Guidelines for the therapy of cardiogenic pulmonary edema or acute exacerbation of COPD imply the use of noninvasive ventilation (NIV). Clinical studies show a decrease in intubation frequency, mortality and length of stay with inhospital NIV. First prehospital reports show a safe and feasible use of NIV in this setting. We report the case of a 102-year old patient who was successfully treated with preclinical NIV.