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Moral Injury in Emergency and Pre-hospital care. Esther Murray on St Emlyn’s podcast

This week we recorded a podcast inspired by a recent publication in the EMJ. Esther Murray aka @EM_Healthpsych is a psychologist working in London. You can listen the podcast by clicking on the link below.

Her recent paper on whether the experiences of medical students might precipitate moral injury during their pre-hospital experiences gives  an insight into how we all cope with and respond to the clinical work we do. Some of the work we do is traumatic, painful and morally difficult to rationalise. We are witness to the very worst aspects of some of our patient’s lives and there may be a price to pay.

I was delighted to explore some of the concepts around moral injury in this podcast and would really recommend that you read the paper 1 and consider whether this is something that can affect ourselves and our colleagues. The paper is open access at the moment so there is no excuse not to 😉

Although the paper is based on a small number of participants from only one aspect of the healthcare system it does recognise this limitation and alludes to future work with different groups of clinician.

What is Moral Injury?

Esther describes ‘moral injury’ as a concept emerging from work with military veterans. It is used to describe the psychological sequelae of ‘bearing witness to the aftermath of violence and human carnage’1–3




Murray E, Krahé C, Goodsman D. Are medical students in prehospital care at risk of moral injury? E. June 2018:emermed-2017-207216. doi:10.1136/emermed-2017-207216
Moral Injury. Wikipedia. Published 2018. Accessed August 30, 2018.
Litz BT, Stein N, Delaney E, et al. Moral injury and moral repair in war veterans: A preliminary model and intervention strategy. C. 2009;29(8):695-706. doi:10.1016/j.cpr.2009.07.003

Cite this article as: Simon Carley, "Moral Injury in Emergency and Pre-hospital care. Esther Murray on St Emlyn’s podcast," in St.Emlyn's, August 30, 2018,

Posted by Simon Carley

Simon Carley MB ChB, PGDip, DipIMC (RCS Ed), FRCS (Ed)(1998), FHEA, FAcadMed, FRCEM, MPhil, MD, PhD is Creator, Webmaster, owner and Editor in Chief of the St Emlyn’s blog and podcast. He is visiting Professor at Manchester Metropolitan University and a Consultant in adult and paediatric Emergency Medicine at Manchester Foundation Trust. He is co-founder of BestBets, St.Emlyns and the MSc in emergency medicine at Manchester Metropolitan University. He is an Education Associate with the General Medical Council and is an Associate Editor for the Emergency Medicine Journal. His research interests include diagnostics, MedEd, Major incidents & Evidence based Emergency Medicine. He is verified on twitter as @EMManchester

  1. […] Cardiac arrest management: An incredible session where we witnessed a theatrical cardiac arrest that explored how we deal with relative present at the end of an unsuccesful cardiac arrest. They performed the arrest on stage and with such skill that everyone in the audience was transported back into those emotions that we all feel when we are faced with tragedy, and when we are required to help family members navigate that life changing event. The panel discussion afterwards explored how we can do this better (be honest) for the family, but also to ourselves. There is no doubt that our exposure to serious illness and injury, and in particular to unexpected death carries potential harm. If you want to know more then I would strongly recommend you listen to the podcast on Moral Injury with Esther Murray2. […]


  2. […] You may already have read some of my previous St Emlyns blogs when I highlighted the journey I went through when this acute stress reaction became a chronic one.  During the the therapy that assisted in my recovery, this emotional “why me” evolved into a more cognitive version of the same question.  Some steps to this path of understanding were started right here at St Emlyns.  There are podcasts with Iain and Liz talking about wellbeing and meaning making.  In another podcast, Simon discussed the concept of moral injury with Esther Murray.  […]


  3. […] ‘moral injury’ comes from a 2018 article (available here). It’s been discussed by St Emlyns and RCEM Learning. In March this year, Zubin Damania (@ZDoggMD) caused quite a stir with a 6-minute […]


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