Prehospital care is a rapidly developing and complex specialty. The effectiveness of prehospital spinal immobilization in preventing further spinal injury has not been conclusively proven in literature. Safe extrication of patient from the site of injury, spinal immobilization and rapid transfer to the hospital is the ultimate desirable aim during prehospital management. Considering prehospital care separately from the rest of the trauma treatment system for road traffic injuries is an artificial distinction; the prehospital phase should be viewed as the start of a continuum of care. Lifesaving interventions should take priority over spinal immobilization. Cervical collar, lateral stabilizer for head and spinal boards are minimum devices used for full spinal immobilization. Logroll and lift and slide maneuvers are used to transfer the patient on or off the board. Repeated transfer of the patient should be avoided. While most developed nations have well-equipped EMS, very few developing countries have EMS to provide prehospital medical care and transport to road traffic casualties. By combining local input and evidence-based sources, models of training directed to local people can be devised to improve prehospital trauma care rendered to roadway casualties in low-income countries.