Clinical sync correctly rejects out-of-order acknowledgments: when an ack arrives before
its alert event, the batch processor marks the batch CONFLICT with `ALERT_NOT_YET_SYNCED`
rather than silently creating orphan ack rows. This differs from POS inventory sync where
ordering is less critical — in clinical workflows, temporal dependencies matter for audit
trails and paging attribution. The integration test passed in 309 ms. A follow-up reorder
retry (alert then ack in a new batch → APPLIED) is specified in Phase 24 Step 3
`ClimateResilienceTests` for full end-to-end coverage.