This proposal considers the recent events in the Gulf of Mexico during the British Petroleum MC 252 explosion and subsequent spill. It will discuss the challenges and innovative solutions applied by those involved in the Safety and Pre-hospital medical branch of the Deepwater Horizon spill response. First, it examines the logistical and practical challenges faced by emergency medicine planners working with a large temporary workforce on a HAZMAT scene for many months. It will also discuss the geographic challenges with working on dock sites that existed in local communities with mostly a rural medicine and hospital system, while also considering the potential for ambulance and further pre-hospital support. Impacts resulting from the public/private Incident Command Structure (ICS) will also be discussed liberally throughout the presentation. The author is the former Emergency Response Coordinator for one of BP's largest contractors in charge of the Vessels of Opportunity (VOO) and Near-Shore Skimming (NSS) programs. He was in charge of coordinating all emergency medicine in multiple US states throughout the response. It will analyze the multi-layered approach taken by on-site contractors in addressing these issues from a planning and operational perspective. Planners discovered that a uniform, one-size-fits-all approach applied by the Unified Area Command in New Orleans was virtually inapplicable to sites that had unique geographic and personnel characteristics. Furthermore those who involved in cleanup work in the Gulf had very different requirements than those on-shore. Therefore, site-specific personnel had to adapt to conditions while working within the framework established in New Orleans in order to satisfy ICS guidelines and ensure that emergency medicine in local communities was not overwhelmed. Lessons for future responses will be discussed, as there will be an examination of both the land-based NSS and the water-borne VOO programs.