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About 8 years ago, California nurse Kate Carleton, RN, was watching a news special on an anniversary of the Sandy Hook elementary school shooting when she began wondering what her kids would do if they were ever in a situation like that.

Her children were 5 and 7 at the time, in kindergarten and second grade.

"It hit home really hard," Carleton told MedPage Today. "I wanted to make sure if they were ever in a situation where they needed to help themselves or help somebody else, they'd have some skills to do it."

So Carleton approached her kids' teachers and the school's principal, offering to teach bleeding control techniques to the students.

When the principal asked about calling 911 and having emergency medical services (EMS) respond to the scene, Carleton emphasized the gaps.

"The scene has to be cleared first, meaning there can't be a threat to EMS, so it can take a minute," Carleton said.

Hearing that, the principal was sold, and so began Carleton's bleeding control course for kids, which she and her colleagues from Sutter Roseville Medical Center have now taught to more than 10,000 students, from kindergarten and elementary school up to high schoolers. It's a modified version of the American College of Surgeons' "" program, which teaches bystanders how to tend to hemorrhages.

Key skills include applying direct pressure, wound packing, and tourniquet application, but these are determined by student age. Kindergarteners through 6th graders are taught how to pack a wound and apply direct pressure, while high schoolers also learn how to manage a tourniquet and give hands-only cardiopulmonary resuscitation (CPR).

The first lesson is recognizing uncontrolled hemorrhage, Carleton said. That means looking for a puddle of blood, clothes that are soaked, or gushing blood -- and for the youngest kids, that's described as looking like a "sprinkler."

A critical component is teaching the kids to make sure they're in a safe environment before going to help. "We don't want them knowing this and then running into a situation where it's not safe," she said.

For wound packing, kids are taught to find something to pack into a wound anywhere on the body. "You pack in whatever you can, and hold direct pressure," Carleton said. "We keep it very simple for them."

When it comes to training younger kids, Carleton said the team has worked hard to make sure the material isn't threatening or scary.

"We work with the teachers because they're the experts," Carleton said. "We try to figure out the best way to get the information across to these kids."

That includes teaching them about the usefulness of bleeding control in situations that may be more relevant to their lives -- such as a parent who gets injured during a car crash, or a classmate getting cut on glass after a ball goes through a window.

"This definitely came from [gun violence] and that's what it's associated with, but I also think it's important because we see all kinds of uncontrolled hemorrhage that's not related to gunshot wounds," Carleton added.

Amanda Makis is the principal at the elementary school that Carleton's children attended, and was the first school to host the bleeding control program. "I thought it was a great idea," she told MedPage Today. "Any time kids can learn first aid skills, it's a benefit."

She noted that kids are given relatable situations, such as a parent cutting their finger while chopping vegetables, or being injured by power tools, or getting into an accident while hiking. "It's introduced as real, practical things that happen in everyday life, so I think it's very relevant for them."

Cedric Dark, MD, MPH, an emergency physician at Baylor College of Medicine in Houston who has an , agreed that it was a good idea to teach bleeding control techniques to children.

"What better place to teach kids beefed-up first-aid skills than in school?" Dark said. "Hopefully they never have to use it, but maybe they will. ... They can use what they learned to save a life."

Dark added that it's "not always about mass casualty incidents. It's an everyday first-aid skill, and as we disseminate it more, it will save people from dying in the field, and give them enough time to get to a trauma center and give us a chance to do our jobs in the emergency department and operating room."

He said bleeding control should be taught widely, including to adults, as it's a critical life-saving skill, "like learning CPR, or how to use an AED [automatic electronic defibrillator]."

Carleton's classes are about 30 minutes long, and they're done during the school day. Sometimes, EMS partners such as a town's fire department will participate.

Out of nursing school, Carleton went straight to work in the emergency department at Sutter Roseville, which is a level-2 trauma center, covering a wide area including the foothills of the Sierra Nevadas, "so it does get quite a few traumas coming in," she said. She then moved into the trauma program full-time and got involved with community education and prevention programs, and has been at Sutter for 17 years.

Few parents have been hesitant about the program, Carleton said, and she's received positive feedback from the community. She recalled one teacher whose class had just been through an active shooter drill, and found the timing of the course to be especially helpful.

"One of the kids looked at her and said, 'What do I do if my friend gets hurt?'" Carleton said. "I do think some of these kids are putting it together, and they want to know what to do."

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