Planetary Health and Educational System Resilience: Lessons from COVID-19 Disruptions to Special Education Evaluation Systems

Abstract

Early pandemic disruptions exposed critical vulnerabilities in special education systems, particularly in referral and evaluation processes governed by the Individuals with Disabilities Education Act (IDEA). This convergent mixed-methods study examined how 86 educational diagnosticians across Louisiana experienced and responded to these disruptions. Quantitative results showed a 38% decline in referrals during school closures followed by a 62% rebound, prolonged evaluation timelines, and notable increases in emotional/behavioral disabilities, other health impairments, and specific learning disabilities. Qualitative findings elaborated on these patterns, revealing challenges related to assessment validity, communication barriers, workload strain, and professional learning needs. Interpreted through systems theory and planetary health frameworks, the findings position special education evaluation systems as critical social infrastructure that links educational continuity, equity, and population well-being. Strengthening diagnostic capacity, digital infrastructure, and crisis-responsive practices is therefore essential not only for IDEA compliance, but for advancing planetary health goals related to resilience, justice, and sustainable human development.

1. Introduction

The COVID-19 pandemic precipitated a global crisis that extended far beyond public health, exposing fragilities in interconnected educational, technological, and social systems [1,2,3]. Within special education, the rapid suspension of face-to-face schooling disrupted federally mandated evaluation procedures under the Individuals with Disabilities Education Act (IDEA) [4,5,6]. Across the United States, schools reported widespread delays in referrals, inequities in access to evaluations and challenges ensuring the validity of remote assessments [5,6]. Early analyses revealed that diagnostic timelines lengthened considerably, particularly in rural districts where broadband access and professional capacity were limited [7].

From a planetary health perspective, education functions as a core determinant of human wellbeing—its disruption affects not only individual learning outcomes but also community resilience and social equity [1,2]. The United Nations’ 2030 Agenda for Sustainable Development situates inclusive and equitable education (SDG 4) as central to achieving broader goals of health, peace, and prosperity (SDG 3 and SDG 10) [3]. Although the United Nations’ 2030 Agenda did not anticipate a global pandemic, its emphasis on inclusive and equitable education (SDG 4) provides a normative framework for evaluating how educational systems respond under crisis conditions. Examining how diagnostic systems adapted—or failed to adapt—during COVID-19 therefore offers insight into institutional flexibility, equity, and justice under systemic stress.

Prior to the COVID-19 pandemic, special education referral and evaluation procedures followed relatively stable, federally mandated timelines under IDEA, which requires that initial evaluations be completed within 60 calendar days of receiving parental consent [4]. Under typical conditions, students progressed through a multi-step diagnostic workflow that included documentation of instructional interventions within a Multi-Tiered System of Supports (MTSS), formal referral for evaluation, parental consent, multidisciplinary assessment, eligibility determination, and placement decisions [3,8]. Educational diagnosticians played a central role in coordinating these processes, ensuring procedural compliance, administering or overseeing assessments, and facilitating eligibility meetings. Even before the pandemic, referral systems were under strain due to increasing student needs, particularly related to emotional and behavioral functioning. National and state-level data documented rising concerns associated with emotional and behavioral disabilities, driven in part by trauma exposure, mental health challenges, and the cumulative effects of socioeconomic stressors [5,6,7].

Louisiana provides salient context for examining these disruptions. The state experienced some of the nation’s most severe pandemic-related instructional interruptions, shaped by extended school closures, uneven broadband access across parishes, and workforce shortages among specialized personnel [2,5,7]. These conditions intensified existing challenges in special education service delivery and placed additional strain on referral and evaluation systems tasked with maintaining procedural safeguards under unprecedented constraints. Understanding how diagnostic processes functioned across this period offers important insight into systemic vulnerability and recovery.

This study focuses on 14 Louisiana public school districts and examines how educational diagnosticians experienced and responded to pandemic-related disruptions to referral and evaluation processes. Guided by a systems-oriented and equity-informed conceptual framework, the study sought to (a) document measurable changes in referral and evaluation patterns before, during, and after the pandemic; (b) examine contextual differences across district environments; and (c) identify implications for educational diagnostician preparation programs, which must now address remote assessment competence, technological equity, and crisis-responsive practice within evolving professional roles [9].

