Background: The care of critically ill children requires specialized multidisciplinary expertise, typically concentrated in tertiary care centers. Germany lacks nationwide dedicated pediatric intensive care transport services to safely transfer critically ill children. This poses a risk of suboptimal or inadequate care for critically ill children in primary or secondary care pediatric units. Objective: Analyzation whether a comprehensive intervention package, including I) telemedicine-supported patient care, II) emergency medicine training for medical teams, and III) establishment of a professional pediatric intensive care transport structure, improves the care of critically ill children and reduces the psychological burden on regional healthcare teams and patient families. Methods: This prospective observational study is part of an innovative pilot project networking the pediatric intensive care unit at the University Hospital Dresden, serving as a tertiary center, with 16 regional partner hospitals and a pediatric rehabilitation clinic. Results: The implementation of the telemedicine network tripled local access to pediatric intensive care expertise for children in the Free State of Saxony. A dedicated pediatric intensive care transport team addresses a critical gap in secondary transfer care. Furthermore, telemedicine consultations and specialized transport services measurably reduced psychological stress for medical teams at partner hospitals during emergencies. Conclusion: Telemedicine and specialized pediatric intensive care transport have the potential to close care gaps in rural areas. To achieve national health policy goals for centralization, widespread national implementation of these services is essential to ensure quality of care for critically ill children.