Korean J Pediatr 2011;54(12):477-480 • http://dx.doi.org/10.3345/kjp.2011.54.12.477 479 centers with pediatric capabilities. As a categorization model for the regionalization of pediatric emergency care, the Emergency Depart- ment Approved for Pediatrics (EDAP) model was established in Los Angeles County in 198518). In this model, only those hospitals meeting requirements as an EDAP in Los Angeles County could receive chil- dren brought in by emergency medical services (EMS). However, parents or guardians usually transport their child directly, by them- selves, rather than by using EMS system and they tend to visit the ED nearest to their home, and not necessarily one with pediatric capabilities. This is referred to as one of the barriers to developing the regionalized network of pediatric emergency care in the US10). Based on previous reports8,10,17), there are some suggestions for success of the regionalization of pediatric emergency care in Korea. First of all, the appropriate categorization should be achieved in all areas in pediatric emergency care. While a transfer of patient by EMS must be achieved according to a level of patient’s acuity, properly assessed at pre-hospital field, a critically-ill child should be transferred to an ED with staffed with certified personnel and equipment. Training and continuing education of pediatric emergency care for EMS providers should be introduced as an essential EMS education course and the classification of pediatric patients must be made using well-established protocols. Information from emergency information center should also be properly matched with the patient’s severity level, along with efforts to better inform the community about the level of critical care and services available for pediatric emergency care at the ED within a region. The categorization of EDs according to their capability for pediatric emergency care is essential for a successful regionalization program. To eliminate controversies, the development of categories should be evidence-based and supported by multidisciplinary expertise. Further, as the IOM report recommended, the coordination of all elements of child healthcare from an EMS system to hospital care, should be governed by legislation and be followed as a matter of policy. A process of accreditation, to dedicate and approve a healthcare facility as a speci- alized provider of pediatric care from a certifying authority, is also required. In this respect, the current “pediatric exclusive emergency department projects” conducted by Ministry of Health and Welfare should be reviewed. The role of the pediatric exclusive ED in the current project is not a comprehensive regional pediatric emergency center for resource-intensive care of critically-ill children, but rather just a well-equipped pediatric ED without a higher level function. Rather, a flock of children with low acuity to the center could make a delay of adequate care for critically-ill patient. This program has been initiated without a sufficient thought and long-term planning, and is focused only the facilities and equipment supply. Actually, it does not provide a plan for managing the human resource, which is the most important factor for the success of pediatric emergency care system. One of the concerns surrounding regionalization of pediatric emer- gency care is that transfer of too many patients from community hospitals would reduce the chance of appropriate pediatric care, raising the concern that there may be an eventual degradation of the quality of pediatric emergency care in whole community. However, the basis for regionalization is that all emergency center scaring for pediatric patients must be prepared to some baseline extent. Further, regionalized systems need a back-transport of patients to non-specialty hospitals after they have been stabilized and their condition improved. Parents or guardians may be reluctant to back-transport, because of their comfort and belief in the high level hospital19). However, if not supported by a re-distribution system, the referred hospital could become crowded with patients awaiting treatment. Other aspects to be addressed in establishing regionalization are a specialist on-call system and financial incentives. It may be difficult to get the on-call personnel to come to the ED, even though their privacy has been compromised by calling them directly, since financial incentives for their participation in emergency care cannot be provided easily under current Korean health insurance policies. For these reasons, it has become increasingly difficult for EDs to find specialists who will be ready for on call for the ED, and the resulting shortage of on- call specialists in pediatric emergency care leads to sometimes tragic results. Currently, the Korean Society of Pediatrics and the Korean Society of Emergency Medicine have been carrying out some efforts to increase medical insurance fees for emergency and pediatric areas. In addition to an introduction of appropriate medical fees, a special compensation and/or financial incentives must be offered to regional pediatric emergency centers to attract highly qualified pediatric emer- gency care personnel. Summary The pediatric emergency care system in Korea is still in its infancy. We took a first step towards understanding the basic status of pediatric emergency care and for determining its preparedness in providing adequate pediatric emergency care. Many resources have been focused on pediatric emergency care regionalization in some developed countries. We need to take some different regionalization strategies in consideration of the different circumstances in medical practices in Korea. To do so, medical personnel, resources, and facilities that are closely related to pediatric emergency care should be identified and adequately categorized before implementation of a regionalization system. Based on this, information in all phases of emergency medical systems, including data from patients, paramedics, and hospitals, should be collected and share efficiently for building an information