Community-based trauma system development: key barriers and facilitating factors.

BACKGROUND Local progress in developing trauma systems has been slow, because of a variety of political, financial, social, and organizational challenges. The purpose of this study is to discuss effective community strategies 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 characteristics (e.g., resident populations of 1 million or more) but had varying progress in the development of trauma systems. RESULTS Several factors were identified in community and leadership characteristics that promoted the development of comprehensive trauma systems. CONCLUSION The most important strategies included broad-based participation 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 numbers of uninsured patients.