From a planetary health perspective, education systems function as foundational social infrastructure that mediates population health, social stability, and intergenerational equity. Disruptions to special education evaluation processes—particularly those governing access to disability identification and support—represent not only educational breakdowns, but systemic threats to child well-being and community resilience. Framing special education diagnostics within planetary health therefore extends analysis beyond procedural compliance, situating evaluation systems as mechanisms through which societies uphold equity, protect vulnerable populations, and sustain human development during global disruption.

2. Materials and Methods

2.1. Design and Participants

This study employed a convergent mixed-methods design to capture both quantitative and qualitative dimensions of the COVID-19 pandemic’s impact on special education referral and evaluation systems [9]. The quantitative phase utilized the Special Education Process Profile (SpEd-PP) survey, an original 42-item instrument developed to examine five domains: (1) demographics, (2) pre-pandemic referral and evaluation procedures, (3) pandemic-related adaptations, (4) post-pandemic recovery, and (5) professional development needs.

Participants were educational diagnosticians employed in public school districts across Louisiana. Educational diagnosticians are state-certified specialists responsible for conducting psychoeducational evaluations, determining eligibility for special education services under the IDEA, and coordinating multidisciplinary assessment teams within public school systems. These professionals play a central role in ensuring procedural compliance, assessment validity, and timely eligibility determination.

The SpEd-PP survey was distributed electronically to 118 educational diagnosticians across 14 Louisiana public school districts. A total of 86 completed responses were received, yielding a response rate of 74%. Respondents represented rural, suburban, and urban district contexts and varied in years of professional experience. For the qualitative phase, a purposive subsample of 12 diagnosticians participated in semi-structured interviews designed to elaborate on survey findings and provide deeper insight into system-level disruptions, equity challenges, and professional practice during the pandemic period. The survey domains and representative constructs assessed by the Special Education Process Profile (SpEd-PP) are summarized in

Table 1. Domains and sample constructs of the Special Education Process Profile (SpEd-PP).

Domain	Focus Area	Example Constructs Assessed
Demographics	Professional context	Years of experience, district type, caseload
Pre-pandemic Procedures	Baseline practices	Referral timelines, evaluation workflows
Pandemic Adaptations	Crisis response	Remote assessment use, procedural changes
Post-pandemic Recovery	System rebound	Referral backlogs, staffing capacity
Professional Learning Needs	Capacity building	Training in virtual assessment, ethics

Note. The Special Education Process Profile (SpEd-PP) is a researcher-developed survey instrument designed to examine changes in special education referral and evaluation systems before, during, and after COVID-19-related disruptions. Domains reflect diagnostician-reported practices and perceptions across district contexts.

, providing an overview of the instrument’s conceptual structure and alignment with the study’s systems-oriented focus.

2.2. Context and Conceptual Framework: Systems Theory, Equity, and Planetary Health

This study is guided by a conceptual framework integrating systems theory and equity-oriented perspectives in education. System theory conceptualizes special education referral and evaluation as interdependent processes embedded within broader institutional, technological, and policy systems, where disruption to one component affects the functioning of the whole [1]. Equity frameworks further emphasize access, timeliness, and validity as core dimensions shaping how evaluation systems operate for historically underserved populations [8,10].

Within this framework, Louisiana’s MTSS provides the operational context for understanding how data-based decision-making, family collaboration, and tiered intervention structures interface with IDEA-mandated evaluation requirements [4,8]. Pandemic-related disruptions are therefore conceptualized not as isolated procedural failures, but as systemic stressors that revealed misalignment among policy expectations, technological capacity, and human resources within special education systems.

Planetary health extends this framework by emphasizing the interdependence of human well-being, institutional resilience, and broader ecological and social systems. Within this lens, special education evaluation systems operate as adaptive structures that must remain functional during global disruptions—whether public health crises, environmental disasters, or climate-related emergencies. Pandemic-related failures in referral access, evaluation timeliness, and assessment validity thus signal not only educational vulnerability, but weakened planetary health capacity to protect children with disabilities during systemic stress.

2.3. Data Collection and Analysis

Quantitative data included pre-, during-, and post-pandemic referral counts, classification distributions, and evaluation timeliness, as reported by district diagnosticians. Descriptive statistics summarized overall patterns, while paired-sample t-tests assessed differences across the three time periods. Interview transcripts were coded inductively, allowing emergent themes to surface regarding assessment validity, collaboration barriers, and professional capacity. Procedures followed established guidelines for mixed-methods design and integration [9], ensuring that quantitative and qualitative findings informed one another in the interpretation stage.

