Emergency department disposition

Emergency department disposition

One of the most important developments of the U.S. Industrial Revolution was the creation of railroads. They brought economic, social, and political change to a country that was only 50 years old. Railroads were first developed in Great Britain after George Stephenson applied the steam technology of his time and created the first successful locomotive. Americans visiting England saw how using steam locomotives for rail transport could decrease shipping costs by almost 70 percent. Shortly thereafter, the U.S. began importing engines from the Stephenson Works along with track from England—a process that continued up until the Civil War.*

In 1827, because Baltimore, MD, was 200 miles closer to the frontier than New York, NY, it was viewed as a strong contender to serve as the hub city for a railroad that would transport goods and people to the West. Thus, the Baltimore and Ohio Railroad became the first registered railroad in the U.S. Next came the creation of the transcontinental railroad, considered one of the greatest feats of the 19th century. Concluding in May of 1869 in Promontory, UT, the Transcontinental Railroad was formed through the merger of the Central Pacific Railroad, which began in San Francisco, CA, with the Union Pacific, which originated in Omaha, NE. Merging these two railroads required an army of 20,000 workers, primarily immigrants, to cross mountains and dig tunnels.*

Accidents are rare

Nowadays we commonly hear on the news of a train crash that has occurred somewhere in the U.S. Just this past May, several high-profile crashes involving trains occurred outside of Baltimore, in southeastern Missouri, and just outside Bridgeport, CT.

Nonetheless, in general, railroad safety is actually improving. According to the Federal Railroad Administration, the number of train accidents declined by more than 43 percent during the past decade. In 2012, a total of 1,712 train accidents, with 284 injuries and nine deaths, occurred.

To examine the occurrence of train derailment injuries in the National Trauma Data Bank® (NTDB®) research dataset for 2012, admissions medical records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Specifically searched was external cause of injury code (E-code) E800 (railway accident involving collision with rolling stock) and the fourth digit value of either (0–railway employee, 1–passenger on railway, 2–pedestrian, 8–other specified person, 9–unspecified person). A total of 27 records were found, 23 of which contained a discharge status indicating that 15 patients were discharged to home, four to acute care/rehab, and two to skilled nursing facilities; two died. These patients were 89 percent male, on average 40.8 years of age, had an average hospital length of stay of 11.7 days, an intensive care unit (ICU) length of stay of 9.7 days, an average injury severity score of 18.1, and were on the ventilator for an average of eight days. A total of 21 percent went directly to the operating room, while another 37 percent went directly to the ICU from the emergency department (see figure).

In 2012, more than 660 million passengers traveled nearly 21 billion miles with an extremely low risk of injury. Freight trains can safely carry a ton of ore and other minerals, scrap metals, grains, refrigerated goods, manufacturing parts, raw supplies, liquids, and even hazardous waste 450 miles on a single gallon of fuel. So the next time you contemplate train travel, don’t let the news of a highly publicized train crash derail your plans.

Throughout the year, we will be highlighting data through brief reports in the Bulletin. The NTDB Annual Report 2012 is available on the ACS website as a PDF file and as a PowerPoint presentation at In addition, information regarding how to obtain NTDB data for more detailed study is available on the website. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at

Statistical support for this article has been provided by Chrystal Caden-Price, data analyst, NTDB.

*U.S. History: Pre-Columbian to the New Millennium. 25b. Early American railroads. Available at: Accessed June 17, 2013.
†Federal Railroad Administration Office of Safety Analysis. Accident/incident overview. Available at: Accessed June 17, 2013.

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