Military Medical Operations Offer Lessons for EMS at Home
In military medicine, maximizing impact on morbidity and mortality in the prehospital setting requires more than timely interventions inside ambulances and medevacs. Care begins at the point of injury, continues while en route to a hospital or forward surgical unit, and outcomes are optimized from a broader operational perspective—one rooted in real-time data integration, dynamic coordination, and frontline decision support.
Military medicine is most effective with the fusion of operational planning and medical intelligence. From casualty evacuations over thousands of miles to medical planning support to complex operations, the Department of War (DoW) leverages centralized coordination, layered situational awareness, and tools forward deployed at the point of injury to ensure that those providing field care maintain situational awareness of the bigger picture.⁵˒⁶
These lessons learned, driven by hard-earned experience from nearly 25 years of combat in the Middle East and other areas, have led to the lowest morbidity and mortality for U.S. soldiers in the history of the United States.⁵˒⁶ Civilian EMS can learn lessons from military successes and adopt these principles to enhance field-level triage and destination decisions, particularly in regions with long transport distances or call volumes that exceed available resources.
Regional Medical Operations Coordination Center (RMOCC) Concept
The existing Regional Medical Operations Coordination Center (RMOCC) concept can elevate day-to-day emergency system performance, not just disaster response, by drawing on military planning principles. They include operational coordination and other advanced technologies that bring real-time situational awareness into the field and assure real-time communications across multiple otherwise previously non-connected communications networks.¹˒²
These system enhancements can transition EMS systems' transport decisions from a reactive to a proactive, data-driven model. A next-generation operations center would change most agencies from their current CAD-terminal communications system to instead provide dispatchers and prehospital providers with mobile access to live hospital status, traffic, weather, and geospatial overlays. ³ This would ensure data-informed decisions for accessing definitive care. However, achieving this vision requires addressing critical communications infrastructure gaps that currently limit interoperability and data access in both routine and surge operations. Bridging these gaps will create a scalable system that supports both daily system efficiency and rapid surge coordination during disasters.⁴
Military Medical Planning as a Model for EMS
The RMOCC was designed to facilitate coordinated hospital and EMS operations, especially during disasters or surge events.¹˒² In Texas, the Southwest Texas Regional Advisory Council (STRAC) has pioneered a highly integrated RMOCC model. It facilitates real-time monitoring of hospital capacities, dispatch coordination, and region-wide situational awareness—improving both trauma response and routine care logistics.¹
In events such as pandemics and mass casualty incidents (MCIs), STRAC's RMOCC provided near-instant updates on ICU bed availability, EMS offload times, and emergency department statuses, enabling the precise distribution of resources.¹˒² The benefits of these capabilities have prompted federal recognition of the RMOCC model as a “national best practice.”² However, these centers were primarily designed for episodic, larger-scale crises, rather than continuous integration into the day-to-day operations of EMS, public safety, or transportation networks.²˒³
A scalable, always-on RMOCC model must provide operational intelligence not only for EMS, but also for allied public safety partners, including fire, law enforcement, and rescue. Further, incorporating transportation departments, public works, and emergency management agencies allows the RMOCC to serve as a joint coordination cell—mirroring an Emergency Operations Center (EOC), but functioning continuously, rather than activating only during disasters.³ This multi-agency approach improves prehospital routing by including real-time data on road conditions, public transit disruptions, construction closures, and crowding at public venues.³
Proposed Improvements
Despite the promise of expanded coordination, current EMS systems face profound communication and interoperability limitations:
- Communication dead zones for radio and cellular communication.
- Incompatible radio systems between agencies, even ones in the next jurisdiction.
- Lack of mobile access to real-time dashboards or enhanced CAD.
- HIPAA and other legislative and policy misconceptions are possibly limiting data exchange.⁷
- Proprietary systems that resist open standards like HL7 or FHIR.⁸˒⁹ (HL7 is an older, message-based standard using fixed structures for event-driven data exchange, while FHIR (Fast Healthcare Interoperability Resources) is a modern, resource-based standard built for mobile web technologies for flexible, granular data access, making it better for cloud, mobile, and complex apps.)
- Lengthy delays when needing to upscale capabilities.⁴
- Funding limitations to enact changes.
