Purpose:Spinal injuries resulting in neurological damage cause significant morbidity.Swift neurosur-gical intervention can mitigate negative outcornes.However,variable mechanisms of injury may be associated with inappropriate transport (IAT),which may delay necessary surgical interventions.Patients with near shore spinal injuries (NSSI) presented with unique mechanisms,so we investigated factors associated with IAT in patients with NSSI.Methods:We performed a multicenter retrospective study of all adult patients transported from a beach resort to 3 hospitals for suspected NSSI between 2006-2017.We excluded patients transferred to other facilities,and those not injured in the water.Primary outcome was IAT,defined as patients with NSSI requiring transfer to another trauma center.To avoid heterogeneity in out analysis,we further excluded patients without NSSI who were inappropriately transported to a level I trauma center.We used multivariable logistic regression to assess association of independent variables (such as demographic,environmental,and clinical factors) with outcome.Results:We analyzed 278 patients with suspected NSSI,and found 14 (5.0％) had IAT.Compared to appropriately transported patients,diving was associated with higher percentages of IAT (28.6％ vs.3.9％,p-0.014) and more were transported by air (50.0％ vs.20.6％,p 0.01).In multivariable regression,patients\' oxygenation saturation (odds ratio[OR]-0.8,95％ confidence intervals[CI]:0770.98) and diving (OR-7.5.95％ CI:1.246) were significantly associated with IAT.Conclusion:Rate of IAT for patients with NSSI was low.However,first responders and emergency medicine providers should be aware that diving is associated witb a higher likelihood of IAT.