The patient with an acute cervical spinal injury or SCI should be expeditiously and carefully transported from the site of injury to the nearest capable definitive care medical facility. The mode of transportation chosen should be based on the patient's clinical circumstances, distance from target facility, and geography to be traveled and should be the most rapid means available. Immobilization of patients with acute cervical spinal cord and/or spinal column injuries is recommended. Cervical SCIs have a high incidence of airway compromise and pulmonary dysfunction; therefore, respiratory support measures should be available during transport. Several studies cited suggest improved morbidity and mortality of spinal cord-injured patients after the advent of sophisticated transport systems to dedicated SCI treatment centers. These studies all provide Class III medical evidence on this issue. © 2013 by the Congress of Neurological Surgeons.