Introduction: There is little information in the literature about the most critical demographic patterns on train accidents. We attempt to assess demographic patterns associated with railway injuries in the US. Materials and Methods: Using the 2017 National Trauma Data Bank (NTDB), we identified adults who suffered train-related injuries. Data collected included age, sex, ethnicity, restraint devices, prehospital and emergency department (ED) vital signs and Glasgow Coma Scale (GCS), time of response and transportation, prehospital cardiac arrest, mechanism of injury, death in crash and in ED, pregnancy more than 20 weeks when applicable, burn injuries, supplemental oxygen, height, weight, ED discharge disposition, history of alcoholism and drug abuse, need of intensive care unit (ICU), length of stay (LOS) at the ICU and hospital, ventilator use in days, hemorrhage control surgery, blood products received, and Abbreviated Injury Scale (AIS) score. For all statistical analyses, a p-value of <0.05 was considered significant. Results: We identified 4,545 patients, of whom 68% were male, and the mean age was 37 ± 16.5 years. The racial distribution was 64% White, 19% Black, 12% Hispanic, 11% Hispanic, and 6% others. The most common mechanisms of injury were intentional self-harm by jumping or lying in front of the train (30%), followed by pedestrian struck by train (26%), intentional collision of motor vehicle with train (19%), and accidental motor vehicle collision with train (14%). Compared to females, males had lower GCS 12 vs 12.7 (p = 0.005). Alcohol intoxication was present in 13% of patients who had longer LOS 13.4 vs 10 days (p = 0.001). Drug involvement was present in 19% of patients who had lower GCS 11.9 vs 12.6 (p = 0.001). Overall mortality was 17% and was greater in suicide attempts (19%) and pedestrian struck (35%). Mortality for car occupants injured by train collision vs intentional collision of motor vehicle was 5.9 vs 3.4%. Conclusion: The most frequent train-related injuries are secondary to suicide attempts. The second most common incidents occur on railway crossings with pedestrians and motor vehicle occupants. Further public care research is needed to improve safety measures and public awareness associated with railway crossings.