Implementing a Stop the Bleed Course and Active Shooter Principles With Prelicensure Nursing Students: A Pilot Study

Deaths by firearms have surpassed motor vehicle accidents as the leading cause of death within the United States. Mass shootings have increased annually, leading to civilian trauma systems implementing military trauma training and rapid tourniquet use to treat extremity injuries.

The American College of Surgeons' Stop the Bleed course has become a widely adopted public education initiative focused on the immediate treatment of life-threatening bleeding caused by firearm injuries.

Thirty prelicensure nursing students engaged in a structured simulation that included a high‑fidelity active shooter scenario utilizing Run‑Hide‑Fight response strategies. Learning objectives were aligned with the Healthcare Simulation Standards of Best Practice, emphasizing psychological safety, structured debriefing, and reflective learning. Postsimulation surveys measured perceived learning outcomes and the relevance of the activity to nursing curricula.

Students reported strong engagement and perceived educational value (M=4.87). Confidence in hemorrhage control (4.70) and tourniquet application (4.83) was high, and participants strongly agreed the training should be mandatory (4.74). Motivation to pursue additional emergency preparedness education was also high (4.83).

In the simulation-based training, facilitators can introduce emotionally provocative scenarios to enhance realism and challenge learners' decision-making under stress. Within a high-stress environment, students deployed principles from a Stop the Bleed course, implementing hemorrhage control interventions using rapid triage, tourniquet application, and hemostatic gauze application.

Stop the Bleed courses are not the answer to implementing trauma care within prelicensure nursing curricula, but they can be a bridge for faculty to gain comfort in teaching trauma-related topics and scenarios. Nurses trained in basic trauma care can make a vital impact on reducing deaths related to gun violence through a focus on community health and education.