Firearm injuries are the third leading cause of death for youths (14% of all deaths of youths 1-19 years of age). In 2016, there were 3,155 firearm deaths of youths less than 19 years of age. Recently, school firearm violence and school shootings have received increasing attention from school personnel, policymakers, and in the mass media. However, little is known about prevention and reduction of school firearm violence. The purpose of this narrative review is to describe the current practices regarding school firearm violence prevention and uses the disease prevention and health promotion framework to describe current practices and policies on school firearm violence prevention measures. A comprehensive review of the literature was conducted from the years 2000 to 2018 to search for school-based practices to reduce firearm violence. Hundreds of millions of dollars have been spent to harden schools. None of the currently employed school firearm violence prevention methods have empirical evidence to show they actually diminish firearm violence in schools. To the extent that schools adopt ineffective firearm violence prevention measures they are creating a false sense of security. School systems need to engage in collaborative research for evidence-based practices and policy advocacy through coalition building to address state firearm laws. Schools also need to expand their mental health services and cost-effective educational interventions for reducing violence (e.g. bullying, peer mediation, conflict resolution, etc.). Hardening of schools seems to be a questionable endeavor for most schools given the dearth of evidence regarding effectiveness.