Abstract Electro-medical waste (EMW) management presents critical challenges related to traceability, regulatory compliance, and operational safety in healthcare environments, where improper handling can pose serious risks to public health and the environment. To address these challenges, this work proposes a blockchain-integrated Internet of Things framework, termed BIOT-EMW, which combines IoT sensing, blockchain-based auditability, and edge-level intelligence to enable secure and transparent EMW lifecycle management. A convolutional neural network-based computer vision module is deployed at the edge to automate EMW classification and reduce manual intervention. The performance evaluation of the proposed BIOT-EMW system emphasizes system-level operational metrics, including latency, delay, bandwidth, power consumption, resource utilization, and scalability, rather than exhaustive model-level benchmarking. Experimental results show that edge-level processing latency ranges from 3.45 to 9.33 ms, end-to-edge communication delay from 6.43 to 12.11 ms, bandwidth usage from 24.54 Mbps to 34.87 Mbps, and device-level power consumption from 6.5 to 13.31 mW, with resource utilization between 78 and 92% and scalability reaching up to 97%. In a prototype-scale experimental testbed, the BIOT-EMW framework shows feasible and efficient operation with promising scalability for automated electro-medical waste management in smart healthcare facilities. Introduction The rapid growth of electro-medical waste (EMW) poses important risks to public health and the environment, mainly in healthcare facilities where improper handling can lead to contamination, regulatory violations, and safety hazards. Traditional waste management systems often lack end-to-end traceability, real-time monitoring, and automated compliance mechanisms, making them inadequate for managing the complex lifecycle of EMW. With the deployment of connected medical devices and digital healthcare infrastructure, there is an upward need for intelligent, secure, and scalable waste management solutions personalized specifically to electro-medical waste streams. Recent advances in the Internet of Things (IoT) have enabled real-time sensing and monitoring across healthcare environments. IoT devices equipped with sensors and cameras can capture