SAN FRANCISCO, CA - JULY 06: A Boeing 777 airplane lies burned on the runway after it crash landed at San Francisco International Airport July 6, 2013 in San Francisco, California. An Asiana Airlines passenger aircraft coming from Seoul, South Korea crashed while landing. There has been at least two casualties reported. (Photo by Ezra Shaw/Getty Images)
Many of those hurt in the crash of Asiana Airlines Flight 214 on Saturday have spinal injuries, according to a doctor who treated them - and they'll likely need long-term treatment.
Patients have fractured spines, stretched ligaments and head injuries, said Dr. Geoff Manley, vice chairman of neurological surgery at the University of California San Francisco. The pattern of injuries is surprisingly similar, he told NBC News, and paints a picture of people badly bounced around as the plane hit short of the runway and tumbled.
"There was some blunt force injury from seatbelts and people striking their heads against the set and armrests," Manley, who treated many of the patients at San Francisco General Hospital, said in a telephone interview.
"We have a lot of spine trauma." People's spinal cords were fractured and hyper-extended, meaning they'll need to be kept stable so the spinal cord itself isn't damaged any more.
"There are some people very, very badly hurt."
Some of the worst injuries are traumatic brain injury, Manley added.Some passengers also suffered internal injuries from being flung against their seat belts. "They were all in the same type of seats, and they all had their seat belts on," he said. So many of the injured have the same types of spinal damage.
There were 291 passengers and 16 crew members aboard the flight, which had crossed the Pacific from Shanghai with a stop in Seoul before crashing as the pilots were attempting to land. More than 180 people were transported to nine San Francisco area hospitals, officials said.
Injuries range from bruises and minor burns to bone fractures, head and internal injuries. Officials said 49 of the patients were seriously injured.
Two people, both teenage girls, were killed in the crash, but Manley noted that he had expected more serious injuries.
"Given the nature of the accident, it is remarkable we did not see more significant injuries," he said.
As the plane hit the ground, passengers would have been thrust forward, backward, up and down. "This is whiplash to the nth degree," Manley said. "People were being flipped forward and back as the plane crashed. When you bend forward or backward like that, you can literally crush (the vertebrae)."
In some of the passengers thespinous process - the piece of bone you can feel when you touch the back of your neck - cracked in half.
One patient appears to be paralyzed from the waist down, Manley said, although it's early to tell.
Even those with no obvious fractures are in danger of becoming paralyzed, as stretched ligaments can no longer keep the spine stable.
"We have a number of these injuries that are highly unstable," Manley said. "We going to go in today and put screws and rods and things like that and stabilize the spine."
Emergency workers who grabbed and stabilized passengers on the runway undoubtedly prevented worse injuries, he said.
"Obviously, people needed to jump off that plane because it caught on fire," Manley said. But immediate triage meant patients with the worst injuries, especially head injuries and damage to internal organs, went straight to hospitals, while others were put in back boards or fitted with cervical collars to prevent more injury to their spinal cords before they were sent.
While many children were aboard the plane and have been treated, they appear to have escaped the kids of spinal injuries seen in the adults, Manley says. "Most of the severe injurieswere in adults," he said.
"I think kids are typically more flexible," he added. "They have a lower center of gravity. Little kids are made to rough and tumble. They do weather injuries well."