BACKGROUND: Although the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) requires healthcare organizations to demonstrate disaster preparedness through the use of disaster exercises, the evaluation of pediatric preparations is often lacking. Our investigation identified, described, and assessed pediatric victim involvement in healthcare organizations' disaster drills and exercises using data from after-action reports. METHODS: Following the IRB approval, the authors reviewed the after-action reports generated by healthcare organizations after a disaster drill and exercise, as a self-assessed reporting tool for JCAHO regulations. Forty-nine of these reports that were voluntarily supplied to the emergency medical services agency were collected. The authors analyzed the data using quantitative and qualitative analytic approaches. RESULTS: Only nine reports suggested pediatric involvement. Hospitals with large bed capacity (M = 465.6) tended to include children in exercises compared with smaller facilities (M = 350.8). Qualitative content analysis revealed themes such as lack of parent-child identification and family reunification systems, ineffective communication strategies, lack of pediatric resources and specific training, and unfamiliarity with altering standards of pediatric care during a disaster. CONCLUSIONS: Although many organizations are performing disaster exercises, most are not including pediatric concerns. Further work is needed to understand the basis for this gap in emergency preparedness. Overall, pediatric emergency planning should be a high priority for this vulnerable population.