August 16, 2016

How Nurses Cope With Mass Shootings And Attacks

How Nurses Cope With Mass Shootings And Attacks

Written By: Lee Nelson

For staff members at The Medical Center of Aurora, Colorado, every time they hear about another mass shooting, there is a sense that they've been here before.

“Our hospital has created a tradition of sending a banner to any hospitals impacted by mass shootings; our entire staff signs the banners,” says Stephanie Manley, Director of Community and Volunteer Services.

As of this writing, they have sent banners to Loma Linda in California, and most recently to hospitals in Orlando.

“It's our way of saying that we're part of a unique group that understands what they’re going through,” Manley states.

The nurses and staff in Aurora indeed understand all too well what others are going through. On July 20, 2012, their hospital was impacted due to treating many of the 70 individuals who were injured in the shooting at an Aurora movie theater where 12 people lost their lives. A gunman, now convicted and sentenced to 12 consecutive life sentences without parole, set off tear gas grenades and shot into the audience with several firearms.

“Our hospital leadership team and staff are trained in the roles we need to execute in disasters; but I don’t think anything could have prepared our team for what would happen in the early morning of July 20th,” Manley remarks.

That scenario of attacks and deadly shootings is frequently repeated across the country in small towns and big cities. In fact, a 2013 FBI study showed that while the U.S. has only 5 percent of the world’s population, it had 31 percent of all public mass shootings.

So what happens to the heroic nurses who take care of these injured souls? Several studies reveal that frequent exposure to traumatic events can have a similar effect to personally experiencing the trauma. A Belgian study concluded that about one in three emergency nurses experienced anxiety, depression, and sleep disorders, while one in 10 showed clinical levels of Post-Traumatic Stress Disorder (PTSD).

Nurses deal each day with unfathomable injuries, trauma, and death. So how do these nurses cope with the powerful emotions stirring inside them? And what preparations for disasters and essential post-event care for the staff are becoming part of hospitals’ protocols?

How Aurora Handled It

As a trauma center, the Medical Center of Aurora holds ongoing preparation and drills for how to handle events that have a potentially mass impact on the community.

“As a community hospital, it is our responsibility to our citizens to be prepared for anything, and at all times,” Manley says.

Before the patients began to arrive after the shooting, staff members were debriefed in the command center that had been set up in preparation.

“The building immediately went into lockdown to prevent further harm in the case of another shooting, as well as to keep media out,” she says.

Meeting rooms where families could reconnect were set up. A call center was quickly created in order to handle the incoming calls from frantic family and friends seeking to know which hospital their loved ones had been transported to.

“We provided the basics to start with -- food, drink, coffee, blankets, and fresh clothes for visitors and staff,” Manley added. For staff support, counselors from the Employee Assistance Program (EAP) were also deployed. The team most impacted initially was the ER; they were debriefed prior to leaving the hospital.

"We also provided chaplain services for staff counseling. In the weeks and months following the tragedy, we worked with leadership teams to identify staff who had been significantly impacted; large-scale tragedies affect the entire hospital community.”

Chicago’s Busiest Trauma Center And Its Nurses

The destroyed lives and devastated families that Cherie Cordero constantly witnesses can be overwhelming despite the training she has received to help her copy with high-stress situations. Cordero is a Charge Nurse at Cook County’s John H. Stroger Jr. Hospital in Chicago, and has been a nurse for 31 years.

“Before I go home, I say a prayer to help me stay on my game, and to pray that everyone else gets home safe from the night of work,” Cordero says. “If it’s been a rough night, I'll probably cry when I get home about all the tragedy and all the things these people will have to face.”

Stroger became the place of refuge and help for more than 900 gunshot victims in 2015 -- with a whopping 3,000 gunshot victims in all of Chicago that year. And the numbers are continuing to increase.

The victims range from gang members to innocent children playing in the park; the shootings have hit teenagers, middle-aged moms, and grandparents.

One of the worst shifts Cordero remembers was when multiple victims came in at the same time, victims of a complex multi-firearm incident.

“Bullets had done everywhere. There were no less than six patients that came here with mass casualties; they suffered gunshot wounds to the abdomen, chest, and limbs."

One person died, but the rest were saved.

“I was so proud of my team,” Cordero remarks.

Stroger, one of four Level 1 trauma centers in this third largest city in the U.S., hosts an annual trauma conference, as well as various events hroughout the year related to violent crime, gangs, and related subjects. The facility also offers the services of a minister and social workers for nurses and staff; the social workers are assigned just to the trauma center, which is unique in comparison to other hospitals. After a traumatic event, staff are approached before they go home.

“They come and ask if we need to talk before we leave; that kind of support is needed,” Cordero says. “When you leave a very stressful shift and get in your car and drive home, it’s tough.”

Sometimes, Cordero adds, just having someone buy a nurse a cup of coffee and keep them there for a few more minutes to unwind and debrief can help.

“I also do yoga and have meditated in some form for a long time,” Cordero says. “Other physical activities help me keep balanced; plus, I have good support from the people I work with. We understand each other.”

Volunteer activities outside of the hospital are also encouraged. Cordero helps with the Wounded Warriors organization.

Shock Trauma Center In Middle Of Chaos

Last April, Karen Doyle came to work as National Guardsmen stood guard with machine guns; they were protecting the University of Maryland Medical Center in Baltimore, where the R. Adams Cowley Shock Trauma Center is located.

“It was intense; we were on high alert for a week or so,” says Doyle, Senior Vice President of Nursing and Operations at the center.

The Shock Trauma Center and Baltimore were in the midst of big headlines in April 2015 after Freddie Gray Jr. died there a week after being detained by policel; he underwent surgery for injuries, fell into a coma, and died one week later. Riots ensued after days and days of non-violent protests.

But Doyle and all the staff needed to continue helping patients in this unique free-standing hospital devoted to trauma.

“We like to call it an orchestra of chaos; it’s very seamless, very organized, and controlled. My team is ready 24 hours a day for the worst,” she said. “We approach every person the same wayl; everyone knows their role.”

She admits most of them at the center are Type A personalities -- very assertive and intelligent individuals with a lot of experience.

“But over time, each event can rock them, especially if we see an unsuccessful outcome.”

Doyle adds that the center and its leaders work diligently at allowing each team to take a pause and allow everyone to grieve in their own way.

“That’s very powerful; we do whatever it is we need to do -- whether it's a prayer, a meditation, or something else. We're human, and we just lost a human life. We need to reflect on that which has been enormously powerful for the team.”

The facility also works on making sure members of their teams have other sources of socialization besides people from work; the guidance and empathy of chaplains available 24 hours a day also can help ease the pain and isolation. Plus, the center offers some type of self-care strategy each quarter that ranges from aromatherapy to pet therapy to massages.

“We really try to help individuals to remember to take care of themselves; if they can’t take care of themselves, they can’t take care of others,” Doyle says.

Next Up: A Mom's Story Of Still-Birth And Those Who Helped Her Through


Lee Nelson of the Chicago area writes for national and regional magazines, websites, and business journals. Her work has recently appeared in,, Yahoo! Homes, ChicagoStyle Weddings, and a bi-weekly blog in