Public health emergencies expose a recurring management problem: institutions must allocate scarce life-saving resources quickly while honoring ethical commitments that cannot be collapsed into a single administrative score. This article examines reserve systems as a planning framework for the allocation of vaccines, ventilators, intensive-care capacity, and antiviral therapies during crisis conditions. The analysis uses a structured conceptual and comparative reading of the formal institutional framework and documented COVID-19 policy applications reported by authors. A reserve system is defined by three managerial levers: the division of units into categories, the number of units assigned to each category, and the priority rule applied within each category. The article’s contribution is to translate those levers into operational design choices, compare how they function across documented policy settings, and identify the implementation trade-offs that arise when resources differ in urgency, durability, and monitoring requirements. The documented experience of U.S. states and health systems that used reserve-based policies during the pandemic, including Pennsylvania, Massachusetts, Tennessee, Connecticut, California, Richmond and Henrico (Virginia), and Washington, DC, is synthesized to test feasibility rather than to claim causal superiority. The analysis shows that reserve systems are best understood not merely as ethical devices, but as operational planning instruments whose value depends on explicit category design, sequencing, transparency, and ongoing adjustment under uncertainty.