Forging the Iron Triangle of Health: An Integrative Review of Operational Health Resilience for Military and Civilian Crisis Response

Background: Globalized threats, from pandemics and natural disasters to asymmetric warfare, demand health systems capable of rapid deployment, sustained operation in austere environments, and seamless integration of clinical and preventive services. Traditional silos between military medical logistics, civilian public health, and clinical specialties create critical vulnerabilities in crisis response. Aim: This narrative review synthesizes contemporary evidence (2015-2025) to analyze how eight critical disciplines—Nursing, Ministry of Defense (MoD) systems, Preventive Medicine, Public Health, Pharmacy, Radiology, Dentistry, and Medical Sterilization & Supply—converge to create a unified, resilient operational health capability. Methods: A systematic search of PubMed, Scopus, CINAHL, Web of Science, and military databases (e.g., Defense Technical Information Center) identified peer-reviewed articles, grey literature, and policy documents from 2015-2025. A thematic analysis was conducted to map interdependencies and synthesize an integrated framework for operational health resilience. Results: Resilience is an emergent property of three tightly coupled subsystems: 1) A Clinical Intervention Core (Nursing, Pharmacy, Radiology, Dentistry) for direct patient care; 2) A Population Health Shield (Preventive Medicine, Public Health) for force and community protection; and 3) A Logistical Sustainment Engine (MoD frameworks, Medical Sterilization & Supply) enabling deployment and continuity. Success depends on pre-crisis integration, interoperable protocols, and shared leadership models. Conclusion: Achieving operational health resilience requires transcending traditional boundaries to engineer integrated "health security units." Future efforts must invest in joint simulation training, modular interoperable equipment, and policies that legitimize cross-sector authority sharing during crises.