Active Shooter Training

A look at Active Shooter Training. The Run, Hide and Fight Options. Quick facts about shootings in the US, workplace violence and why nurses are at risk! Nurses General Nursing Article

Active Shooter Training

I live and work in Miami, Florida roughly an hour's drive from Marjory Stoneman Douglas Senior High School. The recent Valentine's Day shooting at that school which left 17 students and faculty dead continue to be a topic at the nurse's station. I had the opportunity to attend an active shooter training workshop run by a major healthcare/academic institution since then.


Thirty-three percent of shooters committed this horrific act due to a grudge.1 The other data show that 14 % of the shooters did this to flee the hospital. 11% were suicidal. The remaining 15% acted out due to violent tendencies. 1 Although shootings that occur in hospitals are not the norm, active shooter training is still a staple during nursing and system-wide hospital orientations. Data shows that 14 shootings happened per year with a total of 154 between 2000 and 2011.1 This is according to research done at Johns Hopkins.1 Of the 154 shootings, we can further reveal that 59% or 91 shootings happened inside the facilities and 41% or 63 occurrences happened on hospital premises.1


In a shooter situation there are three options, "run, hide, and fight".2 These are your basic choices. Let's imagine a scenario at work in a hospital. A shooter emerges from a patient's room, or the elevator and walks toward the nurse's station. This is where the "run, hide and fight" options come into play.

RUN - Evacuate (Get Out)

This is known as the Run option.2 It means that you should leave the area. In the hospital setting, of course, there are patients. This means to assist others to leave, and this is if possible. Follow your hospital policy and of course, this is your life we are talking about. Go with your survival instincts. Don't worry about your purse or computer gear if you have any there. It is all replaceable. Listen to the police officers once they arrive and don't try to move the injured.

HIDE -Shelter-In-Place (Hide Out) or Hide Options

If you are stuck or trapped in this scenario, you are advised by experts to hide from the shooter.2 In this case, try to find an inaccessible place from the shooter. Do not, however, find a place where you cannot move around to save yourself, that is, a tight space. An office with a shut and locked door is recommended. Using heavy objects to prevent access to your location is also advised. Don't forget to turn off your cell phone or pager, silence is of the utmost importance. Also, silence any radios or TVs that might be in the area. Hide under a bed if you are in a patient's room or behind a filing cabinet if you are in an office.

FIGHT - Protect Yourself (Act Out) or Fight

If all else fails, the last option or choice is fighting the shooter.2 Throw large objects or try to devise a makeshift weapon. Scream and try to distract the shooter and if possible stop him in his tracks. This is advised if you believe the end is near and you will be the next victim.

When the police arrive, listen carefully to their instructions. Place all items in your hands down on the ground. From videos, we have seen victims with their hands up when exiting the building. Do not attempt to speak to the police, proceed out of the building as instructed.


Workplace violence is a real problem in the healthcare industry. This problem is four times more likely to occur in the healthcare arena than other venues.3 An incident of serious workplace violence is one that is defined as necessitating days off from the job to heal.3 Recent statistics from 2013 show that there were 7.8 cases of workplace violence out of 10,000 full-time employees.3

The biggest perpetrators of workplace violence in the hospital setting? The patient. That accounts for a whopping 80 percent of the problem.2 The other twenty percent were problems caused by visitors, colleagues, and others at the facility. Looking at the data, we see that 21 % of RNs and nursing students reported physical assaults over a year time frame.2 Verbal abuse is at a whopping 50%.2 These figures stem from the American Nurses Association 2014 Health Risk Appraisal of 3765 RNs and nursing students.2

None of these topics are pleasant to dwell on. But these are safety issues RNs should be familiar with to survive in today's hospital culture.


1. Hospital shootings: How common are they? 8 things to know Hospital shootings: How common are they? 8 things to know Alyssa Rege Published February 10, 2017. Accessed July 15, 2018.

2. Active Shooter / Armed Intruder UM Emergency Preparedness Active Shooter/Armed Intruder 2018 Accessed February 20, 2018.

3. Workplace Violence in Healthcare 2018.

Accessed July 15, 2018.

Debi Fischer RN, BA, BSN, MSW, LSCW is a nurse in a surgical oncology step down unit. Prior to that she worked in orthopedics and neurology. She has earned a master’s degree in social work and is also a Licensed Clinical Social Worker.

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Specializes in SICU, trauma, neuro.

We actually have this as part of our annual training. Good info!

Specializes in Orthopedics and Neurology.
Specializes in Surgical, quality,management.

This is a sad reference of the state of America. I think I'll stay in countries with tighter gun regulations

Specializes in Orthopedics and Neurology.

Thank you for reading the article.

Specializes in Psych, Addictions, SOL (Student of Life).

I am actually very comfortable with the active shooter training I went to a paid for myself. It was published on the Art of manliness website though the information is very useful to women as well. Here's the link


What to Do in an Active Shooter Situation | The Art of Manliness

Specializes in ER.

This is an issue that concerns me as an ER nurse.

Not only are we the "front door" to the hospital and therefore the first people a shooter would encounter, but also an ER has few places to hide.

We have curtains instead of walls, and nowhere to go.

I have raised specific concerns several times with our in-house security staff, but nothing changes.

We don't even have doors that could be locked or barricaded.

Specializes in Orthopedics and Neurology.

Thank you for reading the article. I agree, you are "out there" so to speak.

Specializes in Orthopedics and Neurology.

I wonder how many other ER nurses feel this way. You pose a valid point.