Three fatalities. Seventy-two people transported to hospital.
Fun fact: I was on the first fire engine that arrived on that accident.
Source: https://en.wikipedia.org/wiki/2017_Washington_train_derailme...
There's a lot of adrenaline. I think even the most seasoned, salty veteran would be lying if they said they responded to that call all cool, calm and collected.
But you go back to training. Which is instilled into you as "don't train until you get it right, train until you can't get it wrong".
Scene safety. For yourself, crew, bystanders, the involved.
Resource needs. More ambulances? Cranes?
Then setting up for a mass casualty incident - usually broken down into triage, treatment, and transport - assigning resources to those.
You're right though, it's hard - you want to not be bored, to have something to do, but you don't want someone to have a horrible day. There's a mental balancing act going on.
I remember one of my EMT students, on her first ride along, was for a bad trauma (felled tree bounced and hit someone in the back, causing significant spinal damage and chest injuries). We rendezvoused with a helicopter, intubated, did needle decompressions of the chest, and off they went. My student was a little 'off' afterwards. I asked if she was okay. "I feel so guilty!". I completely misread her, told her nothing was her fault, and said it was okay that she didn't participate as much as possible in patient care versus assisting. "No, I feel so guilty because that guy is so sick, but that was f-ing awesome to see!"
So yeah...
On the other hand, an aircraft crashing into a populated area will definitely kill everyone on board plus all the unlucky folks on the ground who happen to get hit by it.
[0]: https://en.wikipedia.org/wiki/Santiago_de_Compostela_derailm...
A subversionist can easily sabotage the railway over a bridge, on a slope, or time it to have a collision with another train.
This is pretty much the worst-case kind of derailment: the train derailed mid-switch, causing half the train to go down one track and the other half to go the other track. The sideways car then crashed into the immediately adjacent road pillar, destroying the car and the road on top of it. The rest of the train then plowed into the carnage and folded up like an accordion.
Total death count: 101, of 286 passengers.
An A380 will carry more passengers (500-600, I think), and a typical plane crash will have a much higher death train.
Otherwise, yes, trains are almost as safe as air travel, if not even safer.
Which is a plain idiocity. A train derailment, even of a non-high speed train, will make for a many times bigger bodycount than an even A380 crash.