An unusual motor vehicle collision case is presented involving a complex, prolonged extrication with crush injury. While crush injury and crush syndrome are often considered to be in the realm of disaster medicine and urban search and rescue, more typical single-patient or few-patient incidents such as industrial accidents and vehicular crashes can involve these clinical entities. All emergency medical services (EMS) personnel should have a basic working familiarity with the operational and clinical issues involved in crush injury and crush syndrome. Crush syndrome is reviewed here from the perspective of prehospital management.