The ambulance arrived and the crew accepted your verbal and written SOAP note. They confirmed your findings of upper back and spine pain with good CSM x4 in an alert patient with stable vital signs that are within normal limits. They replaced your improvised collar with a commercial soft collar and with your assistance lifted (BEAM’ed) the patient onto their cot. They secured the patient with the cot straps and a set of head blocks, loaded him into the ambulance, and drove away. Anticipating that your friend would be immobilized with backboard, hard cervical collar, and head blocks you were taken aback by this care.