Acute spinal trauma with its potential to involve spinal cord injury (SCI) hopefully is recognized in a timely fashion to allow for protective and treatment measures to be implemented. In this program emergent management strategies as implemented by organized sports leagues are followed by a review of changes in blood flow to an injured spinal cord and discussion of early intervention means, such as pharmacologic treatment, hypothermia and surgery. Advances in neurophysiolologic technology allow for unprecedented insight in disruption of key pathways within the spinal cord. From the Series:Seventh Annual Harborview Spine Symposium: Improving Outcomes of Spinal Injury