2.4. Ethical Considerations

The study adhered to ethical principles of informed consent, confidentiality, and data protection consistent with institutional and federal requirements. Approval for the study was granted by the Southeastern Louisiana University Institutional Review Board. Participation in both the survey and interview phases was voluntary, and no identifying information was collected.

Data were stored on encrypted, password-protected university servers accessible only to the research team. Participants received a plain-language consent form outlining the voluntary nature of participation, the right to withdraw at any stage without penalty, and the intended use of data for peer-reviewed publications and professional presentations. Participants were informed that their responses would be reported in aggregate form and used solely for scholarly dissemination and professional learning purposes.

3. Results

3.1. Quantitative Findings

Analysis of pre-, during-, and post-pandemic data revealed substantial fluctuations in referral and evaluation activity across the 14 participating Louisiana school districts. Quantitative findings from the SpEd-PP survey revealed three major areas of systemic disruption: (a) referral volume, (b) evaluation timelines, and (c) shifts in disability classifications. Consistent with national reports of pandemic-related disruption [5,6], referrals declined by 38% during the 2020–2021 academic year but rebounded by 62% following the return to in-person learning. These diagnostician-reported patterns of referral decline and rebound are summarized in

Table 2. Diagnostician-reported changes in special education referral volume before, during, and after the COVID-19 pandemic.

Time Period	Direction of Change vs. Previous Period	Percent Change
Pre-pandemic (baseline)	—	—
During pandemic (2020–2021)	Decrease	−38%
Post-return to in-person learning (2022 onward)	Increase	+62%

Note. Values represent diagnostician-reported changes in referral volume relative to the prior period. Pre-pandemic values serve as the baseline for comparison; therefore, no percent change is reported for the baseline period.

.

From a planetary health perspective, these fluctuations illustrate how educational systems respond under population-level stress, with referral suppression during crisis periods followed by destabilizing rebounds that strain institutional capacity and equity safeguards.

Average evaluation timelines expanded from 58 days (pre-pandemic) to 97 days (during school closures) before partially stabilizing at 76 days in 2024. Average evaluation timelines across three periods are presented in

Table 3. Average number of days to complete IDEA-mandated evaluations across three time periods.

Time Period	Average Days to Complete Evaluation
Pre-pandemic	58 days
During pandemic (school closures)	97 days
Post-pandemic recovery (2024)	76 days

Note. Days reflect district-reported averages from consent to eligibility determination.

, illustrating a marked spike in delays during school closures followed by only partial recovery.

This pattern reflects systemic capacity challenges identified in broader studies of special education service delivery under COVID-19 [7,10].

Notably, shifts in disability classification emerged across the three timeframes. Reported increases included +21% in emotional/behavioral disabilities (EBD), +17% in other health impairments (OHI), and +12% in specific learning disabilities (SLD)—a trend consistent with research linking prolonged isolation and instructional disruption to behavioral and academic regression [6,7].

Table 4. Diagnostician-reported increases in special education classifications following COVID-19 disruptions.

Disability Category	Direction of Change	Percent Change
emotional/behavioral disabilities	Increase	+21%
other health impairments	Increase	+17%
specific learning disabilities	Increase	+12%

Note. Percent values summarize reported increases in the proportion of students identified in each category across pre-, during-, and post-pandemic periods.

summarizes these shifts in disability classification, highlighting disproportionate increases in emotional/behavioral disabilities, other health impairments, and specific learning disabilities.

As shown in

Table 5. Relative evaluation delays for rural versus urban/suburban school districts.

District Type	Relative Delay Index (Urban/Suburban = 1.00)	Percent Longer Delay
Urban/Suburban	1.00	—
Rural	1.24	+24%

Note. Rural districts experienced evaluation timelines that were, on average, 24% longer than those of urban/suburban districts.

, rural districts experienced 24% longer average delays than urban or suburban counterparts, paralleling findings that geographic and digital inequities amplified pandemic learning gaps [2,3].

