Although the cause of death is rarely in doubt in train-pedestrian fatalities, the manner of death is often unclear. The distinction between accident and suicide can only be made after careful evaluation of the history, scene investigation, autopsy findings, and toxicologic data. A retrospective analysis of 25 consecutive train-pedestrian fatalities investigated by our office between 1982 and 1992 is reported. The victims were predominantly healthy, young males. All but one person died at the scene. The cause of death was massive blunt trauma in 88% of the cases. In one case, the sole injury was decapitation. A tissue or blood ethanol level greater than 99 mg/dL was detected in 80% of the cases. A total of 60% of the cases involved persons likely to have been sitting or lying across the railroad tracks; all but one of these victims were intoxicated. The manner of death was determined to be accidental in 92% of our cases. Decapitation by a moving train is an injury highly suggestive of suicide. Massive blunt trauma, especially in the setting of ethanol intoxication, was highly associated with accidental death. Toxicologic analysis is essential in discriminating willful suicide from alcohol-induced incapacitation resulting in accidental death. Homicide, disguised as an accident or suicide, must be ruled out in all cases. Accurate determination of the manner of death is an important issue regarding civil litigation and dispersal of insurance benefits.