We only cut up the car if it is impossible to remove the patient any other way. We're pretty good at getting people out of cars and onto boards through the doors. We do have a fair amount of leeway concerning boarding and collaring. While MOI certainly plays into the decision, the patient condition is more important as far as I can tell. Certainly in the more rural areas, practitioners are more familiar to the MDs and therefore have more trust from the doctors. Still, local protocols and standards have precedence. I attended an accident in Dallas (http://bxiieq.wordpress.com/2007/03/12/welcome-to-dallas/) where I thought the patient I was looking after (as a passerby) deserved a board and collar; the FD pulled the patient out of the car without c-spine precautions. I prefer not to board patients unless I have a high degree of suspicion or I find myself figuring out how to explain to the 'A&E' why I didn't board a given patient.