Abstract Background: Prehospital diagnostic accuracy and risks of transportation associated neurological deterioration for patients with spinal injury remain imprecise. Methods: Retrospective review of medical records for patients with suspected spinal injury assessed and escorted by medically staffed team. Results: One hundred and ninety six patients had follow up for spinal injury, 61% with actual injury. Of the 196 patients, 93% involved helicopter transport, 3.5% road vehicle and 3.5% fixed wing transports. Fifty one percent were interhospital transfers. Medical team's scene diagnostic accuracy of spinal injury was 31%. Scene medical interventions were those consistent with current paramedical skills. Of interhospital transferred patients, 19% had no injury. Cervical injuries as part of mixed injuries were the most often missed injuries. Abnormal neurological findings occurred equally amongst patients with and without spinal injury. Transport related incidents were documented for 15%. Interhospital transport patient related incidents occurred for 12% helicopter and 36% road vehicle transports ( P=0.094). No transport related neurological injury or other morbidity was documented. Conclusion: Prehospital diagnosis of spinal injury, even by medical teams remains imprecise. Choice of helicopter transport, based purely upon the suspected presence of spinal injury could not be supported.