American Academy of Pediatrics: Live Crisis Drills in Schools Require Careful Planning With Pediatricians’ Input on Children’s Needs

Pediatricians recommend eliminating student participation in high-intensity exercises that mimic gory events and are carried out without advance warning to students, staff.

In response to mass shootings in schools and other public spaces in recent years, many school districts adopted live crisis drills and exercises intended to help students and staff respond in the event of a shooting incident. While well-intentioned, some drills were put into place with the intent of preparing adults without consideration of harm to children.

The American Academy of Pediatrics (AAP), in a new policy statement, “Participation of Children and Adolescents in Live Crisis Drills and Exercises,” examines the potential benefits and harms of including children in crisis response scenarios. The policy, published in the September 2020 Pediatrics (published online Aug. 24), recommends that children be included in exercises and drills in general only to the extent that they prepare adults to meet the  unique needs of children during a crisis and further children’s own preparedness or resiliency.

“Mass shootings are, thankfully, extremely rare, but we understand the need to think about the very real possibilities and be prepared,” said David J. Schonfeld, MD, FAAP, lead author of the policy, developed by the AAP Council on Children and Disasters; AAP Council on Injury, Violence, and Poison Prevention; and AAP Council on School Health.

“There are safe ways to help prepare children and adults for crisis with careful consideration and input from medical experts. What we have seen in the past, however, is that some of these live active shooter drills may be causing undo distress and anxiety, with little evidence that they are effectively preparing students for crisis,” Dr. Schonfeld said.

The policy statement calls for more research to determine the most effective ways to prepare students and adults for a mass shooting through drills/exercises. The AAP reviews some of the problems associated with high intensity active shooter exercises and advises against the participation of children and youth (with potential exception of teens who have provided advance consent).

Some high-intensity active shooter exercises were designed to mislead students and staff into believing they were experiencing an actual shooting event, according to AAP. In at least one situation, armed weapons were pointed at school children. In another live exercise, high school students sobbed hysterically, vomited, or fainted, and some children sent farewell notes to parents. Children risked physical harm when a stampede ensued, and students jumped over fences to escape.

“Children of different ages and stages may react very differently – and sometimes negatively – to live exercise drills, especially if they are led to believe the drill is a real event ,” said Marlene Melzer-Lange, MD, FAAP, co-author of the statement. “We do not believe children benefit from participating in high-intensity exercises that involve the use of real weapons, gunfire or theatrical makeup that depicts blood or gunshot wounds.”

The AAP also recommends that:

• School officials obtain active consent/assent of adolescent volunteer participants.
• School personnel or other adults present during drills remain vigilant for

psychological distress.

• Organizers eliminate deception in drills and exercises. Notice of drills should be provided to parents, students, and staff members in advance to allow parents to opt out and to clarify to students that they can take a break or stop participation in a drill at any time.
• The drills focus on teaching skills rather than simulating distressing crisis events.
• Schools seek and incorporate student input.

AAP supports legislative advocacy and a move for states that require exercise drills to follow best practices offered by groups including the National Association of School Psychologists and the National Association of School Resource Officers.

Amid the COVID-19 pandemic, schools may choose to opt out of drills or use the time to more carefully plan future exercises with children’s needs in mind.

“We suggest that the focus remain on prevention, and creating a positive school climate and culture,” Dr. Schonfeld said. “As communities work toward the goal of returning students to in-person learning, schools more than ever will need funding to prepare educators to identify and help students who may be struggling with mental health issues.”

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults.