Abdominal pain is a frequently encountered complaint seen by EMS clinicians. A number of life-threatening emergencies may present with abdominal pain, including some with extra-abdominal pathology. A systematic history and physical exam should be conducted on all patients in order to elicit pertinent findings. Management of patients with abdominal pain should focus on acute stabilization of the critically ill patient. Expectant management and transport is the recommended course of action for all other patients with abdominal pain. Areas with clear knowledge gaps and expanding literature bases include pain management, prehospital imaging modalities, and point-of-care testing. Patients with extremes of age, a compromised immune system, women of childbearing age, and obese patients are at increased risk of serious events when presenting with abdominal pain.