The patient with an acute cervical spine or spinal cord injury 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 the target facility, and geography to be traveled, and should be the most rapid means available. Patients with cervical spinal cord injuries have a high incidence of airway compromise and pulmonary dysfunction; therefore, respiratory support measures should be available during transport. Several studies suggest that rates of morbidity and mortality of SCI patients decreased after the advent of sophisticated transport systems to dedicated SCI centers. These studies all provide Class III medical evidence on this issue.