Empowerment: The ethical dilemma

The definition of trauma includes physical, emotional, and mental injury. A system of trauma includes prehospital, in-hospital, and posthospital care. The economic burden of trauma in low- and middle-income countries (LMIC) is significant, and there is an apparent need for better trauma systems in these countries. The key to successful trauma system development is empowering a community that has an infrastructure to support such a community. First responder training, a bottom-up approach, is only sustainable in an environment with an appropriate medical and system support in place. Systems development, a top-down approach, is not successful in a society where citizens do not take the initiative. The dilemma of trauma system development in LMIC lies in promising success while ensuring a bidirectional approach. Efforts should be directed at educational and policy developments to engage the community and alert the public and private sector to mobilize resources. Meeting these goals ensures not only the enhancement of a trauma system, but also a horizontal development of the healthcare system and capacity building within society.