Crush injury is the anatomical injury associated with direct trauma due to a compressive force, usually resulting from prolonged entrapment following structural collapse or industrial accidents. Extended entrapment with compression may cause crush syndrome, traumatic rhabdomyolysis, or compartment syndrome. EMS clinicians must understand the pathophysiology of crush injury and resulting rhabdomyolysis and crush syndrome. A high index of clinical suspicion and astute clinical examination skills are required for proper management, which includes a two-pronged approach centering on prevention of morbidity and mortality from sudden hypotension and cardiovascular collapse and the late development of renal failure. When crush syndrome is clinically suspected based upon entrapment time and mass of skeletal muscle compressed, early fluid resuscitation is the mainstay of treatment, along with empiric sodium bicarbonate to alkalinize the urine to protect the kidneys from the nephrotoxic effects of myoglobin and uric acid. Even in the absence of multisystem trauma, the complex soft tissue, orthopedic, nerve, and vascular injuries from crush injuries make a designated trauma center the preferred acute care destination.