Train accidents involving motor vehicles and pedestrians can be devastating. Approximately 1,234 fatalities were recorded in the United States in 1989. The literature from the United States is sparse, prompting a 7-year review of 23 consecutive train accident victims. Twenty (87%) were male, with an average age of 30.6 years. Sixteen (70%) were intoxicated at the time of the accident, and the average Injury Severity Score was 21.4. There was a total of eight traumatic amputations occurring in the 11 (48%) patients involved as pedestrians. Two of these were railroad workers, and nine were trespassers. Fourteen (61%) accidents occurred between the hours of 2300 and 0700. Three (14%) patients died. Although alcohol use occurred in 16 (70%), there was no significance between alcohol use and amputation. Thus, non-railroad employed pedestrians, because of a lack of protection, are more prone to traumatic amputations, primarily of the lower extremities, than those involved in motor vehicle accidents.