The National Disaster Medical System (NDMS) was established in 1984 to provide care for large numbers of casualties resulting from an overseas military conflict or a domestic disaster. While the NDMS has historically functioned with success during small-scale localized events, it has never had to realize its primary mission during a national-level crisis. Recognizing the need to improve the Nation’s preparedness for protracted patient surge events, Congress directed the Department of Defense to conduct a five-year NDMS Pilot Program (“Pilot”) to strengthen military-civilian health care interoperability, capability, and capacity. Since commencing in 2020, the Pilot’s activities have revealed that the current federal legal, regulatory, and policy environment may be inadequate for supporting the full scope of the NDMS’s mission. COVID-19 also highlighted the crucial role of law and policy in facilitating and hindering the ability of governmental and non-governmental partners to move health resources and provide health care to individuals during nationwide health-related crises. Characterizing the legal, regulatory, and policy landscape governing these life-saving response activities will identify areas requiring additional provisions and actions in preparation for or response to such crises in the future. To strengthen the management of future health crises by the U.S. Government and U.S. health care system in both peacetime and wartime, the Pilot is working with federal and academic partners to identify, review, and curate the current U.S. federal laws, regulations, and policies governing the movement and definitive care of patients, as well as the movement of medical and public health personnel and resources, during: 1. Steady-state responses to incidents requiring medical- or health-related capabilities or support during peacetime; 2. Domestic medical surge events, such as natural disasters and public health emergencies, during peacetime; and 3. Medical surge events resulting from the influx of combat casualties during wartime. Issues emerging from this complex federal administrative environment, potential interactions with state and local environments, and the effects on activities within the NDMS and the federal health community nationwide will be discussed. Opportunities for addressing current gaps through potential federal legislative, regulatory, and policy changes that can facilitate a “whole-of-nation” response to a nationwide medical surge event during peacetime or wartime will be presented. Future efforts will link federal legislation, regulations, and policies with state, local, tribal, and territorial levels to vertically integrate public health and medical preparedness and response actions.