School Safety

The purpose of Courage2Report Missouri is to prevent school violence. Anyone can submit a confidential tip to Courage2Report through the link for their specific school building. More information on Courage2Report Missouri can be found HERE.

Traumatic Blood Loss Protocol

1. Require that a bleeding control kit be placed in areas where there is likely to be high traffic or congregation, such as auditoriums, cafeterias, or gymnasiums, and areas where risk of injury may be elevated, including vocational classes such as woodworking or automotive classes, in each school building in an easily accessible location of such areas to be determined by local emergency medical services personnel. 

2. Include bleeding control kits in the emergency plans of each school building, including the presentation and use of the bleeding control kits in all drills and emergencies; 

3. Require each school building to designate a school nurse or school health care provider or, if no school nurse or school health care provider is available, a school personnel member, who shall obtain appropriate training annually in the use of a bleeding control kit including, but not limited to: 

• The proper application of pressure to stop bleeding. 

• The proper application of dressings or bandages. 

• Additional pressure techniques to control bleeding.  

• The correct application of tourniquets; 

4. Require each bleeding control kit in school inventories to be inspected annually to ensure that the materials, supplies, and equipment contained in the bleeding control kit have not expired and that any expired materials, supplies, and equipment are replaced as necessary; and require a bleeding control kit to be restocked after each use and any materials, supplies, and equipment to be replaced as necessary to ensure that the bleeding control kit contains all necessary materials, supplies, and equipment. 

5. The district shall, in collaboration with the United States Department of Homeland Security and the State Department of Public Safety, include requirements in the traumatic blood loss protocol for school personnel to receive annual training in the use of bleeding control kits. 

6. The training requirements shall be satisfied by successful completion and certification under the "STOP THE BLEED" course as promulgated by the American College of Surgeons Committee on Trauma or the American Red Cross. 

• The training requirements may allow online instruction. 

7. A bleeding control kit may contain any additional items that: 

• Are approved by emergency medical services personnel, as such term is defined in section 190.600; 

• Can adequately treat an injury involving traumatic blood loss; and 

• Can be stored in a readily available kit. 

• Quantities of each item required to be in a bleeding control kit may be determined by each school district. 

8. The school district shall maintain information regarding the traumatic blood loss protocol and the Stop the Bleed national awareness campaign on the district’s website. 

Upon request by a school district or a charter school, the department may, in collaboration with the department of public safety, direct the school district or charter school to resources that are available to provide bleeding control kits to the school district or charter school. 
 

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Emergency Steps - What to Do if Someone is Bleeding

1. Check the scene safety, form an initial impression, obtain consent and put on PPE, as appropriate.

2. Check for signs and symptoms.

• Blood volume equal to about half a soda can (less in a small child or infant)*
• Blood flowing continuously or spurting*
• Signs and symptoms of shock*

*Note: Signs and symptoms with a * require immediate emergency medical treatment.

3. Call 9-1-1 and get equipment if the person requires immediate emergency medical treatment.

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How to Stop Bleeding for External Injuries

1. Apply direct pressure to wound.
2. Apply direct pressure and a tourniquet (if trained) for life-threatening bleeding on a limb.
3. Use wound packing (if trained) for life-threatening bleeding from the scalp, neck, shoulder, groin, and back or from a limb if no tourniquet is available.
4. Continue checking them as appropriate to determine if additional care is needed.
5. Keep them from getting cold or overheated.
6. Give care for shock, if necessary.
7. Stay with them until EMS arrives.
8. Position the person as appropriate.
9. Reassure them you will help and that EMS has been called.
10. Watch for changes in condition, including breathing and responsiveness, and give care as appropriate and trained.

Applying Direct Pressure to Control Bleeding

1. Find the source of the bleeding.
2. Place dressing on wound. Use a hemostatic dressing, if available.
3. Apply steady, firm pressure directly over wound. Make sure the injured body part is on a firm, flat surface.
4. Hold direct pressure until bleeding stops or a tourniquet is available.
5. If bleeding stops before EMS arrive
   • Check circulation beyond injury.
   • Apply a roller bandage over the dressing and secure it firmly.
   • Re-check. circulation beyond the injury.
6. Monitor for re-bleeding. If bleeding recurs:
   • Do not apply an additional dressing or bandage.
   • Remove bandage and leave only the single dressing on wound in place.
   • Apply direct manual pressure.

Life-Threatening Bleeding FAQs

How long should I apply direct pressure for life-threatening bleeding?

Hold direct pressure until:

• The bleeding stops.
• A tourniquet is applied (for life-threatening bleeding from an arm or leg) and bleeding has stopped.
• Another person relieves you.
• You are too exhausted to continue.
• The situation becomes unsafe.

What if blood soaks through the original dressing while I’m applying direct pressure to the wound?

If blood soaks through the original gauze pad, you do not need to do anything, but you can put another gauze pad on top. Replace the new gauze pad as necessary if blood soaks through the pads. Do not remove the original gauze pad and do not stack multiple gauze pads.

How do I check for circulation?

When checking for circulation, check the skin on the side of the injury farthest from the heart (e.g., the hand or foot) for temperature, color and feeling. Also ask the person is there is any numbness or tingling.

What do I do if the wound is from an embedded object?

• Do not attempt to remove it. Removing the object can make the bleeding much worse.
• Apply pressure around the object.
• Place several dressings around the object, then pack bulk dressings or roller bandages around it.
• Bandage the bulk dressings or roller bandages in place around the object and seek medical care.
• If you need to apply a tourniquet, apply above the embedded object.

The person looks pale and feels cold and dizzy. What does this mean?

This means the injured person could be in shock because there isn't enough blood flowing through the body. It can be life-threatening because it can lead to a heart attack or other organ damage very quickly.

What is shock?

Shock is a progressive, life-threatening condition in which the body does not get enough oxygen-rich blood often due to disturbed blood flow. As a result, organs and body systems begin to fail.

Signs and symptoms include:

• Rapid, weak heartbeat
• Rapid breathing
• Pale, gray, or cool moist skin
• Altered level of responsiveness
• Excessive thirst

Should I worry about infection or catching something from the person’s blood?

While the risk of an infection is low, it is best to not contact someone else's blood when possible. You can use latex-free disposable gloves, a plastic bag, or get them to use their own hand to put pressure on the wound.