A guide was created by the Chicago Healthcare System Coalition for Preparedness and Response to help hospitals and health facilities design, implement, and evaluate emergency exercises following the US Homeland Security Exercise and Evaluation Program (HSEEP) format. The HSEEP provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. As a part of a toolkit for hospital use, the pediatric at-risk population is represented with an Exercise Evaluation Guide titled “Pediatric Medical Surge”. Pediatric Medical Surge is defined as the rapid expansion of the capacity of the existing healthcare system in response to an event that results in an influx of children and an increased need for personnel (clinical and non-clinical), support functions (laboratory and radiological), physical space (beds, alternate care facilities), and logistical support (clinical and non-clinical equipment and supplies). The Exercise Evaluation Guide is fully customizable and includes the following activity sections: (1) Pediatric Pre-Event Mitigation and Preparedness; (2) Incident Command; (3) Pediatric Bed Surge Capacity; (4) Pediatric Surge Staffing Procedure; (5) Pediatric Decontamination; (6) Receive, Evaluate, and Treat Pediatric Surge Casualties; (7) Provide Pediatric Surge Capacity for Behavioral Health Issues; and (8) Demobilization. Each of these sections includes a number of exercise tasks and details the potential tasks/observation keys that are completely modifiable in an electronic format. All or a limited number of these activity sections can be used in an exercise. Following the Activity and Tasks, a section for Observations is provided, and includes Strengths and Areas for Improvement. Upon completion of the Exercise Evaluation Guide, the findings are then utilized to complete the After Action Report for the exercise. This planning document is one tool to assure that children are not neglected in health care based exercises.