Development of Recommendations for Medical Civil-Military Coordination: Initial Policy Findings

Introduction: Effective civil-military coordination in medical responses remains an underdeveloped yet increasingly vital area of emergency health planning. Despite existing frameworks, such as the Oslo and MCDA guidelines, gaps persist in addressing operational realities between civilian and military medical teams, particularly during public health emergencies. This study investigates and presents the initial policy findings from a structured Delphi process aimed at developing technical recommendations for medical civil-military coordination (MedCivMil), under the World Health Organization’s Emergency Medical Teams (EMT) initiative. Methods: A Delphi methodology was employed to gather expert consensus from a globally representative Technical Working Group (TWG) of 36 specialists across military, civil, and academic sectors. Participants were organized into three thematic subgroups - coordination, cooperation, and medical standards. Each subgroup evaluated a series of policy statements developed through literature review and expert co-chair collaboration. Consensus was defined as ≥80% agreement and/or a median ≥6 with a standard deviation ≤1.4. The process entailed two rounds of anonymous feedback using structured online surveys. Results: Consensus was achieved on all 41 statements after the second round. The coordination subgroup prioritized principles, planning, task division, and information sharing, with minimal contention. The cooperation subgroup surfaced more complex debates around authority, risk, and trust, requiring significant revision. The medical standards subgroup highlighted the need for ethical consistency, shared clinical protocols, and training across civilian and military actors. Conclusion: Findings underscore the need for clear operational guidance that supports mutual respect, ethical alignment, and practical interoperability. Joint training, transparent leadership structures, and participative planning were emphasized as critical enablers of effective MedCivMil. The study contributes foundational policy direction to an evolving framework, facilitating future operational and tactical guidelines for emergency medical coordination across civilian and military domains.