Immobilization of the spine is an important skill for all emergency providers. This article reviews the literature regarding the equipment, adjuncts, and techniques involved in spinal immobilization. Current prehospital practice is to apply spinal immobilization liberally in cases of suspected neck or back injury. Rigid cervical collars, long backboards, and straps remain the standard implements for immobilizing supine patients. Tape, foam blocks, and towels can complement the basic items and improve stability. Padding may improve positioning and comfort. Intermediate-stage devices include the short backboard and newer commercial devices. Properly used, all provide reasonable immobilization of the sitting patient. Future directions for study include refinement of optimal body position, dynamic performance of all devices, and broadening study populations to include children and the elderly.