Community-based trauma system development: Key barriers and facilitating factors

Background: Local progress in de developing trauma systems has been slow, b ecause of a variety of political, financial, social, and organizational cha llenges. The purpose of this study is to discuss effective community strate gies for dealing with these obstacles to trauma system development. Methods: In-depth case studies were conducted in 12 study sites across the United States, These communities had similar sociodemographic characteristi cs (e.g., resident populations of 1 million or more) but had varying progre ss in the development of trauma systems. Results: Several factors were identified in community and leadership charac teristics that promoted the development of comprehensive trauma systems. Conclusion: The most important strategies included broad-based participatio n of key stakeholders (especially community representatives), local trauma leaders who were patient and resourceful, local events (some of which were orchestrated) that demonstrated the need for change in trauma delivery, and financial programs that recognized the needs of trauma centers with high n umbers of uninsured patients.