Apply direct pressure to wound using latex free gloves if available.  Must apply             enough pressure for bleeding to stop.  Press firmly and continuously.

2. When available place a clean bandage on the wound and press firmly and continuously.               

3.   Firm, steady, continuous pressure is what stops bleeding. You can use direct pressure, a tourniquet, or both to control bleeding.

a.      Direct pressure is used to control life- threatening bleeding on the head, neck or trunk.

b.      A tourniquet is used to control life- threatening bleeding on the arms or legs. Apply direct pressure until the tourniquet is on and tightened.

c.      Direct pressure may also be used to control non-life- threatening bleeding.

4. When a trained person arrives with a tourniquet, they should apply the tourniquet tight enough to completely stop the bleeding, 2-3 inches above the wound.  A second tourniquet may be used if the bleeding is not controlled by a tourniquet and direct pressure above the second tourniquet.

5. When applying a tourniquet use the permanent marker to write the time the tourniquet was applied on the tourniquet, a visible tag, or the patient’s skin.

6. Stay with the person maintaining bleeding interventions, monitoring responsiveness and breathing, and reassure the individual until EMS arrives.

7. NEVER remove a tourniquet after it is applied.  It must be done by a physician.

This visual will be placed with every bleeding control kit.
 

References:  American Red Cross

                           Missouri Revisor of Statutes (.gov)

 

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