Forging the frontlines at home: integrating military-civilian systems for national readiness and resilience

Future large-scale combat operations, high-impact domestic disasters, and infrastructure-disrupting crises will generate casualty volumes and system stress far exceeding those experienced during the conflicts occurring during the previous two decades. These threats will transcend the traditional distinctions between military and civilian healthcare systems. They will necessitate an integrated national response capable of absorbing sustained casualty surges and preserving access to care for the civilian population. At the 2026 Eastern Association for the Surgery of Trauma Annual Scientific Assembly, a multidisciplinary short course entitled "Forging the Frontlines at Home: Integrating Military-Civilian Systems for National Readiness and Resilience" convened military, civilian, academic, and policy leaders to examine readiness gaps and propose actionable pathways to facilitate military-civilian integration. This article synthesizes key themes from that program across three domains: (1) defining the operational problem space, (2) coordinating a synchronized national response, and (3) understanding the financial and administrative consequences of large-scale casualty care. Together, these perspectives highlight that national casualty readiness for combat casualty care needs to be a core component of domestic resilience.