So often today, you turn on the news to see that another shooting has happened in the nation. They happen at schools, movies, concerts, nightclubs, grocery stores, shopping malls, and even in health care facilities.

Do you know what you would do if you were around when an active shooter event took place? David W. McRoberts, CPP, a retired Law Enforcement Captain with 30 years of experience, is a security consultant for The Sullivan Group, is the Owner of Assured Assessments, Inc., and is the co-author of the course “Active Shooter Event in a Healthcare Environment.” McRoberts says that instead of becoming a victim who says after such an event, “I couldn’t believe what was happening, and there was nothing I could do,” nurses need to know that “There is always something each of us can do—but we must have thought it through in advance.”

Develop These 3 Habits

McRoberts says that nurses should subscribe to the following personal protection skills as their personal safety habits:

  • Situational Awareness: Knowing exactly where they are, where they are moving to or from, and what exists around them in terms of their realistic ability to react to occurrences in their presence.
  • It Can Happen Anywhere: Nurses must acknowledge that bad things happen—and often without warning. McRoberts says that this doesn’t mean nurses need to become paranoid, but rather, understand that shootings can happen anywhere.
  • See the Threat: He also states that nurses must develop the ability to look for and see threats—and suspend disbelief. “They must take the first two habits and merge them into an ironclad ability to not become paralyzed with shock and fear and fall victim simply because they never once even considered the fact that they would need to function in a moment of the gravest extreme,” says McRoberts.
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Shots Fired: What Do You Do?

When asked about the first thing that nurses should do, McRoberts says, “Because nurses are professional caretakers with ethical, moral, and personal value-based responsibilities in the care of others, this is not an easy circumstance to navigate. Active Shooter Events on average last about two minutes. Shooter victims can be random or specific individuals that the shooter targets.

“With that as a baseline, I believe that creating or increasing what law enforcement refers to as the ‘reactionary gap’ is essential. Simply put, this is creating more distance and/or cover between themselves and the threat. That may mean temporarily leaving the immediate area of patient care. Nurses may feel they are abandoning their patients, but they need to remember that these events are over in about two minutes. The brutal truth is that when faced with a person bent on shooting and killing people, nurses who are determined to remain stalwart and immovable will, in all probability, become victims themselves and incapable of delivering patient care. It’s better to have moved away from the threat and then return to patients when the event is over.”

Do You Interact?

What happens next? Do nurses provide aid? Should they talk with the shooter? “There are as many different scenarios to Active Shooter Events as there are events themselves; they are very dynamic events. A nurse’s first reaction to an injury resulting from an Active Shooter Event would be to render aid. Perhaps this is the right thing to do—maybe this action will decentralize the shooter’s thought process enough to stop the carnage. But like so many reported Active Shooter Events, it may be that nothing stops the shooting and killing until and unless the shooter stops or is stopped,” explains McRoberts. “A nurse may believe he/she can reason with an active shooter, but attempting this may be a tactical mistake; interacting/talking with a person who has already decided to shoot, injure, and kill others is too risky. Begging for compassion from a shooter—including begging for their own life or the life of another—needs to be supplanted with fighting for their own life and the lives of others.”

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 Keeping a Clear Head

Unless you prepare before an Active Shooter Event occurs, it can be nearly impossible to keep a clear head. “Each of the previous skill developments build one upon the other to create a foundation of action items that give nurses the best chance to survive. With that as underlying support, the next step is practicing ‘stress inoculation’—not the clinical variety, but the very practical application of understanding our limitations as humans and what happens to us physiologically when we are under extreme stress,” says McRoberts.

“Tachypsychia, auditory exclusion, and fine motor skill erosion occur in everyone and diminish our abilities to function under stress. However, we can mitigate these negative effects and develop the ability to function through the high stress of an Active Shooter Event. In its most basic form, stress inoculation is the practice of very specific actions, movements, and functions. Consider what we would need to do in a high-stress event: see clearly what is happening; speak clearly to communicate; walk or run; dial a phone; etc. To complete tasks under stress, nurses need to practice them while under manufactured stress,” says McRoberts. “For example, a common situation in an Active Shooter Event might be finding and climbing stairs, and then dialing your cell phone and telling someone out loud your exact location. Nurses can practice speaking into a phone clearly and in a controlled manner while breathing at an accelerated rate from a brisk walk, run, or stair climb; they can test and challenge each other with random quizzing by unexpectedly asking a colleague exactly where they are located; and they can follow that up with asking them where they would move to for the greatest level of safety. These seem like extremely simple things, but it is practicing them in advance that is the secret to making them ‘simple.’ Once you know you can do these things, it creates a positive cascading effect of believing in yourself and your ability to complete these tasks under stress. Like anything else, the more we practice something, the better we get at it.”

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Final Tips

McRoberts give these final tips to give nurses guidance as to what they should and shouldn’t do in an Active Shooter Event:

  • Look for the threat and then react to it; don’t panic and freeze.
  • Remember that this event will happen quickly and will only take about two minutes, but you will perceive it to be very long and protracted.
  • Rely upon your new mindset, knowing that you can function through this event.
  • Know exactly where you are (your surroundings) and where you must move to for safety.
  • Know what to say to communicate to others, including what may be required by pre-established agency/facility protocols.
  • Know that you may have to move more than once.
  • Don’t try to negotiate or plead with an active shooter; you are better fighting for your life, not begging for your life.
  • Know in advance that you may have to move away from patients temporarily to survive so you can be there to help them later.
  • Know that when law enforcement gets to the scene, they will move quickly past everyone and everything to get to the shooter and stop them; this may mean moving past injured people, patients, colleagues, and you.
Michele Wojciechowski
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