Monday, October 09, 2017

Mass Shootings and Trauma -- the New Normal

Mass shootings and similar tragic events are so frequent here in the United States that they appear to be the new normal. There were apparently more than 250 mass shootings in the U.S. in the first 9 months of 2017. As nurses and healthcare professionals, how do we cope, respond, and prepare for such seemingly commonplace yet traumatic events?


Mass shootings are generally defined as events wherein a minimum of four people are injured or killed, and by this definition, an event with three people shot is not considered a mass casualty. So if we changed the definition, these situations would be even more statistically frequent than they are now.

Healthcare professionals throughout the world treat victims of violence on a daily basis. Whether wartime casualties or civilians shot by strangers or family members, gun violence and other forms of aberrant behavior manifest in our cities and towns on a frighteningly frequent basis.

Being Prepared for the Horrific

Hospital facilities -- especially those designated as trauma centers -- are prepared to handle large numbers of casualties, and many run drills that keep the skills of rapid response teams as sharp as possible.

Nurses, physicians, and other professionals working in trauma centers know fully well that, at any time of day or night, ambulances and vehicles filled with victims could arrive after a violent situation unfolds. The recent Las Vegas shooting was just one such scenario, and stories have emerged of hospitals veritably overwhelmed with the number of seriously injured patients being brought for emergent care on that fateful day, even as off-duty personnel raced to their places of employment to lend a hand.

Most of us can only imagine what might run through our own heads if we were ourselves at the scene of such a shooting. If bullets were raining down, would you be willing to risk your own health and safety to help a bleeding person across the parking lot who is suffering from a gunshot wound? Could you think clearly, stay focused, and compartmentalize the experience enough to get the job done? If you were exposed to live gun fire and the resulting chaos, would your desire to help others supersede your own safety concerns to the extent that you could take action?

Each one of us needs to ask ourselves salient questions when it comes to these types of situations. Here are some I've been thinking about lately:

  • What skills am I prepared to put into action if I'm on the scene when a mass casualty event occurs? 
  • What related skills do I need to improve and refresh -- or learn for the first time? 
  • If I wouldn't or couldn't help out with immediate hands-on trauma response, do I have other skills that might be helpful? (eg: crisis debriefing, logistical support, etc)
  • What organizations doing this type of work would I like to support? 
  • Is there more I can do in preparation for these types of situations, either as a citizen or as a healthcare professional? 

You may also want to ponder and research how (and if) your workplace is prepared for such eventualities by asking related questions, such as:

  • Is my workplace prepared for mass casualties and other disaster scenarios? 
  • Does my place of employment carefully prepare and run drills in anticipation of these types of circumstances?
  • If myself and my colleagues were called on to respond to such an event, would our employer provide aftercare and crisis debriefing for us? 

However you contribute is fine -- not everyone has the skills, knowledge, or even the physical stamina and strength to pitch in directly when disaster strikes. We can all choose our path for making a difference in our own way. We just want to make sure we have the training, backup, and follow up care to make it through the crisis in one piece, emotionally and otherwise.

Healing From Vicarious Traumatization

When a nurse, doctor, fire fighter, police officer, or other responder interfaces with some aspect of a mass casualty event, those individuals' lives can be inextricably altered. Vicarious traumatization involves the empathic response and countertransference experienced by rescue workers, first responders, ER staff, or anyone who has witnessed, or attempted to mitigate, the suffering of others.

Being faced with two hundred incoming patients with acute bullet wounds from an active shooter can be overwhelming on multiple levels for a nurse in the ED. For those with experience in combat, this may not seem so far-fetched, but to a nurse who has only seen normal emergency department scenarios, a mass casualty can be an entirely different experience.

When I was living in Western Massachusetts, my wife and I were trained in a crisis debriefing model developed by the military and subsequently adapted for civilian use. We provided emergency debriefings following a rape, a murder, and even a bank robbery, This type of intervention following a trauma can be very helpful for victims, for responders, as well as others experiencing a more peripheral impact of these types of events.

Vicarious traumatization feels as real as any other trauma, and healthcare workers and first responders need trained professionals to walk them through a debriefing process that moves them in the direction of healing. After all, healed healthcare workers are healthy and productive healthcare workers.

An Unpredictable World

We nurses can volunteer in the face of disasters such as Hurricanes Harvey or Irma. We can also find ourselves in the middle of unfolding events that put us in both imminent danger and the potential to lend a helping hand at a crucial moment. It is an unpredictable world, and we need to be as well prepared as we can be for the unimaginable.

Nursing skills and the nursing process are crucial components of emergency response. When faced with a dire situation, many of us nurses would likely act without thinking, turning on our "nurse's brain" and snapping into action in coordination with other healthcare professionals and first responders.

In this age of seemingly escalating violence, each nursing professional must know his or her own limits and boundaries when it comes to volunteerism and to the ability and willingness to respond in an imminent crisis such as a mass shooting. It's a sad but true reality that we haven't seen the last of unthinkable situations where ordinary citizens come unhinged and wreak havoc. Even so, nurses and other courageous souls will always be there to lean in wherever help is needed.


Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of "Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Centuryand "Aspire to be Inspired: Creating a Nursing Career That Matters". He has contributed chapters to a number of books related to the  nursing profession. Keith has written for,, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

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