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 seat 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.” San Francisco General treated 53 patients, 34 of whom have been discharged. Hospital officials said six of the patients there were in critical condition. 
 
 "These injuries include large abdominal injuries, spine fractures, head traumas, and orthopedic injuries," Dr. Margaret Knudson, chief of surgery at the hospital, told a news conference. 
 
 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 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 the spinous 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 are going to go in today and put screws and rods and things like that and stabilize the spine.” 
 
 Knudson said two patients in critical condition had "road rash" injures that suggested they were dragged along the ground. "We don't know how they got it but we were a little surprised to see it," she told a news conference. 
 
 “We’ve got some very minor burn injuries which went along with the road rash but we did not see burn injuries," Knudson added. “We do have one patient who has (smoke) inhalation injuries.” Knudson said many patients had crush-type injuries, perhaps from heavy items falling on them. 
 
 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. 
 
 Knudson agreed. “I can tell you two of them likely would not have survived" without it, she said. 
 
 While many children were aboard the plane and have been treated, many appear to have escaped the severe kinds of spinal injuries seen in the adults, Manley says. “Most of the severe injuries were in adults,” he said. 
 
 "We don't have too many severely injured children," Knudson agreed. 
 
 “I think kids are typically more flexible,” Manley said. “They have a lower center of gravity. Little kids are made to rough and tumble. They do weather injuries well.” 
 
 Spokespeople at several Bay Area hospitals said they had treated and released lightly injured patients. Stanford Hospital treated 55 patients, with two in critical condition; California-Pacific Medical Center is treating nine patients and released five, the University of California San Francisco has treated and released 15; Kaiser Permanente treated and released 15 from two of its area hospitals; St. Mary's Medical Center admitted four patients while the associated St Francis Medical Center treated seven and has released six of them. 
 
 Matthew DeLuca, Ami Schmitz and Stacey Naggiar contributed to this story. ||||| SAN FRANCISCO (Reuters) - Tapes of 911 emergency calls made moments after an Asiana Airlines jet crashed at San Francisco airport last Saturday reveal panic and confusion, and highlight some possible problems as emergency services raced to the scene. 
 
 Passengers evacuate from a Asiana Airlines Boeing 777 aircraft after a crash landing at San Francisco International Airport in California July 6, 2013 in this file handout photo provided by passenger Eugene Anthony Rah released to Reuters on July 8, 2013. REUTERS/Eugene Anthony Rah/Handout via Reuters/Files 
 
 The crash of the Boeing 777 killed two and injured more than 180. The first police and fire personnel arrived at the crash scene in about two minutes, and local officials said brave rescue efforts and effective triage of the many wounded likely saved lives. 
 
 Still, the 11 minutes of 911 tapes released by the California Highway Patrol portray a tense and sometimes chaotic situation as severely injured passengers awaited help. 
 
 “There are people laying on the tarmac with critical injuries, head injuries. We’re almost losing a woman here,” one passenger said in a taped call, stating she had been waiting for 20 to 30 minutes. 
 
 The tapes appear to confirm witness accounts that several people were left unattended near the end of the runway as emergency crews focused on the main crash site. 
 
 “We have people over here who weren’t found,” another 911 caller said. 
 
 Three flight attendants and one Chinese student, who died in the accident, were ejected from the back of the plane after the tail broke off, according to National Transportation Safety Board Chairwoman Deborah Hersman. 
 
 Officials are also investigating whether one of the two Chinese teenagers killed in the crash was run over by a fire truck, according to the San Francisco Fire Department. The large number of non-English-speaking passengers also presented some unexpected problems. 
 
 “We’re looking at this, and what we can learn from it,” Rob Dudgeon, deputy director of the department of emergency management at the city and county of San Francisco, said in a phone interview on Thursday. 
 
 ‘SOMETHING OUT OF A NIGHTMARE’ 
 
 At a news conference on Monday, police and firefighters described a dramatic scene of running up an emergency escape chute to board the burning aircraft, handing out knives so crew could cut trapped people free, and tearing away seats and luggage to clear choked exit paths. 
 
 “It was like something out of a nightmare,” said San Francisco police officer Jim Cunningham, describing a plane cabin filling with thick black smoke as rescuers worked to free a few trapped passengers even after most had gotten off safely. 
 
 The call to evacuate the plane was made 90 seconds after it came to a halt on the runway, Hersman said on Wednesday. The crew first told passengers to remain seated, but an evacuation began after a flight attendant reported seeing fire outside the plane. 
 
 The NTSB will examine whether proper evacuation procedures were followed, Hersman said, adding that “hindsight is 20/20.” 
 
 Some passengers on the taped 911 calls reported not seeing ambulances and fire trucks. 
 
