Ethics Under Pressure: Resource Allocation and Moral Resilience in Emergency and Disaster Medicine

Mass-casualty incidents and disasters place frontline responders - emergency medical services (EMS) crews, disaster triage teams, field-hospital personnel, nurses, and physicians - in situations where urgent needs exceed available staff, equipment, time, and clinical resources. These conditions demand rapid allocation decisions that are not merely operational but carry deep ethical weight, often conflicting with professional values and usual standards of care.Questions persist regarding the ethical basis of prioritization. Key issues include the role of prognosis and social vulnerability in allocation decisions. Furthermore, debates continue over the legitimacy of departing from usual standards of care, alongside the boundaries of individual clinician responsibility within institutional frameworks. To promote consistency, transparency, and fairness, various health systems have developed triage systems and crisis standards of care. However, their real-world application remains contested and highly variable. Existing allocation models are not always evaluated or adapted across all operational settings. These include hospitals, prehospital services, field hospitals, and low-resource environments. Finally, these institutional constraints are shaped by higher-level governmental and civil protection policies. Decisions regarding preparedness investment, resource stockpiling, and emergency planning are made at this macro level. Ultimately, these systemic policies establish the boundaries within which frontline allocation choices are subsequently made.At the same time, applying these approaches involves high uncertainty, inconsistent guidance, inadequate communication, and perceived inequity. These conditions have been shown to intensify moral distress and psychological strain among decision-makers. Documented consequences include burnout, post-traumatic stress symptoms, emotional exhaustion, and intentions to leave the profession. Existing literature tends to examine allocation approaches and the psychological experience of frontline professionals largely in isolation. Therefore, a more integrated approach is needed. This approach must connect scholarly and institutional models of resource allocation with the lived, ethical, and psychological realities of the professionals who enact them.This collection aims to examine the relationship between scholarly models of resource allocation and the frontline professionals who apply them. Specifically, it explores how institutional approaches to scarcity intersect with moral resilience, psychological wellbeing, and professional sustainability. It will consider how allocation approaches are designed, communicated, implemented, and evaluated. Additionally, it investigates how these frameworks influence trust, professional responsibility, moral distress, and patient outcomes.The topic seeks to bridge two distinct research communities. It brings together experts on normative triage models with those focused on the psychological experiences of frontline responders. The goal is to identify educational, organizational, and policy interventions. These interventions should simultaneously strengthen decision fairness and protect decision-makers. Finally, contributions may include empirical studies, normative analyses, and policy evaluations. Educational initiatives and evidence-based support approaches for clinicians and institutions facing scarcity are also welcome.This Research Topic spans prehospital, hospital, field-hospital, and public-health perspectives. It covers a broad range of disaster types, including natural disasters, pandemics, armed conflicts, and mass-casualty incidents. Crucially, submissions are not limited to a single clinical specialty.We welcome articles addressing, but not limited to, the following themes:Ethics of allocation and decision-making• Proposed ethical approaches and frameworks for disaster triage and resource allocation• Crisis standards of care: design, implementation, and evaluation• Allocation of ICU beds, ventilators, medicines, blood products, and staff• Equity, vulnerability, disability, age, and social justice in allocation decisions• Legal and policy dimensions of altered standards of care• Decision-support tools, algorithms, and predictive models for triageMoral resilience and psychological wellbeing• Moral distress, moral injury, and moral resilience in disaster and emergency response• Long-term psychological and professional consequences of ethically difficult decisions (burnout, PTSD, attrition)• Development and validation of assessment tools for moral distress/resilience• Personal, team-based, and organizational interventions to strengthen ethical resilienceInstitutional and organizational dimensions• Institutional governance, ethics consultation, and accountability during crises• Leadership, peer support, and team-level protective factors• Communication, transparency, and public trust in crisis decision-making• Organizational responsibilities of individual clinicians within institutional frameworksGovernmental and civil protection ethics• Ethical dimensions of state and civil protection policy in disaster preparedness and response• Impact of upstream governmental resourcing on downstream clinical allocation and access• Accountability and transparency in state-level disaster policy-making• Tensions between centralized policy directives and institutional/clinical ethical autonomyEducation and preparedness• Simulation, ethics education, and moral-courage training for disaster and emergency teams• Debriefing and post-incident support practicesComparative and cross-system perspectives• Cross-cultural and cross-system perspectives on disaster ethics• Comparative analyses across different countries, health systems, and disaster types Topic editors: Michael Igoumenidis, Andreas Follmann Source: https://www.frontiersin.org/research-topics/85599/ethics-under-pressure-resource-allocation-and-moral-resilience-in-emergency-and-disaster-medicine