The case histories of the 44 ventilated spinal cord damaged patients who have been treated at the Mersey Regional Spinal Injuries Centre prior to 1985 were reviewed. Complications of ventilation were commoner in patients whose ventilation was initiated prior to transfer to the specialised centre. Inappropriate early management before or during transfer to the spinal injuries centre led to the need for ventilation in several cases. Spinal cord damaged patients should be transferred to a specialised comprehensive centre as soon as possible after injury so that the requirement for ventilation can be minimised, the incidence of cardiac and respiratory arrest reduced, optimal methods of ventilation and weaning employed and global emotional and educational support provided from the outset for the patient and his family.