During a 12-month period ending on November 30, 1988, all ambulance arrivals at a pediatric emergency department (ED), all prehospital communications with this ED, all first-responder ambulance runs on Oahu and the state of Hawaii, and all neonatal/pediatric interhospital transports were examined to evaluate pediatric prehospital care. Handicapped patients were more likely to use an ambulance, and their care was more likely to be perceived as a weakness on the part of ambulance personnel. Poorer communication clarity was associated with longer duration of communication. Common pediatric diagnoses were trauma, respiratory problems, seizures, near drownings, and poisonings. Mean transport times were shorter on Oahu than on the outer islands. Premature newborns and handicapped children commonly required interhospital transport. The care of children can be improved by addressing some of the identified problem areas, eg, improving prehospital communication and improving the training of prehospital personnel in the care of infants and handicapped children.