Background
School shootings. Nothing scares parents, caretakers, and educators more than the thought of children facing this type of trauma. During one school lockdown, a 7-year-old girl used a colored marker to write a final note to her parents on her arm in case she did not survive. It said simply “Love mom and dad.” During other events, terrified children reacted by crying, vomiting, and fainting. Others risked injury by jumping over fences to escape.
What’s most shocking about these examples is that they did not happen during a real school shooting. The children were going through well-intentioned, high-intensity training drills conducted to prepare for a potential active shooter situation. For some training exercises, administrators did not explain that the practiceswere drills, therefore many children thought they were real events.
As a pediatric emergency physician and Chair of Disaster Preparedness and Response at University Hospitals – Rainbow Babies & Children’s Hospital in Cleveland, Ohio, Regina Yaskey, MD, FAAP, understands the need to keep children safe. But when she and other pediatric healthcare experts noticed the drills were causing stress, anxiety, and depression in children, they knew something needed to change.
Broader Challenge
After tragedies like the shooting at Sandy Hook Elementary School in 2012, more than 95% of schools in the U.S. added active shooter drills to their emergency preparations. While the goal was to improve children’s health and safety, the reality showed the drills can have a significant psychological impact. One studyfound that children aged 5-18 had increases of 39% in depression, 42% in anxiety, and 23% in mental health problems following active shooter drills.
In response to growing evidence that the drills were negatively impacting children, the American Academy of Pediatrics (AAP) released guidance in 2020 including recommendations designed to help educators plan effective safety training that does not cause distress.
Action
Armed with evidence that some drills were harmful to children, Regina began educating school personnel, updating her hospital’s emergency training, and advocating for progress with organizations like PPN’s Disaster Response Collaborative (DRC).
School training
To guide educators, Regina recommended they include mental health professionals and parents in planning, customize drills by age and trauma history, and provide parents with the option to keep children out of drills if desired. This level of transparency and communication helps to reduce chaos and improve reunification efforts during actual emergencies.
Hospital drills
By working with the AAP’s Council on Children and Disasters and other organizations, Regina has shaped the development of new guidelines to aid hospitals. At UH Rainbow Babies & Children’s, she increased the number of training drills and regularly conducts tabletop exercises and mini drills throughout the year focused on increasing multidisciplinary teamwork and pinpointing areas of improvement. For drills involving children, Regina’s team designed non-traumatizing exercises that include thorough briefing with stringent consent and assent practices.
DRC Reunification Sessions
Reuniting children with caregivers is critically important during emergencies, especially for school shooter events where they are already separated from their families. Regina’s ongoing work with the DRC Reunification Focus Area Oversight Group involves planning educational sessions designed to share knowledge that improves preparedness. The sessions feature subject-matter experts including emergency managers and clinicians who discuss ways to help hospitals, schools, and other institutions develop or refine their reunification plans.
Impact
The efforts by Regina and other experts to improve how schools and hospitals prepare for active shooter emergencies have been successful. Through organizations such as the AAP and initiatives like the DRC, Regina has helped to create and disseminate recommendations and resources that enable pediatricians, educators, and administrators to implement better training and reunification practices.
In response to these guidelines, many schools have replaced stressful, active shooter drills with calmer, age-appropriate training and tabletop exercises that include advance notice for children and teachers. Another small but important change has been a shift in terminology away from “active shooter drills” to “safety drills” or “lockdowns.” These changes have helped to reduce fear, decrease anxiety, and limit re-traumatization in children with prior exposure to violence. Simultaneously, the process improvements have strengthened organizations’ ability to respond to pediatric emergencies more efficiently.
Next Steps
While local practices and national standards have progressed, the work to improve community-wide communication and create empathetic spaces for children is ongoing. Looking forward, Regina would like to expand this effort by empowering children and giving them more tools to deal with hostility and anger.
“Educating our children is essential,” Regina states. “Teaching them to practice violence prevention should happen not just in schools, but everywhere. We have a responsibility as physicians, parents, and community leaders to teach kids violence prevention and let them know they can peacefully coexist. So that would be my future goal. Not just getting children through these drills but teaching them that they have a part in this effort, too, and that we’re all on one team.”
Key Takeaways
The recent changes to active shooter planning and reunification practices demonstrate that it’s possible to protect and empower children without sacrificing their mental health. It requires ongoing community collaboration, evidence-based education, and trauma-informed approaches. Regina recommends that organizations start with key resources from the American Academy of Pediatrics, the AAP Council on Children and Disasters, the Pediatric Pandemic Network, and PPN’s Disaster Response Collaborative.
“By changing our practices and emphasizing community-wide communication, we’ve seen a drop in mental health issues related to training,” Regina states. “It doesn’t just happen in schools. It involves discussions between parents, health professionals, and educators. My hope is that we can bring this same collaboration to all communities. That’s one reason why we continue to advocate for kids everywhere.”
Resources
- Go to the American Academy of Pediatrics and Council on Children and Disasters
- Find resources from the Disaster Response Collaborative.