The psychological impact on 101 train drivers of accidents causing major injuries or death to persons was studied by means of clinical interviews and questionnaires (Impact of Event Scale, General Health Questionnaire and a questionnaire addressing stress symptoms plus past and pre accident expectancies of being involved in accidents). The drivers were examined within hours to a few days after the accident and later at 1 month and 1 year. One month after the accident the symptoms of distress were significantly reduced and most so among the drivers with no preaccident risk experience according to self reports during the acute phase. A minor further reduction of distress was found at 1 year. Drivers with two or more previous accident experiences and those who had worried about being involved in accidents showed highest symptoms of distress at follow-up. Eleven out of 101 drivers reported sick leave more of than 1 week after the accident and this was related to higher intrusion scores. The few drivers who report longterm psychological distress are best predicted by a combination of acute high IES scores, experience of previous accidents and risk expectancy prior to the current accident. The study suggests that premorbid and non-accident related variables are more important for the 1 year psychological outcome of healthy drivers after on-the-track accidents than the stress event itself.