A modern RMOCC should act as a fusion cell, connecting dispatch centers, hospitals, EMS, and public agencies.¹˒² AI-powered tools could predict transport routes or anticipate bottlenecks.⁹ Field medics using Android Team Awareness Kit (ATAK) a powerful geospatial mapping and collaboration app for Android devices, could receive real-time, actionable data directly on their devices.⁶˒⁹
Challenges include financial costs, proprietary software, lack of HL7/FHIR adoption, and in some cases, overly strict privacy interpretations.⁷,⁹ Solutions may require federal funding and policy alignment.¹⁰˒¹¹ Expected benefits include faster definitive care, reduced secondary transports, improved load balancing, enhanced communication, and scalable systems that function effectively in both daily operations and disaster scenarios.¹˒²˒⁴˒⁹˒¹¹
Integrating Post-Acute and Continuity-of-Care Concepts
A truly resilient system must also anticipate downstream patient flow beyond initial transport. Post-acute care (PAC) entities–including skilled nursing facilities, long-term care hospitals, and inpatient rehabilitation centers–play a critical role in sustaining surge capacity and continuity of care.¹⁰ The military plans all of this out in its long chain of patient care.
Integrating PAC data into RMOCC platforms allows real-time visualization of available rehabilitation and recovery beds, facilitating timely transfers and reducing acute-care overcrowding.¹⁰˒¹¹
Moreover, these networks could link seamlessly with IoMT-enabled systems⁹ to track patient recovery and rehabilitation remotely, using secure channels that align with data-governance standards.⁷
The Human and Organizational Component
Disaster coordination depends not only on technology but also on human capacity, adaptability, leadership, and communication efficiency. Studies show that breakdowns in information flow and interagency understanding remain among the most common causes of poor outcomes during major incidents.⁴˒¹¹
Military after-action reports highlight similar issues: inconsistent command-and-control structures, fragmented documentation practices, and variable adherence to clinical guidelines.⁶ Applying those lessons to civilian EMS can improve standardization, improve future performance, foster accountability, and reduce preventable delays.
The use of centralized trauma registries and data feedback loops-key features of the Joint Trauma System–provide a model for regional EMS data sharing.⁵˒⁶ Ongoing professional education on the state and regional levels must also emphasize interagency cooperation, situational awareness, and decision-making under uncertainty.¹˒⁴˒⁶
Conclusions
Modern EMS requires integration, intelligence, and coordination. Aligning RMOCC frameworks with transportation, public-health, and post-acute care systems creates a unified, scalable model that supports daily efficiency and disaster resilience. Supporting interagency coordination and formalizing TMC–EOC linkages aligns with best practices and helps prepare systems for future crises.³˒¹⁰
Implementing interoperability solutions from IoMT research⁸˒⁹ and adopting lessons from military trauma systems communication and logistics successes⁵˒⁶ will strengthen prehospital decision support and patient outcomes. A comprehensive, always-active coordination system can transform EMS operations from reactive transport to proactive, data-driven care delivery.¹˒²˒⁴˒⁹˒¹¹
References
Abbas, T., & Miller, R. (2025). Exploring communication inefficiencies in disaster response. International Journal of Disaster Risk Reduction, 87, 103642. https://doi.org/10.1016/j.ijdrr.2025.103642
Ajibade, D. A., Thiel, C., Thompson, P., et al. (2025). The need to incorporate post-acute care entities into the National Disaster Medical System. Disaster Medicine and Public Health Preparedness, 19(2), e7–e13. https://doi.org/10.1017/dmp.2025.15
Alanazi, A. F., & Shaban, R. Z. (2025). Challenges and strategies in maintaining continuity of care for chronic disease patients by emergency nurses during disasters. International Nursing Review, 72(1), 44–55. https://doi.org/10.1111/inr.13142
Armstrong, J., Martin, L., Vang, J., et al. (2025). Regional medical operations coordinating centers promote readiness for daily trauma care and mass casualty incidents. Journal of Trauma and Acute Care Surgery, 98(3), 412–420. https://doi.org/10.1097/TA.0000000000004556
ASPR TRACIE. (2024). Medical operations coordination centers toolkit (3rd ed.). Office of the Assistant Secretary for Preparedness and Response. https://asprtracie.hhs.gov/technical-resources/resource/13753/medical-operations-coordination-centers-toolkit-third-edition
Eastridge, B. J., Mabry, R. L., Seguin, P., et al. (2012). Death on the battlefield (2001–2011): Implications for the future of combat casualty care. Journal of Trauma and Acute Care Surgery, 73(6 Suppl 5), S431–S437. https://doi.org/10.1097/TA.0b013e3182755dcc
Federal Highway Administration, Office of Operations. (2012). Role of transportation management centers in emergency operations guidebook. U.S. Department of Transportation. https://ops.fhwa.dot.gov/publications/fhwahop12050/sec3.htm
Rosenbaum, S. (2010). Data governance and stewardship: Designing data stewardship entities and advancing data access. Health Services Research, 45(5 Pt 2), 1442–1455. https://doi.org/10.1111/j.1475-6773.2010.01140.x
Seth, D., Rao, A., Singh, P., et al. (2022). Technologies for interoperable internet of medical things platforms: Protocol. JMIR Research Protocols, 11(4), e36122. https://doi.org/10.2196/36122
Seth, D., Rao, A., Singh, P., et al. (2025). Technologies for interoperable internet of medical things platforms: Scoping review. JMIR Medical Informatics, 13, e45121. https://doi.org/10.2196/45121
Shackelford, S. A., Butler, F. K., Blackbourne, L. H., et al. (2018). USCENTCOM theater trauma system assessment. Joint Trauma System, Defense Health Agency. https://jts.health.mil/assets/docs/cpgs/USCENTCOM-Theater-Trauma-Assessment-2018.pdf
Endnotes
1. Armstrong et al., 2025 – Provides detailed description of Regional Medical Operations Coordinating Centers (RMOCCs), including their structure, function, and integration within trauma systems. Supports statements about RMOCC readiness, STRAC model success, and improved daily and mass-casualty coordination.
