A spinal cord injury is a devastating event that occurs with a survival incidence of 30 to 40 per million. The percentage of complete neurologic injuries appears to be decreasing. This is thought to be attributable to a number of factors, including more and better trained paramedics, improved extrication and splinting techniques, earlier diagnosis, and transfer to an appropriate regional spinal cord injury center. The emergency department physician, whether in an urban or rural setting, plays a major role in the successful outcome of the spinal cord injured patient, by the application of early, appropriate management techniques, the insuring of proper spinal stabilization, and the use of all diagnostic services and personnel at his or her disposal. These measures guarantee that no further injury is likely to occur during this most crucial period of time.