3.2. Qualitative Findings

Qualitative data were obtained through semi-structured interviews with 12 educational diagnosticians conducted following analysis of survey results to elaborate observed quantitative trends. Participants represented rural, suburban, and urban school districts across Louisiana and varied in years of professional experience. Interview transcripts were analyzed using inductive thematic analysis, employing a two-cycle coding process that included initial open coding followed by pattern coding to refine and consolidate themes. Four primary themes emerged:

• Assessment Validity and Reliability—Diagnosticians reported persistent challenges ensuring assessment validity during remote and hybrid evaluation conditions, echoing national concerns regarding non-standardized testing environments and compromised psychometric integrity during COVID-19 disruptions [6,7]. Participants cited environmental distractions, caregiver presence, limited student engagement, and technological disruptions as primary barriers to reliability. These concerns were reported across district types but were most pronounced in rural districts with limited broadband access, consistent with documented geographic inequities in digital infrastructure [2,3]. To mitigate these challenges, diagnosticians described increased reliance on record reviews, rating scales, observational data, and data triangulation, reflecting adaptations noted in prior pandemic-era assessment literature [3,4].
• Communication Barriers and Family Engagement—Participants described significant breakdowns in communication with families during school closures, particularly related to obtaining informed consent and explaining evaluation procedures remotely. Diagnosticians noted that families with limited digital literacy or inconsistent internet access experienced greater difficulty engaging in the evaluation process, contributing to delayed referrals and prolonged timelines. These challenges align with research documenting pandemic-related disruptions to school–family partnerships and inequitable access to special education services [2,3]. Participants emphasized that communication barriers often compounded preexisting inequities, particularly for families already marginalized within educational systems [10].
• Workload and Systemic Capacity—All participants reported substantial increases in workload following the return to in-person instruction, including large referral backlogs, expanded caseloads, staffing shortages, and pressure to address evaluations deferred during school closures. Diagnosticians indicated that capacity strain persisted well beyond the immediate pandemic period, extending into 2023, mirroring national findings related to educator burnout and system overload during prolonged recovery [9]. These experiences aligned closely with quantitative findings showing prolonged evaluation timelines and uneven recovery across the 14 participating districts, reinforcing systems-theory assertions that disruption to one subsystem generates cascading strain across the broader educational network [1].
• Professional Learning Needs—Diagnosticians consistently identified gaps in professional preparation related to virtual assessment practices, ethical decision-making under nonstandard conditions, and remote collaboration with families and multidisciplinary teams. Participants emphasized the need for targeted professional development focused on virtual assessment validity, culturally responsive family engagement, and crisis-responsive evaluation protocols. These findings align with broader calls for restructuring educator preparation and ongoing professional learning to enhance resilience and equity in disrupted systems [8,9]. Participants noted that existing training models were largely designed for stable, in-person contexts and were insufficient for sustained crisis conditions.

Collectively, these themes illustrate how pandemic-related disruptions functioned as a systemic stressor, revealing vulnerabilities in assessment infrastructure, communication systems, and professional capacity that disproportionately affected the equity and timeliness of special education evaluations [1,2,3,9,10]. Taken together, these findings demonstrate how pandemic conditions disrupted the social and technological ecosystems that sustain equitable evaluation practices—reinforcing planetary health assertions that institutional fragility disproportionately affects vulnerable populations during global crises.

3.3. Integration of Findings

Quantitative and qualitative strands converged to highlight systemic strain in maintaining equity, timeliness, and validity under crisis conditions, consistent with recommended procedures for mixed-methods integration [9]. Findings suggest that the pandemic functioned as a “stress test” of special education infrastructure—revealing how fragile procedural safeguards can be when technological, human, and policy systems misalign [1,2]. Collectively, results support calls for resilient educational systems that embed flexibility, cross-sector collaboration, and ongoing professional learning to sustain equitable evaluation practices in future disruptions [3,9,10].

4. Discussion

This study examined how COVID-19-related disruptions reshaped special education referral and evaluation systems in Louisiana, revealing patterns of systemic fragility, uneven recovery, and equity-relevant consequences. Interpreted through a systems-oriented and equity-informed conceptual framework, the findings demonstrate that disruptions to instructional delivery cascaded across interconnected subsystems, including referral volume, evaluation timelines, assessment validity, and professional capacity. These results align with prior research documenting prolonged delays, compromised assessment conditions, and widening access gaps during the pandemic [5,6,7,10].

