4.0 Spinal Immobilisation Techniques and Devices  The clinical importance of prehospital immobilisation in spinal trauma remains unproven. There have been no randomised controlled trials to study immobilisation techniques or devices on trauma victims with suspected spinal cord injury. All existing studies have been retrospective or on healthy volunteers, manikins or cadavers1. Prehospital spinal immobilisation has never been shown to affect outcome and the estimates in the literature regarding the incidence of neurological deterioration due to inadequate immobilisation may be exaggerated. Spinal immobilisation can expose victims to the risks associated with specific devices and the time taken in application leads to delays in transport time.2,3,4 4.1 Cervical Collars  The use of semi rigid (SR) cervical collars by first aid providers is not recommended (CoSTR 2015, weak recommendation, low quality evidence).5 ANZCOR recommends all rescuers in the pre-hospital environment review their approach to the management of suspected spinal injury with regards to SR cervical collars. Consistent with the first aid principle of preventing further harm, the potential benefits of applying a cervical collar do not outweigh harms such as increased intracranial pressure, pressure injuries or pain and unnecessary movement that can occur with the fitting and application of a collar. In suspected cervical spine injury, ANZCOR recommends that the initial management should be manual support of the head in a natural, neutral position, limiting angular movement (expert consensus opinion). In healthy adults, padding under the head (approximately 2cm) may optimise the neutral position.6,7 The potential adverse effects of SR cervical collars increase with duration of use and include: unnecessary movement of the head and neck with the sizing and fitting of the collar discomfort and pain restricted mouth opening and difficulty swallowing8 airway compromise should the victim vomit8 pressure on neck veins raising intra-cranial pressure9 (harmful to head injured victims) hiding potential life-threatening conditions10. 4.2 Spinal Boards  Rigid backboards placed under the victim can be used by first aiders should it be necessary to move the victim. The benefits of stabilizing the head will be limited unless the motion of the trunk is also controlled effectively during transport.11,12 Victims should not be left on rigid spinal boards. Healthy subjects left on spine boards develop pain in the neck, back of the head, shoulder blades and lower back. The same areas are at risk of pressure necrosis.13,14,15 Conscious victims may attempt to move around in an effort to improve comfort, potentially worsening their injury. Paralysed or unconscious victims are at higher risks of development of pressure necrosis due to their lack of pain sensation. Strapping has been shown to restrict breathing and should be loosened if compromising the victim.16,17 Victims may be more comfortable on a padded spine board, air mattress or bead filled vacuum mattress; devices used by some ambulance services.18,19 4.3 Log Roll  The log roll is a manoeuvre performed by a trained team, to roll a victim from a supine position onto their side, and then flat again, so as to examine the back and/or to place or remove a spine board.20