Burned for the likes: A comparative study of train surfing injuries, high-voltage trauma, and social media perspectives.

Abstract

This study presents the clinical course of train surfing (TS) high-voltage (HV) injuries versus other HV burn victims (non-TS, NT) in Switzerland and explores the potential role of social media in promoting this risky behavior. HV accidents involving unauthorized individuals on railroad tracks from 2016 to 2023 were retrospectively collected from the Federal Office of Transport (FOT) and the Swiss Transportation Safety Investigation Board (STSB). Additionally, clinical data of TS and NT patients treated at the University Hospital Zurich (USZ) Burn Center during 2016-2024 were retrospectively analyzed to compare injury severity, clinical course, and healthcare costs. An exploratory social media content analysis was also conducted to assess the potential influence of TS trends on TikTok and Instagram on the behavior's popularity and perception. The FOT and STSB recorded 29 train-related HV accidents. 41 HV patients were treated at USZ, including 12 TS patients. TS were younger (43.6 vs. 20.3 years) and suffered more severe injuries (18.5 % vs. 44.3 % burned total body surface area, TBSA), higher rates secondary injuries (100 % vs. 31 %), longer ICU stays (48.5 vs. 13.2 days), and more complications (100 % vs. 58.6 %) than NT patients. As a result, rehabilitation time and hospitalization costs increased for TS (109 vs. 73 days and CHF 503 152 vs. CHF 174 307). Social media analysis revealed that TS-related content was popular and often glamorized the activity, with safety warnings frequently bypassed, potentially contributing to increased engagement in this risky behavior. TS causes worse outcomes and higher medical costs compared to NT. Review of social media posts suggested that TS-related content achieved high visibility (measured by views, likes, and shares) and was often portrayed in an appealing or thrill-seeking manner, hence 'glamorized' the activity. This underscores the urgent need for targeted prevention and awareness efforts to reduce these avoidable injuries.