478 DK Kim • Regionalization of pediatric emergency care in Korea Adult (19-64), 52.9% Elderly (≥65), 15.9% Children (<19), 31.2% Fig. 1. Emergency department visits by age, 2008. dents (first- and second-year). Monitoring services for children sedated for radiologic studies were not available in 53.1% of the EDs. The survey showed that a huge unpreparedness exists in current pediatric emergency service in Korea. An analysis of the NEDIS data for 3 years, from 2006 to 2008, provides us an estimate of the point of preparedness for pediatric emer- gency care in Korea2). The main reason for seeking pediatric ED was different between age groups. For children younger than 9 years, fever was a major complaint, while abdominal pain and headache were the most common symptoms for children over the age of 10. Admission to the hospital was required in 15% of patients, and the admission rate was above 20% in infants younger than 1 year. During the 3 years, about 6,000 patients were critically ill or injured so as to require care in intensive care units (an average of 16 patients per day). Need for regionalization in pediatric emergency care Originally, the emergency medical system was initiated to provide proper care for adult patients, and the need for pediatric emergency care has not been met adequately for a long time. The resources that need to be established for pediatric patients who visit the ED are different from those needed for adult patients. For adequate care for children, experienced staff, who understand the anatomical and physiological differences between adults and children is needed. Considering the growth and development of children, emergency medical equipment and appliances of various appropriate sizes must also be prepared. Moreover, a child-friendly environment, preferably separated from adult patients, is strongly recommended in order to reduce the psychological trauma and discomfort to the child. A comprehensive and regionalized system should be prepared, in addition to proper preparation for basic pediatric emergency care. Without specialized pediatric emergency and critical care, the outcome of critical pediatric illnesses is poor5,6). In reality, it is impossible that all EDs can be made ready to support high-quality pediatric emergency care. The occurrence of serious pediatric emergency cases is not only relatively low compared to adult cases, but also the pool of experts for pediatric advanced care is limited. Especially in Korea, the facilities and human resources for the pediatric field are greatly limited. Considering both cost-effectiveness and efficiency, a critically-ill or severely-injured child should be transferred to a specified referral center, which can take a charge of the definite treatment7). In addition, a child who needs a special procedure such as air-reduction or endoscopic foreign body removal, should be directed to a center with adequate personnel and equipment without delay. The term “regionalization” in healthcare refers to the development of a structured system of care “to improve patient outcomes by directing patients to facilities with optimal capabilities for a given type of illness or injury”8). Historically, the landmark report ‘Accidental Death and Disability: The Neglected Disease of Modern Society’9) has been a powerful driving force for regionalization in the United States (US) since the 1970s. Regionalization improves patient outcomes through 2 primary mechanisms: specialized care at high-volume, high-specialty centers and increased coordination of care within a given geographic area10). The first successful model for regionalization is a trauma care system in the US. There is substantial evidence that regionalization of services to designated hospitals with greater experience improves outcomes and reduces costs of care for severely injured patients11,12). Although the number of studies addressing pediatric experience of trauma centers is limited compared to adult trauma centers, the main results are that regionalized pediatric trauma system reduced the mortality of pediatric patients with severe damage13,14). Another successful regionalization model in pediatrics is neonatal care system. All hospitals cannot be prepared to house neonatal intensive care units (NICUs) for a fraction of complex preterm neonate. With regard to consideration of efficiency, the US and European countries have operated a regionalized NICU, which is invested in facilities and personnel. Substantial data from NICUs in these regions showed that NICU regionalization programs contributed to a low infant mortality15,16). Regionalization of pediatric emergency care The 2006 Institute of Medicine (IOM) Report “Emergency Care for Children: Growing Pains” concluded that pediatric emergency care is uneven in the US17). Fifty percent of all US EDs see fewer than 10 pediatric patients per day. In the US, a comprehensive and definite care for critically-ill or injured pediatric emergency cases has been performed mainly at 226 children's hospital and 170 trauma