A United States Marine with an open abdominal injury from a single gunshot wound to the chest and abdomen was placed in the prone position after suffering from acute respiratory distress syndrome (ARDS). Prone ventilation in traumatic injuries involving an open abdomen has been rarely reported or attempted because of the potentially fatal complication of bowel dehiscence. Improvement of gas exchange in patients with ARDS has been shown to occur with prone ventilation when conventional modes of ventilation have failed. The patient benefited from a sustained improvement in oxygenation hours after return to the supine position allowing for his rapid transport to a higher echelon of care and definitive management.