The National Center leads a Congressionally directed effort to assess and strengthen the National Disaster Medical System (NDMS) to meet the health and medical needs of U.S. casualties returning home from an overseas large-scale combat operation (LSCO). The National Center’s extensive interagency partnerships enable it to address the complex issues related to synchronizing healthcare delivery between the civilian and military communities. The effort is focused on enhancing interoperability and expanding capability and capacity within the NDMS, including an initial focus on five Pilot sites strategically located throughout the country (Washington, D.C.; San Antonio, TX; Denver, CO; Omaha, NE; and Sacramento, CA). The National Center has partnered with organizations across the federal interagency as well as at the state and local levels to design, implement, and assess dozens of discrete projects across the Pilot sites.