An active shooter incident is a situation in which the attacker is actively engaged in killing or attempting to kill people in a confined and populated area. The gunman is not there to commit any other crime. Most incidents are over within 10 to 15 minutes, often before law enforcement arrives (FBI active shooter research), which is exactly why ordinary people have to know how to react on their own.
The scene is chaos: gunshots, alarms, people running and screaming. Even trained responders feel the same fear, anxiety, disbelief, and denial everyone else does. Survivors often say afterward that they didn't know what to do. Knowing how to react gives you the mental footing to regain self-control, recall your training, and move. One person who takes the lead can change the odds for everyone around them.
Run, hide, fight
Respond immediately, in this order: run, hide, or fight, the response model promoted by the US Department of Homeland Security. No two situations are alike, and your distance from the shooter drives the choice. You may not make the perfect decision, but any action beats doing nothing.
Run away from the shooter whenever you can, and pull others with you. Know your exits and have an escape route in mind. A sharp "Follow me" or "Gunshot, get away" can shake bystanders out of inertia. Don't wait for anyone who refuses to move and don't try to relocate people who are already wounded. Leave your belongings, keep your hands visible, and call 911 once you reach safety.
If you can't evacuate, hide where the shooter can't see you. Pick a spot that also shields you if shots come your way, like behind a solid door or heavy furniture. Get into a room, lock the door, and barricade it if you can. Stay quiet, silence your phone, and turn off any radio or television. Dial 911 if it's safe, even leaving the line open without speaking, so law enforcement can locate the shooter.
Fight only as a last resort, when your life is in immediate danger. Disrupt or incapacitate the shooter by acting as aggressively as you can: yell, throw heavy objects, swing makeshift weapons. It feels counterintuitive, but if you can't escape, your odds are far better when the shooter is distracted or taken down.
Cooperate fully once officers arrive. Their only priority is stopping the shooter, so expect them to appear aggressive: armed, shouting commands, possibly using pepper spray or tear gas, pushing people aside. Follow their instructions and answer fast. They need the shooter's location, how many shooters there are, and the weapons involved if you know. Don't ask them for information or expect them to guide you or treat the wounded. Drop anything in your hands, including bags and jackets, raise your hands, and keep them visible.
Give help once it is safe
Treat the injured only after the scene is secure. As a nurse, you can deliver lifesaving care like rapid hemorrhage control while EMS is still en route. Once the shooter is down or arrested, the location is a crime scene, so move and touch nothing except what's needed to help the injured. Casualties are usually moved to a central assembly point where a mass casualty plan takes over, and you can keep helping there within your training and skills.
Every healthcare facility is required to have an emergency action plan, and most run drills, but those drills are usually limited to fire and bomb-threat evacuations. Staff also need to train specifically for an active shooter: what to expect and how to react. Several agencies offer active shooter preparedness training that facilities can arrange.
Resources you can use
- Active Shooter Preparedness, US Department of Homeland Security
- Incorporating Active Shooter Incident Planning into Health Care Facility Emergency Operations Plans, Public Health Emergency
Frequently Asked Questions
What is the Run, Hide, Fight response?
It is the federally recommended order of actions during an active shooter event. Run from the shooter if you can and bring others with you, hide and barricade if you cannot escape, and fight only as a last resort when your life is in immediate danger.
How long do active shooter incidents usually last?
Most are over within 10 to 15 minutes, often before law enforcement arrives. That short window is exactly why staff need to know how to react on their own rather than wait for help.
When should a nurse treat the injured during an active shooter event?
Only after the scene is secure. Once the shooter is down or in custody, you can deliver lifesaving care like rapid hemorrhage control, but the area is a crime scene, so touch only what you need to help the wounded.
How should I respond when law enforcement arrives?
Officers are focused on stopping the shooter, so expect them to appear aggressive. Drop anything in your hands, raise your hands and keep them visible, follow instructions, and quickly share the shooter's location, the number of shooters, and the weapons involved if you know them.
Are healthcare facilities required to prepare for active shooter incidents?
Every facility must have an emergency action plan, but most drills focus on fire and bomb-threat evacuations. Staff should train specifically for an active shooter, and several federal agencies offer preparedness training that facilities can arrange.