The National Center for Disaster Medicine and Public Health in the Uniformed Services University of the Health Sciences, and the Health and Human Services’ (HHS) Administration for Strategic Preparedness and Response (ASPR) are collaborating on the National Disaster Medical System (NDMS) Pilot Program to increase and enhance capability, capacity and interoperability of patient movement and definitive care of casualties during a medical surge resulting from an overseas large-scale combat operation (LSCO). The pilot is based on the need to mobilize 1000 patients per day for 100 days into the NDMS. Upon the DoD medical repatriation of service members, NDMS would provide medical support and mobilization of casualties to definitive care provided through its 1,600 NDMS civilian partner hospitals across the country. NDMS will need to accommodate a high surge volume while providing multiple levels of medical care during mobilization. ASPR Disaster Telemedicine (DTM) is positioned to provide services to mitigate surge and specialized care demands on NDMS resources while maintaining current standards of medical care. DTM can expand NDMS capabilities through reach-back specialist consults, remote patient management, critical care support during transports, and support for specialized medical equipment operation. Another need identified through the NDMS Pilot surrounds casualty disposition oversight. For service members receiving care through the DoD, medical disposition, follow-up care planning, and fitness for duty determination is managed and tracked through the Defense Health Agency (DHA) system. Thus, DoD maintains a clear view of troop status which supports high level decision making. When casualties are transferred into the NDMS, there is no current mechanism to provide DoD with troop status updates. Additionally, civilian medical providers and healthcare facilities do not make determinations as to fitness-for-duty, nor do they understand the components and parameters used to guide such decisions. Training all NDMS hospital partner civilian providers to make fitness-for-duty determinations based on military standards would require significant resources and put undue burden on the NDMS hospitals. DTM proposes a solution that will focus on DoD needs without requiring significant strain on NDMS partner hospitals and providers. Through its customized and secure cloud-based platform, the DTM Electronic Medical Record (EMR) can integrate medical data, prompt providers to enter critical findings and recommendations, and enable the use of an algorithm to provide fitness-for-duty recommendations based on criteria defined by DoD. DTM proposes that their EMR serve as a secure, intermediary platform through which DoD can extract pertinent service member medical data and records, including fitness-for-duty.