Wireless sensor networks are expected to make a significant contribution in the healthcare sector by enabling continuous patient monitoring. Since medical services and the associated to them information are considered particularly sensitive, the employment of wireless sensors in medical environments poses many security issues and challenges. However, security services and the underlying key management mechanisms cannot be seen separately from the efficiency and scalability requirements. Network clustering used in both routing and group key management mechanisms can improve the efficiency and scalability and therefore can also be envisioned in medical environments. This paper introduces a general framework for cluster-based wireless sensor medical environments on the top of which efficient security mechanisms can rely. We describe two different scenarios for infrastructure and infrastructure-less application environments, covering this way a wide area of medical applications (in-hospital and medical emergencies). We also examine the existing group-key management schemes for cluster-based wireless networks and discuss which protocols fit best for each proposed scenario.