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Tuesday, 17 October, 2000, 13:25 GMT
Train crashes: likely injuries
Crash victim
Crush injuries are a serious problem
Injuries sustained in train crashes can be among the most serious of any type of accident.

Many people are standing up on trains, and so are thrown the length of the carriage without any protection at high impact.

This is particularly relevant in the case of the Hertfordshire train crash, in which it is thought that the buffet car suffered the most severe damage.

Also the heavy engineering associated with trains can make it extremely difficult for the emergency services to free trapped people.

The problems are also compounded by the huge amount of glass present in most trains which can cause severe lacerations.

Dr Peter Holden, press spokesman for the British Association for Immediate Care, said: "If you are thrown the length of a carriage it is just the same as being knocked down by a car, except you are then also hit by everybody else and everything else in the carriage, and then probably also showered with glass."

Dr Holden said a person caught up in a serious train crash will suffer three types of damage:

  • That caused by being thrown across a carriage
  • That caused by others smashing into you
  • That caused by the body's organs crashing against the body's other internal structures

Crush injuries

In a train crash crush injuries are often the most serious problem, and may often require urgent surgery.

Organs can be severely bruised, lacerated, or even ripped away from their vital blood supply, causing internal bleeding which can rapidly lead to death.

Haemorrhagic shock is another serious concern. Head and limb injuries are a common problem, as are the effects of smoke inhalation.

Medical officers arriving at the scene of a train crash are trained to "do the most for the most".

This means rapidly assessing the severity of people's injuries, and categorising them as either: requiring delayed treatment, urgent treatment (two to four hours), immediate treatment or dead.

The definition depends on whether a patient can breath, and whether they have a proper circulation.

Doctors' top priority is to attempt to establish a working airway, and they will hook those patients who require it to an intravenous drip and to an oxygen supply.

However, the top priority at the scene of a crash is not to administer medical treatment, but to stabilise patients and to transport them to hospital as quickly as possible

Dr Holden said: "People who are yelling and screaming are not your first priority, it is the quite ones that are - at least those who are screaming can clearly breath and have a circulation."

Not all seriously injured patients can be guaranteed treatment at a local hospital.

Dr Holden said: "Some patients may be taken some distance, you cannot suddenly put 20 seriously injured people into one hospital. They may need as much as six hours surgery each within 24 hours, and no hospital can cope with that."

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