 But emergency responders say procedures call for not bringing vehicles too close to the scene, in order to avoid chaos and collisions. In this case, there was also a worry that the plane could explode, said Mindy Talmadge, a spokesman for the San Francisco Fire Department. 
 
 “There’s active fire, and there’s fuel leaking, and there’s debris all over the field, the last thing you want to do is take a chance of the plane exploding,” she said in a phone interview on Thursday. A fire burned through much of the plane’s cabin, although Hersman said the fuel tanks did not rupture. 
 
 Dudgeon said procedures called for a methodical approach in identifying the injured, starting in one spot and working forward. That could potentially leave some victims unattended for many minutes. 
 
 “If you start to worry about go here, go there, you miss things,” Dudgeon said. “As a paramedic, when you’re doing triage, you start where you are. You keep moving forward until you’ve triaged everybody.” 
 
 Naj Meshkati, a professor at the University of Southern California who studies aviation safety, said he recalled other plane crashes where passenger groups were overlooked initially. 
 
 “In this day and age that we have the GPS and the surveillance camera system, I think something should be changed and could be changed,” he said, adding that overall emergency response at the crash “worked beautifully.” 
 
 Some 40 to 50 ambulances were sent to the crash site, said Dr. John Brown, medical director for Emergency Management Services, San Francisco. Some left the scene with up to five injured people in them to make sure the critically injured arrived quickly at hospitals, he said. 
 
 ‘OVERALL, SYSTEM WORKED WELL’ 
 
 The most sensitive issue for responders in the aftermath of the crash was whether they may have inadvertently caused one of the fatalities. 
 
 Robert Foucrault, coroner for San Mateo County, where the airport is located, said autopsy results on how two Chinese teenage girls died would be released in about two weeks. 
 
 Emergency personnel declined to comment specifically on the matter. Dudgeon said that generally speaking, emergency-vehicle drivers are trained to look everywhere around them. “Everybody’s eyes are everywhere,” he said. “It’s heads on a swivel.” 
 
 The triage of the injured resulted in some non-English speaking victims being separated from their families. Most of the passengers on the flight were Chinese and Korean, and it is not clear if any of the emergency responders spoke those languages. 
 
 Passenger Eugene Rah recalled helping a non-English speaker whose injured wife was sent to San Francisco General Hospital. 
 
 “He was very nervous,” Rah said on Monday, adding that for several hours the man was not sure where his wife was or what condition she was in. 
 
 Medical personnel say the most important thing is to make sure the most critically injured patients get treatment as quickly as possible, even if it means separating families. 
 
 “The psycho-social issues are real, but they’re trumped by the medical issues,” said Chris Barton, chief of emergency medicine at San Francisco General Hospital, which received 66 injured passengers and crew. 
 
 In some cases, when uninjured Korean or Chinese children arrived at the hospital with their injured parents, the hospital admitted the children to the pediatric ward so they would have a place to stay and would not be separated from their recuperating parents, he said. 
 
 Barton and other area hospital staffers said the response by emergency personnel on the crash site was impressive, with patients arriving promptly and with initial care, such as drip systems for intravenous fluids, already handled. 
 
 “Overall, the system worked well,” Barton said. “The triage, the communication.” 
 
 That was not always apparent to passengers on the scene. 
 
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 “There’s not enough medics out here,” one 911 caller said, saying a woman on the runway was “pretty much burned, very severely on the head, and we don’t know what to do. 
 
 “She will probably die soon if she doesn’t get help,” the female caller said. “Is there any way we can assist her?” 
 
 To another caller, who said he had yet to see a fire truck, the dispatcher said, “We are responding, trust me.”
– If Saturday's plane crash in San Francisco had happened 25 years ago—or if passengers hadn't been wearing seat belts—the death toll would have been a lot higher than two out of the 307 passengers and crew, experts say. FAA mandates in the late 1980s forced manufacturers to bolster seat strength, and if this had happened before then, "the inside of that plane would have looked like a jigsaw puzzle dropped from a second-floor window," an aviation safety expert tells the San Francisco Chronicle. Among the survivors, there are numerous spinal injuries that are the result of being violently shaken in their seats, says the doctor overseeing the passengers' care. "They were all in the same type of seats, and they all had their seat belts on," so many of the injured have the same pattern of spinal damage caused by their upper bodies being flung over their lap belts, Dr. Geoffrey Manley, the neurosurgery chief at San Francisco General Hospital, tells NBC News. Other experts say the injuries are like those before shoulder belts in cars, though it's not clear whether shoulder belts in planes could have prevented the injuries, the AP notes. Six patients are still in critical condition and two are unable to move their legs, though Manley says remarkably few of the many children on the flight are among the seriously injured. "They have a lower center of gravity. Little kids are made to rough and tumble," he says. "They do weather injuries well."