Emergency Support Function 8 (ESF-8) is the mechanism through which the federal government coordinates public health and medical services under the National Response Framework (NRF), the nation’s comprehensive guide for domestic incident management. The NRF identifies ESF-8’s purpose, leadership, and operational approach, with the Department of Health and Human Services (HHS) serving as the lead agency. Within HHS, the Administration for Strategic Preparedness and Response (ASPR) holds delegated authority for all emergency response activations, reflecting its central role in preparedness and response. ESF-8 encompasses federal support for medical surge capacity, public health assessments, disaster behavioral health, patient movement, and medical logistics, ensuring that the nation can mobilize critical resources when state, tribal, local, and territorial systems are overwhelmed. The framework highlights indispensable partnerships, particularly with the Department of Defense (DoD) and the Department of Veterans Affairs (VA), which provide unique medical and logistical capabilities essential to a coordinated federal response. Public Health and Medical Defense Support of Civil Authorities (PH & MED DSCA) represents the pathway through which DoD, once approved, delivers health and medical capabilities to augment civil authorities, integrating requirements validation, tasking processes, and joint or regional medical planning and operations (JRMPO/RMPO). The VA contributes through Federal Coordination Centers (FCCs) and engagement with healthcare partners, expanding the capacity to manage patient movement and regional care coordination. These mechanisms have been demonstrated repeatedly in real-world emergencies: during the 2017 hurricanes affecting Puerto Rico and the U.S. Virgin Islands ESF-8 coordinated National Disaster Medical System (NDMS) teams, deployed resources from the Strategic National Stockpile (SNS); organized patient transport for dialysis patients, coordinated behavioral health support, and integrated DoD and VA capabilities to restore care delivery; during the COVID-19 pandemic, ESF-8 managed nationwide distribution of vaccines and therapeutics, facilitated ventilator allocation across hospitals, established alternate care sites such as the Javits Center in New York City, and partnered with DoD to deploy field hospitals and aeromedical evacuation. Beyond large-scale crises, ESF-8 has supported civil authorities in wildfire evacuations by coordinating NDMS and DoD transport of vulnerable patients from nursing homes and hospitals to safer areas. In each case, civil authorities-initiated requests through established emergency management channels, and HHS validated and translated those needs into coordinated federal support, ensuring that federal action amplified rather than displaced local authority. These examples illustrate how ESF-8 transforms abstract frameworks into operational outcomes through strategic collaboration, leveraging the complementary strengths of HHS, DoD, and VA to ensure resources are delivered where and when they are needed most. Implementation occurs through Regional Emergency Coordinators (RECs), who connect federal capability to local needs, and preparedness is sustained through stockpile readiness, pre-positioned contracts, and routine interagency exercises that enable rapid activation. Together, these elements create a federal health enterprise capable of synchronizing resources in the critical first 24 hours of an incident, establishing a joint cadence that accelerates time to care, strengthens equitable access to services, and improves outcomes in saving lives and preventing disease.