4.1. Systemic Resilience and Capacity

Within planetary health scholarship, resilience is defined as a system’s capacity to absorb shock while sustaining core functions that protect population well-being. Quantitative findings showing sharp declines in referrals during school closures followed by substantial rebounds upon return to in-person instruction illustrate how procedural safeguards within IDEA operate as interdependent system components rather than isolated compliance mechanisms. Systems theory suggests that resilience depends on a system’s ability to absorb disruption while maintaining core functions [1]. In this study, the dramatic extension of evaluation timelines during closures—and only partial recovery thereafter—indicates limited system elasticity. Qualitative findings further reveal that diagnosticians experienced prolonged backlogs, staffing shortages, and capacity strain extending well beyond the acute phase of the pandemic, consistent with national analyses of pandemic-era system overload and educator burnout [10].

These findings echo prior studies showing that special education systems lacked the infrastructural redundancy and procedural flexibility necessary to sustain timely evaluations during prolonged disruption [6,7]. Rather than functioning as temporary setbacks, pandemic-related delays appear to have restructured evaluation workflows in ways that persisted into post-pandemic recovery, suggesting that future crisis preparedness must be embedded structurally rather than addressed through ad hoc accommodations.

4.2. Technological Equity and Access

Disparities in technological access emerged as a central planetary health equity issue shaping diagnostic access, evaluation timeliness, and procedural justice. Rural districts experienced significantly longer delays than urban or suburban counterparts, mirroring broader research linking broadband access, staffing capacity, and geographic isolation to uneven educational recovery [2,3]. From a planetary health and equity perspective, technology functions as a public good that mediates access to educational and health-related resources [1,2]. When digital infrastructure is uneven, crisis conditions amplify rather than neutralize preexisting inequities.

Qualitative findings underscore that limited connectivity constrained not only assessment administration but also family communication, consent acquisition, and collaborative decision-making. These challenges align with prior work demonstrating that remote assessment practices disproportionately disadvantaged students and families with fewer technological resources, raising ethical concerns about validity and procedural fairness [2,3,6]. Strengthening digital infrastructure and establishing clear ethical guidance for virtual assessment are therefore essential components of resilient special education systems.

4.3. Human-Centered Practice and Professional Preparation

Beyond technological constraints, diagnosticians’ narratives highlight the human costs of systemic disruption. Persistent workload intensification, emotional exhaustion, and moral distress related to delayed services were salient across interviews, reinforcing broader concerns regarding workforce sustainability in special education [10]. These findings support calls for preparation programs and districts to attend not only to technical competence but also to relational, ethical, and adaptive capacities required under crisis conditions [8,9].

Participants consistently identified gaps in preparation for virtual assessment, data triangulation, and remote collaboration—competencies that were largely absent from pre-pandemic training models designed for stable, in-person contexts. Aligning with recommendations from Darling-Hammond and Hyler [8], these results suggest that diagnostician preparation must evolve to emphasize flexibility, equity-oriented decision-making, and crisis responsiveness as core professional competencies rather than ancillary skills.

4.4. Equity, Race, and Structural Limitations

Equity in this study is understood as the capacity of educational systems to ensure timely, valid, and accessible evaluation processes across contexts. While equity was foregrounded conceptually, race- and gender-disaggregated referral and evaluation data were not available within the present dataset. This limitation reflects broader structural constraints in special education data systems, which often obscure how disability identification and service access vary across intersecting identities [7,10].

The decision to collapse urban and suburban districts in quantitative analyses was driven by sample size constraints and overlapping operational characteristics during remote service delivery. However, these environments are not equivalent, and collapsing them necessarily limits interpretive nuance. Differences in population density, service infrastructure, and community resources likely shape referral and evaluation processes in ways not fully captured here. Future research should disaggregate district contexts more precisely and examine how race, gender, geography, and disability intersect to shape diagnostic experiences under both routine and crisis conditions.

4.5. Implications for Policy and Practice

Taken together, these findings position the pandemic as a stress test that exposed latent vulnerabilities in special education evaluation systems. Policy efforts aimed at strengthening resilience should prioritize investments in digital infrastructure, crisis-responsive procedural guidance, and workforce development that explicitly centers equity. Establishing cross-sector coordination among education agencies, public health systems, and technology providers may further support continuity of evaluation services during future disruptions [1,2,3].

