Abstract: Objective To develop a regional coordination capability index system for emergency medical responders to biosafety incidents, thereby providing a reference for formulating cross-regional emergency coordination strategies, optimizing resource allocation, and strengthening biosafety risk response capacity. Methods An index system was developed through literature review, qualitative interviews, and the Delphi method. Results The effective questionnaire response rate for both rounds of Delphi consultation was 100% (22/22). The experts’ judgment coefficient was 0.945, familiarity coefficient was 0.873, and authority coefficient was 0.909. The Kendall’s concordance coefficients for the first-round of consultation across indicator level were 0.203, 0.262, and 0.256, and for the second round were 0.230, 0.327, and 0.278 (all P < 0.01). The constructed regional coordination capability index system comprised five first-level indicators: organizational structure and coordination mechanisms, resource support capacity, information-sharing and communication technology capability, training and collaborative response efficiency, with corresponding weights of 0.196, 0.194, 0.194, 0.206, and 0.211, respectively. These were further divided into 13 second-level indicators and 38 third-level indicators. Conclusions The proposed index system can provide a valuable reference for optimizing emergency response processes, improving cross-regional collaboration frameworks, and enhancing overall capacity for managing biosafety incidents, demonstrating strong practical value.