How to Deal with An Active Shooter in Your Hospital

Active shooter incidents in hospitals are rare, but when they happen, they unfold quickly and pose unique dangers. Hospitals are open environments with vulnerable patients, constant movement, and emotionally intense situations.

Because of this, every member of the healthcare team should understand the hospital's active shooter protocol, recognize Code Silver hospital safety alerts, and know how to respond decisively.

Continue reading to learn more about how hospitals coordinate their responses, and what nurses can expect before, during, and after an incident.

Know the protocol: Code Silver

What is a Code Silver?

A Code Silver is the alert many hospitals use to signal an active shooter or armed intruder. The alert may come as:

Overhead page
Computer screen pop-up
Text message
Badge alert
Security call

When this announcement is made, it immediately activates the facility’s emergency response plan.

Staff may be instructed to lock down their units, prepare to shelter in place, or evacuate, depending on their location relative to the threat. Understanding this alert and responding immediately is essential.

Immediate actions: Run, hide, fight

Hospitals use the “Run, Hide, Fight” framework, adapted to the realities of clinical care.

Here’s how it works:

Run: Evacuate if safe

If the shooter is not near your location, evacuation is the safest option. Nurses should assess which patients can be safely moved and which cannot.

Ambulatory patients or those who can maintain their own airway can sometimes evacuate with staff guidance.
Critically ill or immobile patients may need to remain sheltered if attempting to move them would cause harm or delay escape.

Always use routes that lead away from the threat, and only use elevators if directed by security.

Hide: Secure your space

If evacuation isn’t possible, hiding and securing your unit becomes the priority. This may involve locking patient rooms, shutting off lights, silencing phones and monitors, and staying out of sight.

Nurses often need to quickly reposition patients behind curtains or farther from doors and windows. In many cases, equipment like beds or carts can be pushed into place to create a barricade.

Quiet, concealment, and locked barriers buy time until law enforcement arrives and are key components of nurse safety in active shooter response.

Fight: Last resort

If the shooter is directly in your space and escape or hiding is impossible, fighting becomes a last resort option.

This may involve using objects within the environment—such as fire extinguishers, chairs, or heavy equipment—to incapacitate or disrupt the attacker.

Nurses are never expected to confront a shooter unless there is no other choice and life is in immediate danger.

Nurse responsibilities during an incident

During a Code Silver, nurses play a crucial role in protecting patients and supporting the hospital’s emergency plan.

If you witness the shooter or hear gunfire:

Contact security.
Report the attacker’s location and direction of travel (if known).

Securing rooms, calming patients, reducing noise, and creating physical barriers all help decrease visibility and vulnerability.

Medical care during an active threat is limited to what is absolutely necessary. Survival comes first. If the shooter is not nearby, nurses may use hemorrhage control kits or basic first aid to stabilize injuries until help arrives.

Clear communication with charge nurses, supervisors, and security teams supports coordinated action across the hospital.

Security and law enforcement coordination

When a Code Silver is announced, hospital security enacts a coordinated response. This may include locking down entrances, monitoring cameras, clearing hallways, and guiding staff to safer areas. Security teams remain in contact with police from the moment the incident begins.

Law enforcement will move quickly and directly toward the source of danger. Their priority is to stop the shooter, meaning they may not stop to assist victims until the threat is neutralized.

When officers arrive, it’s important for staff to keep their hands visible, avoid sudden movements, and follow instructions immediately.

Afterward, police may restrict movement inside or outside the facility while they secure the building and begin their investigation.

Aftermath: Recovery and response

Once the “All Clear” is issued, nurses help re-establish order and safety. This often starts with accounting for all patients and colleagues, confirming locations, and identifying anyone missing.

Injured individuals may need immediate treatment once the threat is gone, and emergency departments may see a sudden influx of casualties.

Nurses may be asked to give statements to security or law enforcement to help reconstruct the timeline of events.

Emotional impact is common after a violent incident, so hospitals typically provide psychological support resources such as debriefings, counseling, or peer support programs.

Using these services is an important part of long-term recovery.

Training and prevention for nurses

Preparation is the most effective defense against workplace violence.

Many hospitals conduct regular active shooter drills that teach staff how to recognize Code Silver hospital safety alerts, shelter in place, evacuate patients, barricade doors, and use bleeding control kits.

These exercises build confidence and reduce panic in real emergencies.

Violence prevention training often includes situational awareness, de-escalation strategies, reporting procedures, and proper use of duress alarms.

Many states now require healthcare facilities to conduct annual risk assessments, improve security features, and collaborate with law enforcement. These measures help strengthen the overall hospital system's response to workplace violence.

Nurses can support daily safety by:

Memorizing the layout of their facility.
Knowing the location of all exits
Keeping staff-only doors secured
Reporting concerning behavior early
Participating in every drill
Ensuring that visitors follow identification protocols

FAQs

Here are a few important FAQS that nurses can follow during an active shooter situation that occurs in a hospital.

What steps should nurses follow during an active shooter situation?

Follow “Run, Hide, Fight.” Leave if possible, secure and hide if evacuation is unsafe, and fight only as a last resort.

Always follow your hospital’s established active shooter hospital procedure.

What security measures help prevent hospital shootings?

Visitor screening, badge-controlled access, trained security personnel, surveillance systems, and behavioral threat assessments all reduce risk.

How are staff trained for active shooter response?

Most hospitals use a combination of drills, simulation exercises, training modules, and practice with communication systems and lockdown procedures.

How can nurses stay safe if there’s an active shooter on their unit?

Stay out of sight, lock and barricade doors, silence alarms, and remain as quiet as possible. Escape only if a safe route exists.

What should nurses do if they’re with patients who cannot be moved?

Lock the room, dim the lights, hide the patient behind protective barriers, and create a barricade. Do not attempt evacuation unless it is unquestionably safe.

How to make a difference during an active hospital shooting

Hospital shootings unfold quickly, but preparedness makes a lifesaving difference.

Understanding the hospital's active shooter protocol, recognizing Code Silver alerts, and staying calm under pressure empower nurses and staff to respond effectively.

Through ongoing training, awareness, and strong teamwork, healthcare professionals can help protect themselves, their colleagues, and the patients they care for.

Take a moment to review your hospital’s Code Silver protocol. Knowing your unit’s procedures, exits, and communication systems before an emergency can save lives.