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Emergency Preparedness: Active Shooter Situations

Emergency Preparedness: Active Shooter Situations
Georgia Reiner, MS, CPHRM, Nurses Service Organization

Risk analyst Georgia Reiner, MS, CPHRM, with Nurses Service Organization, reports on safety measures for nurses.

While relatively rare, active shooter incidents are unpredictable and not entirely preventable. It is not easy to predict when or where violent incidents will occur, but nursing professionals should be empowered to detect signs of threatening behavior and act quickly to protect themselves and those around them.

Spotting warning signs
Individuals with a history of violent behaviors usually plan to target specific individuals such as a current or estranged intimate partner, supervisor, or coworker. Behaviors that may indicate that an individual may act violently with the intent to harm themselves or others include:

  • Repeated incidence or history of bullying, harassment, aggression, or intimidation.
  • Increasingly pathological preoccupation with an individual or institution.
  • Close association with weapons, military or law enforcement paraphernalia, or previous attackers or assassins.
  • Financial hardship.
  • A history of physical violence towards others.
  • Directly or indirectly communicated threats.

Ultimately, you need to trust your instincts. If someone’s behavior seems concerning, do not ignore the situation or assume that someone else will take care of it. If you suspect an individual may pose a threat to the health and safety of themselves or others, you should follow your facility’s procedures and chain of command for reporting such concerns.

Having a plan of action
Every crisis is unique, and healthcare facilities present unique challenges for active shooter planning and response. To prepare, The Joint Commission and others recommend that nursing professionals and other healthcare workers should be aware of their facility’s emergency response policies and procedures, including those regarding:

  • Activating emergency response measures and internal security alerts.
  • Procedures for lockdown and emergency evacuation.
  • Expectations for protecting and caring for patients on your unit during an emergency response.
  • What to expect when law enforcement officers arrive.
  • How to identify an all-clear directive.

There are also some strategies that the U.S. Department of Homeland Security recommends to put distance and barriers between you and the shooter:

  • Run. Exit, and help others evacuate, if there is an accessible escape route. While exiting, keep your hands visible so law enforcement can see that you are unarmed.
  • Hide. If there is no safe route out or if patients lack mobility, hide. Seek shelter without windows, or away from windows, and draw any curtains or blinds. Lock the door and push all available furniture up against the door. Silence all devices and turn off any other sources of light or noise. Get out of view and remain in hiding until the all clear signal is given.
  • Fight. As a last resort, and only if your life is in imminent danger, try to distract and/or incapacitate the shooter. Act aggressively: yell and throw items.

Preparation can save lives
Unfortunately, in today’s environment in the United States, no organization is immune from the threat of gun violence. Maintaining situational awareness, reviewing your facility’s emergency response plans, policies and procedures, and participating in trainings and drills can and will make a difference in the event of an active shooter incident.


The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information. Please note that Internet hyperlinks cited herein are active as of the date of publication but may be subject to change or discontinuation.

This risk management information was provided by Nurses Service Organization (NSO), the nation’s largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to or call 1-800-247-1500.