For preparation programs, embedding training in virtual assessment validity, ethical decision-making, and culturally responsive family engagement is essential. These competencies align with systems-oriented and equity-driven approaches to special education practice and reflect the evolving realities of professional work in increasingly unstable educational environments [8,9]. Positioning special education evaluation systems within planetary health underscores that investments in digital equity, workforce sustainability, and crisis preparedness are not ancillary educational concerns, but essential components of resilient, health-promoting societies.

4.6. Limitations

Several limitations should be considered when interpreting the findings of this study:

• Lack of Race- and Gender-Disaggregated Data—Although equity framed the conceptual orientation of this study, race- and gender-disaggregated referral and evaluation data were not available within the dataset. As a result, the analysis could not directly examine how referral patterns, evaluation timelines, or disability classifications varied across racialized or gendered groups. This limitation reflects broader constraints in special education data systems and underscores the need for future research that explicitly centers race, gender, and intersectional identity in analyses of diagnostic processes.
• Reliance on Self-Reported District-Level Data—Quantitative findings were based on diagnostician-reported estimates of referral volume, evaluation timelines, and classification trends rather than archival district records. While diagnosticians are uniquely positioned to observe system-level patterns, self-reported data may be subject to recall bias or variation in local reporting practices. Future studies should triangulate survey data with administrative records where feasible.
• Collapsed Urban and Suburban District Categories—Urban and suburban districts were combined in quantitative analyses due to sample size constraints and overlapping operational characteristics during remote service delivery. However, these environments differ meaningfully in population density, resource distribution, and service infrastructure. Collapsing these categories limits contextual nuance and may obscure important differences in how referral and evaluation systems function across district types.
• Limited Qualitative Sample Size—Qualitative findings were drawn from interviews with 12 educational diagnosticians. While sufficient for thematic analysis and mixed-methods integration, the sample does not capture the full diversity of diagnostician experiences across Louisiana. Perspectives from additional districts, particularly those serving highly urbanized or historically marginalized communities, may yield additional insights.
• State-Specific Context—This study focused exclusively on public school districts within Louisiana. State-level policy structures, workforce capacity, and digital infrastructure shaped both pandemic disruption and recovery, which may limit the generalizability of findings to other states or international contexts. Comparative, multi-state research would strengthen understanding of how systemic resilience varies across policy environments.

Despite these limitations, the study provides valuable insight into how special education referral and evaluation systems respond under conditions of prolonged disruption and offers direction for strengthening equity-oriented resilience in future practice and policy.

5. Conclusions

The COVID-19 pandemic exposed significant vulnerabilities in the special education evaluation process, disrupting IDEA-mandated timelines [4], altering classification patterns [3,4], and widening existing inequities in access to high-quality assessment [2,5]. Findings from this study demonstrate how instructional interruptions, technological barriers, and uneven district capacity reshaped the diagnostic landscape across Louisiana—illustrating broader global concerns regarding the fragility of educational, social, and health systems during crises [1,2]. These disruptions were not merely operational challenges but indicators of deeper structural strains within education systems tasked with upholding procedural safeguards and equitable access to services [3,7].

At the same time, the study identifies clear opportunities for strengthening professional practice and district-level preparedness. Diagnosticians described pressing needs for training in virtual assessment protocols, data triangulation, and culturally responsive collaboration—needs echoed in national analyses of pandemic-era educator capacity [6,10]. Districts will benefit from investing in digital infrastructure, crisis-responsive communication systems, and cross-sector coordination with community and public health partners, supports essential for maintaining timely evaluations during conditions of instability [1,2,3,8]. Such investments align with resilience-oriented recommendations for educational systems navigating future public health or environmental disruptions [9,10].

Together, these findings reinforce that advancing equity in special education requires intentional capacity-building across preparation programs, school systems, and policy frameworks. Embedding adaptive assessment skills, ethical data practices, and collaborative problem-solving into diagnostician training and district procedures reflects the systems-oriented approaches recommended in both equity frameworks and planetary health education [1,2,3]. By strengthening these capacities, educational systems are better positioned to safeguard continuity—ensuring that students and families maintain access to fair, timely, and high-quality evaluations during both routine operations and future disruptions [4,5,6,7,10]. Viewed through a planetary health lens, the resilience of special education evaluation systems represents a critical indicator of societal capacity to safeguard vulnerable populations during global disruption—reinforcing the need to align educational policy, public health planning, and equity-centered system design.