School nurse preparedness for critical events – a multi-modal simulation training pilot

School-based emergencies, notably school shootings, are emotionally taxing events for school nurses (SNs). As frontline healthcare providers, SNs must rapidly assess injuries, coordinate emergency response, support the school community, communicate with families and emergency medical services (EMS), and manage their emotions. Yet most SNs receive minimal standardized training to manage mass-casualty incidents effectively. In the United States, SNs in the Boston Public School System (BPSS), have experienced increasing penetrating trauma, prompting leadership to pursue targeted educational solutions. Although a U.S. prominence, school violence remains a global concern, emphasizing its worldwide relevance and underscoring the international need for school-based emergency preparedness. In response, an interprofessional team developed a tailored, integrated emergency curriculum informed by a collaborative needs assessment. Recognizing that medical crises occur more frequently than shootings, the curriculum intentionally addressed both traumatic and medical emergencies. The multimodal program prepared SNs to bridge care until EMS arrives and included two hours of interactive workshops followed by two realistic multi-victim simulations. Interprofessional faculty facilitated skills training, simulation, and debriefing while assessing adherence to evidence-based practices. Pilot findings revealed gaps in leadership, communication, triage, CPR/PALS initiation, and task delegation. Strong engagement led BPSS leadership to request continuation in 2024, with returning participants demonstrating improved command presence, delegation, and closed-loop communication. Next steps include formal program evaluation using validated assessment tools and expansion to incorporate disaster triage protocols and preparedness. Given global lack of standardized emergency training for SNs, this innovative curriculum offers a scalable, adaptable, impactful model for strengthening school-based emergency readiness worldwide.