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EMERGENCY preparedness drills help staff learn what to do in a real incident, and the more realistic the drill, the better—but only up to a point. Drills should not cause emotional trauma or create safety concerns that could cause harm and expose the company to liability. That’s why some experts advise against surprise drills, even though they are a truer test of employee response in a crisis.

A recent drill at the Siena campus of St. Rose Dominican Hospitals in Nevada, which involved the scenario of an off-duty police officer bursting into the intensive care unit brandishing a gun, made headlines because nurses, patients, and patient families told the media that they were unaware that the drill was coming.

The “gunman” did announce to those in the vicinity that the exercise was only a drill, but that on-the-spot announcement is technically considered a “no-notice” drill. Hospital spokesman Andy North acknowledged to Security Management that more notice should have been provided before the exercise and that the drill is currently under investigation.

In a surprise, no-notice drill, you do “get to capture the adrenaline of the employees,” notes Anita Tallarico, president and CEO of CONOPS Consulting LLC. Even though the scenario will begin with the person saying it’s a drill, staff will still have an “oh my gosh” moment where they realize that they don’t have time to look at their emergency plan, she says.

“If you tell people in advance that there is going to be a drill, you can’t really test the true response,” agrees Tzviel “BK” Blankchtein of Masada Tactical, who is the lead defensive tactics instructor for police in Maryland.

But the question is whether that approximation of a real response in a no-notice drill is worth the added potential for liability. And lawsuits do happen: a New Jersey pharmacy technician is currently suing her employers for a training drill that involved a masked gunman and no advanced warning.

Hospitals represent a challenging environment in which to conduct no-notice drills. They are public spaces full of people who may be confused by the drill and panic, says Blankchtein. For that reason and others, Blankchtein says that he does not conduct no-notice drills in hospitals.

Lee Clarke, sociology professor at Rutgers University, says that many people in hospitals are already in compromised situations. “Imagine somebody was on the operating table, and somebody made a mistake because they were too excited at the thought of an active shooter,” says Clarke.

Even without the element of surprise, drills can achieve many objectives. Announced drills are often used for testing on something that the staff has recently been trained on. Everyone should know what role they play in the exercise and get a chance to practice, says Tallarico. Blankchtein says this is a good way to develop muscle memory and proper execution of skill in participants. Additionally, by gathering all the stakeholders together ahead of time in a planned drill, you’re building trust between individuals and entities, says Clarke.

Another advantage to an announced exercise is that important individuals can be guaranteed to be present.

An alternative option is a middle-ground between specific advance notice and no notice. Many times, employees are provided with a notice that a drill will be happening in a certain time period, but they don’t know exactly when it will be or what it will entail.

Whatever the form of the drill, there should always be monitors who are aware of what’s going on, both for safety and for evaluation purposes, says Blankchtein. And the most important things to know in advance are the goals of the exercise and how the results will be assessed.