Abstract
Few crises are more distressing to prehospital care providers than the inability to care for a patient who is desperately ill due to entrapment. Occasionally, these patients require medical care above and beyond the scope of practice at the paramedic level. Although a federal response system is in place to provide physician-level out-of-hospital medical care during presidential declarations of disaster,1 there is a paucity of scientific literature concerning an organized emergency department response to assist local fire/rescue or EMS agencies with patient care activities. The George Washington University Medical Center (GWUMC) Department of Emergency Medicine has developed such a prehospital emergency medicine capability in conjunction with the District of Columbia Fire and EMS Department (DCFEMSD). A case report and issues related to physician response into the prehospital environment are presented.