This comprehensive review of the literature from 2000 to 2018 regarding school firearm violence prevention failed to find any programs or practices with evidence indicating that they reduced such firearm violence. Hardening of schools with visible security measures is an attempt to alleviate parental and student fears regarding school safety and to make the community aware that schools are doing something.

Federal data show that 2018 was the worst on record for school shootings and gun-related incidents. The Naval Postgraduate School’s K-12 School Shooting Database says there were 94 school gun-violence incidents, a record since the data started being collected in 1970. The database includes every instance a gun is displayed or fired on campus or if a bullet hits school property for any reason.

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The Washington Post has maintained its own school shootings database for several years, and it found that since the 1999 massacre at Columbine High School in Colorado — in which 12 students and one teacher were killed by two teenagers who then killed themselves — more than 226,000 children at 233 schools have been exposed to gun violence. At least 143 children, educators and other people have been killed in assaults, and 294 have been injured.

The review published in Violence and Gender of 89 journal publications and some media reports was undertaken by James H. Price, professor emeritus in the Department of Public Health at the University of Toledo, and Jagdish Khubchandani, an associate professor of health science at Ball State University.

According to the Centers for Disease Control and Prevention, gun violence is among the leading causes of death for young people. But Price and Khubchandani wrote that little is actually known about how to prevent and reduce school firearm violence.

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Schools use a variety of practices to make campuses more resistant to attacks, including employing armed school resource officers; installing video cameras, bulletproof glass and metal detectors; requiring teachers and staff to wear identification tags; establishing schoolwide electronic notification systems; limiting open access to a school; developing active shooter plans; and conducting neighborhood police patrols.

The researchers concluded that the “ideal method for eliminating school firearm violence by youths is to prevent them from ever gaining access to firearms,” but, “unfortunately, studies have found an alarming rate of firearms accessible to youths.”

A second approach is assuming young people can obtain weapons but installing measures that will prevent guns from entering schools, the report says.

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According to the most recent data available, from 2015-2016, these are the most commonly implemented security measures:

— Monitored doors: 94 percent of public schools.

— Written plan for procedures to be performed in the event of an ‘‘active shooter”: 92 percent.

— Security cameras: 81 percent.

— Locked doors: 78 percent.

— Electronic notification system in school: 73 percent.

— Classrooms locked from inside: 67 percent.

— Lockers randomly searched: 53 percent.

— Metal detectors: 11 percent.

Such measures have not stopped shooters or weapons from being brought into school, the study authors wrote. And while 57 percent of schools indicated they have security staff on their campuses, only 13 percent of elementary schools and 46 percent of secondary schools had such coverage for the entire instructional day.

A third prevention technique, they said, is arming teachers, resource officers and other adults in a school “to shoot and kill youth who are shooters.” That won’t really work either, the study authors said.

The problem with this concept of a shootout in the public schools can best be seen with the following example. In the morning of January 3, 2018, a 15-year-old white male walked into Marshall County High School in Benton, Kentucky with a Ruger 9mm semiautomatic pistol and within 10 sec of shooting, he killed 2 and wounded 14 schoolmates. Armed school personnel would have needed to be in the exact same spot in the school as the shooter to significantly reduce this level of trauma. Ten seconds is too fast to stop a school shooter with a semiautomatic firearm when the armed school guard is in another place in the school.

What will work? They said more research is necessary to find out.