The development of an international or multinational telemedicine system has been discussed several times over the past 30 years or so. The integration of telecommunications and information technology in the aftermath of a disaster can be of tremendous value in addressing acute and chronic medical needs. The growing consequences of disasters increase the need for more medical support in response actions. The financial realities of recent years however have led to a decreased level of expertise and size of the medical “footprint” on-site. Effective use of telemedicine can close this gap by allowing provision of clinical healthcare from a distance. In 2012, the NATO Russia Council was asked to setup a telemedicine project funded by NATO Science for Peace and Security (SPS). In 2013, SPS Program funded a project to develop and demonstrate a Multinational Telemedicine System (MnTS) for Emergency Response. This project aimed to address the identified shortfalls with multi-national pre-defined emergency measures and augment disaster response care with telemedicine technologies based on agreed procedures with trained personnel and interoperable equipment. In February 2014, the inaugural MnTS conference was convened at NATO Headquarters in Brussels with teams of telemedicine experts assembled to develop a Concept of Operations (CONOPS) for this 3-year project. Topics identified and described in the CONOPS included Governance, Medical Care, Legal Issues, and Information Technologies. Subsequent meetings were held in Romania, Belgium and the United States to further develop the plans and programs for the MnTS. The system also participated in a proof of concept disaster response field exercise in September 2015 in Ukraine.