He added that many people were standing up on trains, and so could be thrown the length of the carriage without any protection if there was a high impact. Also the heavy engineering associated with trains could make it extremely difficult for the emergency services to free trapped people. The problems were also compounded by the huge amount of glass present in most trains which could cause severe lacerations, he stated. 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. The definition depends on whether a patient can breathe and whether they have 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. It is the quiet ones that are - at least those who are screaming can clearly breathe and have a circulation. The top priority for people who have suffered burns is to get them to hospital as quickly as possible so that their injuries can be assessed and doctors can ascertain whether they are able to breathe unaided and whether lung damage has reduced their ability to get sufficient oxygen into the body.