Active Shooter: What Can School Nurses Do?

Beth Hawkes MSN, RN-BC - 03/20/19

Active Shooter

The sound of gunshots rang out in the elementary school’s hallways, followed by screams of terror. Then there was complete silence, which was equally terrifying. Kim, the school nurse, instinctively grabbed the third grader who had limped in with a scrape on her knee, and pulled her to the far corner of the office. They crouched down. There was nowhere to hide. Silence.

They jumped as gunshots suddenly went off again, but this time closer. The office door was closed, but they could clearly hear approaching footsteps outside in the empty corridor. Brianna, the third grader, whimpered and clung to Kim, knee wound forgotten.  Neither noticed the warm trickle of urine spreading on the floor at their feet. Overhead Kim heard “Code Red Lockdown, Code Red Lockdown”. “It’ll be OK, it’ll be OK” she reassured little Brianna and hugged her close.

Kim’s felt paralyzed, too afraid to move. Was the door locked? Should she get up and lock it? Push her desk in front of it to barricade?

From Rare to Recurrent

Nurse’s training does not include preparing for an active shooter while on the job. Not so long ago, a scenario such as this one was unimaginable. Mass shootings were unheard of, let alone mass shootings of children.

Everyone remembers the school shooting at Columbine High School in Jefferson County, Colorado, 1999. No one can forget the massacre at Sandy Hook Elementary School in Newton, Connecticut, in 2012. But today, so many school shootings have happened that they fail to shock as Columbine did. The list and names of schools and victims are too long to recall, and were not etched into memory with the horrifying shock that made Columbine a household word.

Only the most deadly shootings capture our interest. Violence has permeated our society at all levels. Some authorities claim there have been over 18 school shootings in 2018 alone, while others dispute that number. All agree shooting sprees are not rare. What once was an isolated, horrific occurrence has become a recurrent nightmare. According to the Washington Post, half of the 12 deadliest shootings occurred after 2007.

Active Shooter

The U.S. Department of Education, the U.S. Department of Justice/FBI, and the U.S. Department of Homeland Security/Federal Emergency Management Agency all agree that the definition of an active shooter is “an individual actively engaged in killing or attempting to kill people in a confined and populated area.”

A study of active shooter incidents initiated by the FBI in 2014 provided federal, state, and local law enforcement with data to better understand how to prevent, prepare for, respond to, and recover from these incidents. This information resulted in guidelines that have been adopted by institutions, including schools and hospitals. No one is immune, including healthcare workers.

Be prepared

When someone is in an emergency or extreme stress, they can experience diminished capacity to process and make decisions. Some victims don’t react fast enough because they remain in denial mode. Often shooting events are over in a matter of minutes, even seconds. Nurses must be prepared to react immediately in the event of an active shooter in a school or hospital.

Being prepared means your mindset is that a shooting can happen any time, any day, any place. Being mentally prepared for action can mean survival.

There’s a reason CPR skills are repeated and practiced regularly. It’s so the respondent can immediately go into action in the event of an emergency. The same is true for active shooter preparation.

  • Know your facility’s emergency plan and procedures. That means actively engaging during the training session. It could save your life. Boost your memory later by reviewing the information. 
  • Know your facility’s nooks and crannies, exits and hallways. Look at spaces as potential hiding areas, and identify what could be used as a barrier to block a door.
  • Identify two exits whenever you enter a space
  • Know your facility’s address! You will be asked the physical address if you call 911.

Call For Help

If it’s safe to do so, call 911. If it is not safe to speak, dial the number and leave the line connected so the dispatcher can hear what’s going on. Some areas now have texting to 911 to activate emergency response in situations where talking puts you in danger.

If possible, give the location of the shooter, the number of shooters, the weapons and number of injured or potential victims.

Active Shooter in School

A complete lockdown is immediately ordered when there is an active shooter and an imminent threat of danger. A complete lockdown means:

  • Everything Locked
  • Everyone Secured
  • On the Floor and Quiet

Teachers are to make their rooms look unoccupied by locking the doors, turning off the lights, and getting children away from the windows. Everyone immediately gets into a lockable space. They get down on the floor away from view of windows, and remain completely quiet. The door should not be unlocked for anyone. The door can be barricaded with bookcases, furniture and desks.  

Active Shooter in Hospital

The code for an active shooter is “Code Silver”. Nurses are now taught to “Run”, “Hide” or “Fight” with an emphasis on “Run”.


  • Leave your belongings
  • Leave immediately
  • Leave your patients
  • Discontinue tasks/care
  • Don’t wait for others to follow you
  • Do not stop to help wounded victims


Depending on the situation or where you are your best option may be to hide. You know your facility better than anyone else- the halls, closets, exits. Lock the door to your hiding place and block the entry. Silence your cell phone or pager.


Prepare to fight as a last resort. If there is nowhere to run or to hide, attack the shooter with whatever is at hand. Scissors, fire extinguishers, syringes and books make impromptu weapons

If you are going to fight for your life, be as aggressive as possible. Disrupt and incapacitate.

When police arrive

 According to the Department of Homeland Security:

  • Remain calm and follow instructions 
  • Put down any items in your hands (i.e., bags, jackets) 
  • Raise hands and spread fingers 
  • Keep hands visible at all times 
  • Avoid quick movements toward officers such as holding on to them for safety 
  • Avoid pointing, screaming or yelling 
  • Do not stop to ask officers for help or direction when evacuating

Being prepared and having a plan can keep you alive if the unthinkable happens at your school or hospital.

Related CE topics: BioterrorismDomestic and Community Violence 

Blair, J. Pete, and Schweit, Katherine W. (2014). A Study of Active Shooter Incidents, 2000 - 2013. Texas State University and Federal Bureau of Investigation, U.S. Department of Justice, Washington D.C. 2014.