2. ASPR TRACIE, 2024 – Defines the federal standard for Medical Operations Coordination Centers (MOCCs), including operational templates, communication models, and interoperability strategies. Supports RMOCC conceptual framework, scalability, and its recognition as a national best practice.
3. Federal Highway Administration (FHWA), 2012 – Explains transportation and interagency coordination between Transportation Management Centers (TMCs) and Emergency Operations Centers (EOCs). Supports sections describing integration of EMS, public works, and transportation networks for real-time coordination and routing efficiency.
4. Abbas & Miller, 2025 – Identifies inefficiencies in interagency communication and data exchange during disaster response. Supports discussion of communication barriers, need for interoperability, and rationale for enhanced coordination and predictive analytics in EMS systems.
5. Eastridge et al., 2012 – Analyzes U.S. battlefield mortality data (2001–2011) and defines key success factors in trauma-system organization and data feedback loops. Supports military-to-civilian translation of lessons and claims regarding record-low battlefield mortality.
6. Shackelford et al., 2018 – Provides Joint Trauma System (JTS) assessment data, reinforcing the importance of centralized command, standardization, and continuous data review. Supports application of military trauma coordination and communication frameworks to civilian EMS.
7. Rosenbaum, 2010 – Discusses health-data governance, HIPAA, and privacy concerns in data-sharing frameworks. Supports statements about data-governance misconceptions and regulatory barriers limiting interoperability and real-time data access.
8. Seth et al., 2022 (Protocol) – Outlines methods for developing interoperable Internet of Medical Things (IoMT) systems. Supports claims related to HL7/FHIR standards and open-architecture integration challenges in EMS systems.
9. Seth et al., 2025 (Scoping Review) – Reviews global IoMT implementations and real-world interoperability case studies. Supports assertions about AI-enabled coordination, real-time data overlays, and ATAK/IoMT cross-applicability to EMS.
10. Ajibade et al., 2025 – Advocates for integrating post-acute care (PAC) entities into national medical response systems. Supports proposal’s PAC-integration model, system scalability, and policy-alignment recommendations.
11. Alanazi & Shaban, 2025 – Explores continuity-of-care challenges for chronic-disease patients during disasters. Supports statements about long-term care continuity, post-acute transitions, and interagency coordination.
About the Authors
Barry Bachenheimer, Ed.D, NREMT, is a frequent contributor to EMS World Magazine. Dr. Bachenheimer is a veteran educator and EMS professional with over 39 years of BLS and ALS experience. He has served in a variety of roles for several agencies in New York and New Jersey including Director of EMS Operations, Training Officer, and still remains an active field provider and instructor. In addition to his EMS and Fire career, Dr. Bachenheimer has a 33 year career in K-12 and higher education as a teacher and administrator. He is also an adjunct professor at Montclair State University and is the founder of edRescue Solutions, LLC, a consulting company focused on AI, EMS, and education innovation and training.
Erik Glassman is a critical care paramedic with 20 years of experience across all facets of Operational Medicine. Prior to joining the Cooper MILDAF team, he worked for the US Government providing medical support for crisis response and dignitary protection and as a medical planner. Erik has a Bachleors degree in Human Physiology from Boston University and Masters Degrees from Thomas Jefferson University in Disaster Medicine and Southern California University of Health Sciences in Medical Sciences.
Zachary O. Knable, MAOL, MHA, NRP, FP-C, is a critical care flight paramedic, clinical educator, project manager, and inventor with a focus on high-acuity transport medicine and systems-level healthcare improvement. He serves in leadership, instructional, and quality roles across critical care transport, paramedic and nursing education, and organizational performance initiatives. Zachary holds graduate degrees in Organizational Leadership and Healthcare Management from Siena Heights University, with academic concentration in strategic leadership, operations, and healthcare innovation. His work emphasizes the design of scalable, data-driven solutions that improve communication, integration, and operational efficiency across prehospital, hospital, and public-safety systems. His professional interests include healthcare systems engineering, clinical operations strategy, and translating frontline clinical insight into sustainable organizational and technological advancement.
