Care of the combat casualty with spinal column or spinal cord injury has not been previously described, particularly in regards to spinal immobilization. The ultimate goal of spinal immobilization in the combat casualty is to first ``do no further harm'' and then provide a stable, painless spine and an optimal neurologic recovery. The protocol for treatment of the combat casualty with suspected spinal column or spinal cord injury from the battlefield to final arrival at a definitive treatment center is discussed, and the special considerations for medical evacuation off the battlefield and for aeromedical transport are delineated. Selective prehospital spine immobilization, which involves spinal immobilization with backboard, semi-rigid cervical collar, lateral supports, and straps or tape, is recommended if there is suspicion of spinal column or spinal cord injury in the combat casualty and when conditions and resources permit. The authors do not recommend spinal immobilization for the combat casualty with isolated penetrating trauma.