Undiagnosed Air Crash Brain Injury in Asiana Flight 214
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Not enough focus on the Asiana 214 crash at San Francisco International Airport is on the potential for undiagnosed air crash brain injury to the 304 survivors. We think of air crashes as catastrophic events, ending with crushed and burned planes, trying not to think of the human carnage inside. When we see a crash where a plane is only broken and the overwhelming percentage of those onboard walk away, we are prone to forget just how much force the human body absorbed when a plane goes from 150 mph to zero, in an instant.
With passengers seat belted, most of that force is going to be whiplash. But unlike a 10 mph rear end auto collision, the forces on the human brain and spine caused by the kind of deceleration seen in the Asiana 214 crash at San Francisco International airport, can still be catastrophic. The most vulnerable spot in that target of force, the brain.
I can still remember the thrill of my first airplane flight. I was 17 years old. The most amazing part was the feeling of acceleration as we sped down the runway, far greater than anything in a car. After perhaps a thousand flights, I still am grabbed by the deceleration of braking as soon as the wheels touch down. That sensation of speed each time we take off or land, is a reminder of how terrible the forces would be if a something went wrong. We know how bad it is when a car is suddenly stopped from highway speeds. The potential for trauma is exponentially worse when it is a jet that hits a sudden stop.
In the Asiana 214 crash, the risk of undiagnosed brain injury to the 304 survivors is even greater because of the 360 degree spin/roll the Boeing 777 experienced before coming to a rest. According to the NTSB, after contacting the seawall at San Francisco International airport (SFO), the aircraft ballooned, yawed left and went into a 360 degree spin. See ABC news video recreation at http://abcnews.go.com/Nightline/video/asiana-airlines-crash-seconds-horror-flight-214-19612468
To try to simplify a complicated engineering analysis, a brain can be injured by the application of force in a straightline, called linear force. This could potentially happen if you walked into a wall in the dark. However, the brain is far more vulnerable to injury if the straightline deceleration is combined with rotational force (meaning force where there is rotation of the head and neck). In a classic whiplash injury, the brain is most exposed because the head rotates in an arc around the waist, which is held in place by the seatbelt. That is the primary mechanism of injury when the head is not struck and one car rear-ends another. However, when a car wreck involves cars moving not in the same line, but in opposing angles (such as in an intersection collision) the rotational force can grow exponentially.
In Asiana 214, these biomechanical issues combined to create severe risk of brain injury:
- Deceleration of the plane suddenly from the 122 mph crash speed to zero, in a short distance on the runway;
- A bouncing or wrenching type of force to the body, from the direct impact with the seawall, which would be transferred to a human body through the frame of the aircraft;
- Rotational forces as the plane first yawed to the left and then rotated the other direction through an entire 360 degree of spin;
- Additional dramatically increased force for any head/brain which hit either a part of the plane or another passenger, with head to head contact being amongst the most severe.
- A direct blow to the head from flying debris or luggage. As the overhead luggage racks were shattered and debris was strewn throughout the plane so that there was no walking pathway for first responders.
- The seat’s collapsing on the plane, adding to the unanchored debris and potentially eliminating the safety effect of the seatbelt.
Each of the above forces is considerably more severe to the actual brain than it would be to any other part of the body, because the head and brain are the parts of the body furthest from the center of rotation, the seatbelt. The next most vulnerable point of injury in the body is the neck, as it is the part of the body which the head has to rotate upon.
Despite all of the media buzz around this crash, news reports have almost no discussion of concussion. Were the survivors of this Asiana 214 immune from concussion or did brain injuries go undiagnosed?
The high probability is that as many as 10 times more people suffered a concussion as were treated for air crash brain injury. However, evaluating for potential for serious harm and disability from the brain injury is even greater because of the potential for contemporaneous PTSD from the fright and shock of being in this crash. While the concussional forces in the crash may have only lasted for the 10 seconds the plane was spinning and coming to a stop, the traumatic stress event certainly lasted until everyone was off the plane and likely continued up to and through the treatment at the hospital. Traumatic brain injury can result in Post Concussion Syndrome or worse. Traumatic brain injury and or Post Concussion Syndrome (PCS) can disable, generally a minimum of 15% of those with a concussion will suffer disability as a result. Exposure to the extreme emotion and fright of an air crash can result in Post Traumatic Stress Disorder. Post Traumatic Stress Disorder (PTSD) can disable, although it is more difficult to estimate a percentage of long term disability than with concussion, because of the wide range of potentially frightening traumas. However, there is no question that an air crash would be at the high end of the frightful experiences.
Yet the risk of disability in Asiana 214 Crash is even greater, because of the likelihood that those with a brain injury, will have also have suffered PTSD. What we have learned from war time brain injury is that the neural pathologies involved in Mild Traumatic Brain Injury and Post Traumatic Stress disorder overlap. The sum total of such overlapping pathologies is dramatically increased rates of disability. Anyone who survived this crash must not only assure that they get full diagnosis and treatment for brain injury, but also that the co-morbid issues that come from PTSD be treated concurrently.
For more on understanding the forces which cause air crash brain injury, click here.
For more on the Asiana 214 crash, click here.
For other types of injuries suffered in Asiana 214, click here.
For understanding compensation for air crash brain injury, click here.