Some “Red Flags” in an Active Shooter

Source: Cliff Akiyama, MA, MPH, AAFS Fellow

In July, the Forensic Nursing Science Section posted an article by Cliff Akiyama providing information on active shooter incidents. This month we would like to provide an update to that article with "red flags" for this type of scenario. Forensic nurses and those in charge with the direct care of individuals must learn to counter an active shooter. While there is no one approach that works all the time and the threat must be continually assessed. Please read further to learn what key components are important to diffuse what could be a tragic outcome.  

For the last several years, each and every time there was an active shooter incident across the country, the question always remained, why would someone do such a horrific act? As academics and practitioners from forensic science, nursing, law enforcement, criminology, behavioral and public health scramble to figure out and explain the rationale and state of mind through some "red flag" identifiers that could help keep us safe and alive by raising our internal alarm. Very often in an emergency situation, we don't trust our "intuition" or our "gut" and when the hair on the back of our neck stands up, we need to follow that intuition because physiologically our bodies are telling us something, "danger" "this is not right" "act" "get out" or "fight."

It is critical that forensic nurses and those in charge with the direct care of individuals learn to counter an active shooter, which involves a multidisciplinary team with a multidimensional approach. There is no one approach that works all the time and the threat must be continually assessed. The following are some "red flags" and key warning signs that are often present with an active shooter.

  • Preparation: This is when people plan and prepare the details of their attack, like accumulating ammunition, buying firearms in secret or building bombs or other incendiary devices in their garage. The goal of the shooter is expressing one's anger by getting a firearm. It is so important to remember that when you have nothing to lose, you can do anything!
  • Identification: This perhaps one of the most important warning sign. As one takes on an identity that shifts from a preoccupation with other mass shooters to wanting to become one himself. In Parkland, Florida, the shooter posted on YouTube six months before opening fire at the high school that he was going to become a "professional school shooter."
  • Leakage: This is the most common warning sign, when a person communicates their intent to attack to a third party. It occurs in 60% to 90% of targeted attack cases, usually in the days or hours before the attack.
  • Last resort: The potential attacker says things that indicate an urgent need to act violently within a specific time. They might say it's "up to them" or use other words to communicate that they must act. The goal of the shooter is to inflict the largest amount of damage in the shortest amount of time with the least amount of security such as a school or food court. It is also an important point out that in these active shootings, it's not about the people, it's about being seen and heard. For the shooters, they were going to scream out so that everyone was forced to listen because they felt that they were not being heard or listened to.
  • Mental health is also so important to examine, especially in our children, teens and young adults. Since the pandemic, nearly 85% of children present with anxiety or depression and 65% with both. Also present with our youth is trauma and generational trauma. In addition to loneliness and self-isolation. We need to address and treat mental illness in our children, teens and young adults before it becomes worse later in life.

It's important to remember that when someone treats you like a person, when you don't even feel like you are human, it could change your life. If you see someone in that spot "emotionally" and needs that love, give it to them. Try and talk to those that are the least talked to. The ones that are the most "on edge" are the ones that never get talked to. Love the ones that you feel deserve it the least because they need it the most. Show them that they could exist in this pain and that even if the pain is intense, there is light at the end of the tunnel. You need to talk about your darkness to see the light.


The views and opinions expressed in the articles contained in the Academy News are those of the identified authors and do not necessarily reflect the official policy or position of the Academy.