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Changes in NHS Major Incident management and their relevance to the Defence Medical Services. High-profile Major Incidents in the UK civilian setting in the last few years have appropriately raised awareness of the principles and frameworks involved in the design of reliable response systems. The introduction of the Joint Emergency Services Interoperability Principles in tandem with increased investment in Major Incident Planning has supported practitioners to successfully respond to high numbers of incidents.Defence Medical Services personnel are increasingly being asked to deploy to resource-limited 'contingency' settings where much of the established guidance relating to Major Incident response requires reconsideration and modification in the face of severely constrained space, manpower and equipment.This editorial seeks to review contemporary theories and principles of Major Incident response and discuss how military medical personnel may need to adapt these to address the various Major Incident challenges that they may face on operations.