The care of critically ill children has become more complex and demanding. This document establishes recommendations for developing regionalized integration of the care of these children into the emergency medical services system. These recommendations were developed by pediatricians with expertise in pediatric critical care, transport, and emergency medicine from the Pediatric Section of the Society of Critical Care Medicine Task Force on Regionalization of Pediatric Critical Care and the Committee on Pediatric Emergency Medicine from the American Academy of Pediatrics. The document was developed from existing guidelines from a number of professional organizations (including the Society of Critical Care Medicine and the American Academy of Pediatrics), a thorough review of the literature, and expert consensus.