Analysis of emergency medical service areas of pediatric severe emergency patients and the appropriate number of pediatric emergency centers in the Republic of Korea

Purpose: Pediatric emergency patients have clinical characteristics that differ from adult patients, making the timely provision of emergency medical services crucial. Currently, 12 pediatric emergency centers (PECs) operate in Korea with uneven geographic distribution, creating medical care gaps for critically ill patients. The authors aimed to establish medical service areas using an inflow-outflow index based on patients’ medical use patterns and to suggest the optimal number of PECs in Republic of Korea.Methods: We analyzed data from the Korean National Emergency Department Information System for patients aged 18 years or younger who visited regional or local emergency medical centers in 2022. Critically ill patients were defined as those given a Korean Triage and Acuity Scale 1-3 and relevant diagnostic codes. The relevance index and commitment index were calculated using the postal addresses of patients and institutions. Medical service areas were established using the inflowoutflow index, defined as the relevance index divided by the commitment index, with the optimal number of PECs estimated using the volume of critically ill patients in each area.Results: Among 895,302 total visits, we analyzed 48,790 visits after applying exclusion criteria. Based on the inflowoutflow index, 12 medical service areas were established, namely Seoul, Gyeonggi, Incheon, Busan-Ulsan-Gyeongnam, Daegu-Gyeongbuk, Daejeon, Chungnam, Jeonbuk, Gwangju-Jeonnam, Gangwon, Chungbuk, and Jeju. The optimal number of PECs was calculated as 18 centers total, with Seoul and Gyeonggi requiring 4 each, and the other regions requiring 1 each based on the regional disparities in patient volumes.Conclusion: In addition to the currently operating 12 PECs, 6 centers should be designated in the medical service areas of Seoul, Gyeonggi, Gwangju-Jeonnam, Gangwon, Chungbuk, and Jeju. It would be more evidence-based to establish medical service areas based on the patients’ medical use patterns than on the administrative boundaries.