Preventing tragedies

Shots heard across the nation: Taking steps to avert mass shootings in our schools

Associate Professor Miko Rose, DO, recounts being in East Lansing during and after the Michigan State University mass shooting. She also discusses steps we can all take to prevent future violence.


I lay drenched in sweat on the yoga mat, blinking up toward the wall, finally feeling my lungs fill fully with air. The instructor entered the room and said, “I am so sorry to do this right now, but everyone needs to leave the studio as quickly and safely as possible. There is an active shooter on campus; an event just occurred two blocks from here.”

As I left the studio, the night sky lit up with police and fire trucks whizzing by as far as the eye could see. Along with thousands of university students, faculty and staff, I received an automated message instructing me to “Run, hide, fight” due to the presence of an active shooter in the community. The calls repeated every 20 minutes throughout the night.

My heart raced as I watched the emergency response vehicles speeding across campus and town. My partner and I drove to our home near campus. That night, between emergency calls from the university, I looked out my living room window and wondered if the shooter was hiding somewhere in the bushes or trees outside.

I kept thinking, “I just need to be alive and be OK for my daughter. Please God, let me be OK for her.” That night, my partner and I silently ate dinner in the dark, jumping at the slightest noise outside.

On Feb. 13, 2023, the shots fired on the Michigan State University campus were heard across the country. Three students were killed and five were injured. The MSU shooting is the 12th incident in which a lone gunman killed three or more people on a college campus and was the first active shooter incident to hit a campus university of an osteopathic medical school.

The response

For days, weeks and months following the shooting, faculty and community counselors held listening sessions for students, administrators, faculty and staff. As a faculty psychiatrist and group leader of wellness programming, I was asked to lead a health colleges faculty and staff listening session, as well as co-facilitate a listening session for medical students. University physicians, staff, resident physicians and community counselors gathered to provide emergency mental health support for students and others directly impacted by the shooting.

As faculty and staff, we first addressed the physical safety of all involved, and then the mental health sequelae that followed. After the shooting, many students did not feel safe returning to campus. Students mourned the losses and found ways as a group to take steps forward in the aftermath. The MSU Counseling and Psychiatric Services and the Department of Psychiatry joined forces to mobilize emergency mental health services. Several physicians, resident physicians, counselors and community mental health professionals volunteered countless hours of their time to provide crisis support.

The evaluation: Working to rebuild

In the aftermath of the shooting, campus officials, administrators and community members conducted root cause analysis of tragic events, rebuilding and long-term follow-up. Several experts in the field of mass school violence prevention shared learnings and insights that helped shape recovery efforts.

“There isn’t going to be a quick fix. This isn’t going to be a one size fits all. This will require everyone coming together as interdisciplinary teams and communities to do this work,” said Michele Gay, co-founder and executive director of Safe and Sound Schools and mother of Josephine Grace, a victim of the Sandy Hook Elementary School shooting.

Though not often highlighted in the mainstream media, the number of averted violence events far outnumber the number of completed violence events, noted Frank Straub, PhD, who in 2016 established the Averted School Violence database, which tracks averted and completed incidents of targeted school violence. “We wanted to know what works [by] looking at mass-averted violence, looking at the phenomena of mass violence and examining what we can do to avoid these types of incidents,” he said.

With over 300 incidents tracked, database findings indicate that individuals who planned and completed acts of school violence were often depressed and demonstrated impaired social/emotional function, disregard for authority, social isolation and a history of becoming easily enraged. When abnormal violent tendencies presented in childhood, violent events were often averted through early intervention and monitoring.

The intervention: Preventing recurrence behind the scenes

Alyse Ley, DO, associate chairperson of education and research at the MSU Department of Psychiatry, joined forces with community leaders to establish and direct the Prevent 2 Protect: Adolescent Targeted Violence Prevention Project. Supported by Michigan Governor Gretchen Whitmer and funded by a $15 million appropriation from the Michigan Department of Education, the program focuses on working with adolescents at risk of committing acts of targeted violence. The project is administered by a research-to-practice hub of mental health and law enforcement experts who provide holistic assessments of adolescents deemed to be high risk, individualized care plans for high-risk adolescents, community consultation, education and training.

Using a holistic approach, the Prevent 2 Protect project aims to avert acts of mass violence before they occur. “If you have one positive adult, you can change the trajectory of a young person’s life. There is a critical window when we can change the path that a person is on and prevent a critical incident from occurring in the future. By changing one life, you may save many,” noted Dr. Ley.

Sometimes our nation’s greatest heroes are people you hear nothing about, but who mobilize efforts to prevent tragic events from occurring. Dr. Ley and her team have worked tirelessly behind the scenes, volunteering countless hours toward the creation of this program. They are helping to change the way our nation addresses mass violence by targeting individuals and events before they happen.

