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Prehospital triage should match patient needs with hospital service availability. For emergency medical services (EMS), hospital destination choices are guided by patient conditions, transport times, jurisdictional resources, local hospital capabilities, and patient or family preference. Evidence-based guidelines (EBG) have been developed to aid EMS destination choices for adult patients suffering from trauma, myocardial infarction, and stroke. However, analogous guidelines do not exist for any pediatric condition other than trauma. Regionalization of care has concentrated on pediatric specialty or critical care services, magnifying the consequences of the destination decisions of EMS and increasing rates of interfacility transport (IFT) and secondary transport. Studies have identified several specific medical conditions that frequently necessitate secondary or interfacility transport. Preventable patient harms due to secondary and interfacility transport have also been identified. To avoid such harms and better serve the definitive care needs of the estimated 1.8 million children transported by EMS annually in the United State, EBG development should be explored for pediatric conditions beyond trauma.[1][2][3][4]