The extent of the injuries suffered by some of the passengers in the M4 coach crash were described by one of the consultants who helped to treat them.
Fire crews had to cut passengers from the wreckage
David Houlihan-Burne, trauma consultant at Hillingdon Hospital, west London, said some travellers had limbs torn off by the force of the accident.
The surgeon said: "At the scene sadly there were traumatic amputations due to the accident itself.
"We had to complete some of those surgically in the early hours."
Commenting on the casualties the A&E department had to deal with overnight, he added: "What was clearly evident, those patients were thrown or dragged along grass or mud because there was heavy contamination of all of the wounds.
"Whether they were ejected from the vehicle or not I don't know, but the injuries were consistent with that."
Asked if he thought the passengers had been wearing seatbelts, he replied: "It's very difficult to say.
"If that coach was sliding on its side, sliding along the embankment, and those arms were out of the window, those patients could easily have been wearing seatbelts."
He added: "Thankfully we don't have to deal with this very often.
"We have an excellent major incident protocol which swung into action and worked extremely efficiently and made the whole system run very smoothly.
"Despite the severity of the injuries we saw, the staff that were called in dealt with it very well and swiftly."
He said one patient had been treated in theatre and four others would be operated on later to treat limb injuries.
He said they were all extremely anxious and all conscious.