“The prevention part goes right to the heart of the issue: cataloging, researching and funding the data collection on averted violence encounters, and from there, building preventive strategies,” said Frank Ochberg, MD, project collaborator and founding board member of the International Society for Traumatic Stress Studies (ISTSS). “This is a very different approach than looking backward at incidents after they have occurred. To prevent these types of incidents, we need to focus more on what worked to prevent these events from occurring and build on the successes from there.”

Sound osteopathic? Find what works and build from there. Intercept an interference before it becomes disease. It’s an approach that can help keep patients healthy and, in this case, help prevent a mass violence tragedy from hitting an entire university and community.

The aftermath: Rebuilding communities

The shootings at MSU highlight a bigger challenge facing the next generation of medical trainees and future physicians: the long-term effect of mass shooting events.

Prior to the MSU shooting, the high school attended by Dr. Ochberg’s grandchildren received seven false active shooter threats. “We had high school children who were retraumatized by the event. It was a ‘double whammy.’ We had grandparents who did not know if their grandchildren had been killed for hours,” he said.

Jed Magen, DO, MS, chair of the MSU Department of Psychiatry, noted the importance of community inclusion in debriefing and addressing the aftermath of community upheaval. “The things that often get ignored are the long-term consequences, not just on campus, but within the surrounding community,” he said. “In this case, the shooter killed himself in a residential neighborhood. We need to look collectively at communities, and all involved, in the long term.”

Lessons learned: Creating new pathways toward aversion and prevention of mass violence

What can we do? Here are some things that can help create a better future.

Universities, medical institutions and clinics

According to Dr. Ley, preparation is key—especially when it comes to coordinating university and community mental health services. “It takes a village. It’s ideal to develop a collaborative mental health crisis interdisciplinary team of professionals who are trained in crisis response. Optimally, universities and institutions of higher education will have a designated, coordinated team that can be deployed should an event occur on campus,” she said.

When she entered her role as senior associate dean at Michigan State University College of Osteopathic Medicine, Katherine Ruger, EdD, developed a handbook with detailed plans for addressing a long list of potential catastrophes that could impact the school, including a mass casualty shooting. “It was unfortunate that this happened, but we were ready,” she said.

Sean Switz, former manager of campus security at Pacific Northwest University of Health Sciences University, worked in collaboration with the school’s emergency medicine student club to plan a mass casualty incident drill, which will now become an annual community event.

To set up a similar event in your community, Switz recommends coordinating efforts with an emergency management group, law enforcement and medical personnel. “We used realistic paint [and] 3D bullet holes on bodies (mannequins and student actors) to practice physical and psychological responses. Students participated as well for medical response readiness,” Switz said.


Dr. Ley recommends the following for practicing physicians:

  • Be aware of signs of suicidality and homicidality and become comfortable assessing and treating both.
  • View suicidal and homicidal ideation as you would view any other medical condition. In other words, suicidal and homicidal ideation are symptoms of life-threatening conditions, similar to a child/adolescent saying, “I can’t breathe,” and we need to respond with the same urgency and assuredness.

Trainees and medical students

Dr. Ley offers the following tips for osteopathic medical students and residents:

  • If you are a trainee or medical student, begin taking steps to familiarize yourself with psychiatric assessments, suicidal ideation and homicidal ideation, and know how to identify “at risk” cases.


Dr. Ley advises medical practice faculty and staff to:

  • Recognize the importance of training in mental health awareness and basic interventions to identify early warning signs to support students and residents in their treatment of patients.

Community and the osteopathic profession

Dr. Ley advises individuals to be proactive when it comes to eliminating stigma and recognizing psychiatric conditions as medical conditions. “Be the one person who gives hope; be a mentor. We know that mentorship plays a pivotal role in preventing targeted mass violence in communities,” she said. “Medicine is so fast-paced now, but we need to take the time to listen if someone is crying for help. By doing so, we might save lives.”

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

Related reading:

Preventing targeted gun violence in our schools

Under the gun: The physician response to gun violence in America

One comment

  1. Dixie Tooke-Rawlins D.O.

    Unfortunately, this is not the first time it happened on a campus with an osteopathic medical school. In the first few years Virginia Tech, the partner institution with VCOM experienced such a mass shooting, only with much greater casualties. Much as with your COM, it was VCOM administration and faculty who responded on campus, who worked with families throughout the night, and who cared for those injured in local hospitals. It is sad to say but this was a student with mental illness who had been released from the hospital and who professors at VT had identified as a risk. Although in treatment, the risk continued and the unthinkable occurred. Thank you for a very well written article as we must all do our best to prevent such violence on our campuses where students should feel safe.

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