More than seven years after the disaster of September 11, 2001, the U.S. remains relatively unprepared for a large-scale disaster involving children. Despite important advances in our country's ability to respond effectively to chemical, biological, or nuclear terrorism, there continues to be inadequate development of pediatric protocols that could be implemented by the local, State, and Federal agencies charged with preparation and consequence management. Emergency preparedness plans have evolved over recent years to include not only intentional (terrorist) disasters but also unintentional public health emergencies such as natural disasters (e.g., earthquakes or floods; chemical incidents such as hazardous materials releases; and emerging infections such as Severe Acute Respiratory Syndrome (SARS), West Nile virus, and pandemic influenza). Under principles of dual functionality, emergency response plans must now take the approach of creating response plans that integrate intentional and unintentional disasters. Children differ from adults in many ways that are of great importance in building public health emergency response plans. Their greater susceptibilities result from differences in breathing rate, skin permeability, innate immunity, fluid reserve, communication skills, and self-preservation instincts. These differences and others require that disaster response plans be modified for such a priority population. Children also spend as much as 70-80 percent of their waking hours away from their parents in school. Schools, therefore, have a vital role in assuring that children are cared for and proper interventions are delivered after a public health emergency. When this project was undertaken in 2004, there was no national model for school-based public health preparedness. Consequently, school districts across the Nation had rudimentary, fragmented, or non-existent emergency preparedness programs. Since 2006, there has been a marked increase in awareness of the vulnerability of schools and the challenging logistics involved in protecting children in schools during unexpected events. However, there continue to be obstacles for many school districts in creating a practical, comprehensive, and practiced school-based emergency response plan. Among these obstacles are evacuation, accommodations for children with special health care needs, and inclusion of after-school programs in emergency response plans. Under a contract from AHRQ, the Center for Biopreparedness at Children's Hospital Boston conducted an analysis of emergency response plans from school districts in Massachusetts, Florida, Wisconsin, Colorado, and California. Using these findings in conjunction with existing recommendations on the development of school-based preparedness programs, we developed a template that provides an overview, including "best practices" for school districts to use in their development of a comprehensive emergency response plan. Finally, in cooperation with the Brookline, Massachusetts, public schools, we designed a roadmap for the development of school-based plans for each of the eight elementary schools, high schools, preschools, and after-school programs in Brookline. This monograph provides guidelines for use by school districts of all sizes. Our goal in creating this monograph is to describe to readers a practical approach to creating a school-based all-hazards emergency response plan from the national literature in combination with "lessons learned" in the field.