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Relevance. The problem of organizing specialized medical care in emergency forms for children is caused by three groups of reasons: the presence at the junction of several adult and pediatric medical specialties, the medical and geographical features of the country and the lack of a unified regulatory framework.Intention. To increase the availability of medical services and reduce regional inequality in their distribution. A model of organizing a single operational service of specialized medical care for children and the basic principles of its functioning on the territory of the Russian Federation are proposed.Methodology. Statistical data, features of legislation, ways of solving the problem in certain regions and the achievements of initiative groups of specialists are analyzed.Results and Discussion. Since 2000, the number of hospital beds for children, the number of emergency medical stations has decreased, and the number of diseases and conditions requiring specialized emergency care for children has increased. Infant mortality rates in remote and hard-to-reach regions exceed the national average by 1.5–2.6 times. At the same time, the current statistics of medical evacuations of children are not accurately reflected in any of the official sources. The regulatory framework for medical evacuation of children includes three “ Procedures for providing medical care “in the profile “ambulance”, “neonatology” and “obstetrics and gynecology” and Federal Law N 323. The law implies the presence of mobile teams in hospitals and departments of different profiles that are not related to each other, but there is no structure that unites them and analyzes the results of work at the federal level.Conclusion. To solve the problem, it is necessary to create a federal operational service and a “hotline” that can be contacted by any resident of the country, to form a federal medical register of critical conditions in children, to develop and implement common principles of diagnosis and treatment. The presented model and principles contribute to the development of a three-level system of emergency medical care and correspond to the goals and objectives of the Ministry of Health of the Russian Federation set out in Letter N 14-3/n/2-2339 of 20.03.2019.