The National Disaster Medical System (NDMS) was originally established in 1984 to support the movement and medical care of U.S. combat casualties to healthcare facilities across the Nation. However, the ability of the NDMS to manage a large influx of casualties from an overseas military conflict, such as 1000 casualties per day for 100 days, remains unclear. The Congressionally-authorized Department of Defense NDMS Pilot Program was launched in 2020 with the aim of strengthening interoperable military-civilian partnerships across the NDMS and expanding the surge capabilities and capacities of the NDMS definitive care network at five regional NDMS sites in large metropolitan areas. The Military-Civilian NDMS Interoperability Study (MCNIS) was the initial “formative research” phase of the Pilot and assessed current definitive care capabilities of the Nation’s healthcare systems to strengthen military-civilian health surge preparedness.

Six themes emerged from MCNIS to improve the NDMS: (1) coordination, collaboration, and communication; (2) funding; (3) staffing; (4) surge capacity; (5) training, education, and exercises; and (6) metrics, benchmarks, and modeling. This study informed the initial development of the NDMS Pilot’s implementation framework, including the establishment of Field Implementation Teams as well as site-specific and cross-site surge capacity plans. NDMS Pilot initiatives such as MCNIS and the subsequent MCNIS-informed implementation activities continue to identify opportunities for strengthening military-civilian interoperability and surge preparedness for an overseas conflict or nationwide large-scale health surge event.