Trauma care is rarely one-size-fits-all, and bariatric patients present challenges that push standard approaches beyond their limits. As obesity rates continue to rise, EMS and air medical providers are increasingly faced with critically injured patients whose body habitus, comorbidities, and physiology complicate every phase of care, from assessment to transport. Airway management becomes more precarious, vascular access more difficult, and movement and extrication more hazardous for both patient and provider. This critical care level presentation examines how these factors influence trauma care in the prehospital and transport environment, where familiar techniques may need to be adapted in real time. This session focuses on the high-risk decisions and operational barriers that define bariatric trauma care. Participants will explore why these patients often experience worse outcomes, including the impact of respiratory compromise, cardiovascular strain, and challenges with accurate assessment and interventions. Practical field considerations are also explored, including equipment limitations, scene logistics, medication choices, and transport decisions, all of which require careful balance between patient care and crew safety. By combining current evidence with real-world insight, this course equips clinicians with practical, adaptable strategies to improve care and navigate one of the most complex patient populations in modern EMS.