Conclusions Based on Medical Information from Russian Sources
by Andreas Wielgosz, François Dubé
Published August 10, 2015
Comprehensive medical examinations of victims can shed light on the circumstances of an air crash and are routinely conducted following such disasters. Likewise psychological characteristics and behaviours of the flight crew form an important part of the assessment. In order to understand the behaviour of each member of the flight crew during critical moments of an accident, every piece of information is sought, particularly from the flight and voice recorders, when it is not possible to conduct a debriefing because of the death of crew members. In addition, previous behaviour including responses in similar situations during training and in tests on simulators may provide an opportunity to recreate a possible response scenario during the accident under investigation.
In the usual investigation of an aircraft crash, one of the pathologist’s most important tasks is the identification of all bodies and parts thereof. This is done by using several different techniques, such as x-rays, photographs, fingerprints, dental records and DNA.
The initial work begins at the crash site, noting where the bodies lie in relation to the aircraft as well as to the seat in which they sat, the position of the bodies as they are found and their condition as well as the condition of their clothes.
Dr. François Dubé a retired pathologist, pilot and investigator of many air accidents in Canada and several other countries, and I examined the English translation of the Russian Interstate Aviation Committee final report on the Tupolev TU-154M crash of April 10, 2010 in Smolensk in order to review medical aspects contained in the report and thereby try to gain insights to the cause(s) of the crash. It should be remembered that the opinion around the world about this accident and in particular about its cause was formulated by the Russian report.
The report of the Air Accident Investigation Commission of the Interstate Aviation Committee attributes the crash to a determined landing by the pilot in command in spite of repeated advice from air traffic control to seek another airport because of poor visibility due to fog. The psychological state of the pilot in command is also questioned with implications that he was pressured to land at any cost by his Commander in Chief, given the circumstances surrounding the flight.
The report identifies the final moments of the flight beginning with the loss of a portion of the left outer wing panel after collision with a birch tree, resulting in loss of control and a roll of the aircraft to the left, as it crashed. Analyses of the mechanical aspects of the incident do not explain in full this crash. Therefore pathological examinations of the victims are potentially valuable as they can help corroborate the explanation that has been provided or such examinations shed new light on the opinions provided by engineers and other experts examining the crash. Our comments are restricted primarily to certain medical aspects as contained in the Russian report.
The pathological investigations, in this case, did not provide much information concerning injuries sustained by all the passengers. It is not clear that photographs of the bodies or remains were taken systematically. No autopsy reports were provided to indicate, among other things, injury patterns and specific causes of death. The official report, for example, indicates that death resulted from injury to multiple organs as a result of the crash, which is superficial and unprofessional. There is a lack of information regarding toxicology tests. Tests for carboxyhemoglobin (carbon monoxide or CO) and cyanide on victims could have helped determine whether there was a fire on board prior to the crash or whether there were any survivors who inhaled these toxic materials from a fire after the crash.
The Polish weekly “W Sieci” reported results of blood tests done on four individuals, who perished on the 10th of April. These tests were done by the Russians themselves in the first days after the crash, at the request of Polish medical investigators. It is not clear whether carboxyhemoglobin levels were tested on all the victims however, tests results on three individuals, who were not smokers, showed elevations suggesting that these passengers may have survived the crash. The fourth person also had an elevated level but was known to be a smoker.
Cyanide is usually produced by incomplete combustion of materials, such as wood or plastic and is in the thick black smoke above flames. Nitrogen and carbon react together to produce cyanide.
Apart from the above-mentioned report, a question has arisen about the presence of TNT or other explosive devices. There was no mention in the report of any injuries that would typically be caused by explosions, such as lung injuries, penetration by shrapnel or burn marks. No microscopic examinations or chemical tests were reported if they were even done at all. The lack of such data on the victims neither refutes nor supports such a hypothesis.
The Russian report claims that there was no evidence of TNT however it does not provide specific information about what exactly was examined and by which method. This all the more, raises questions if not doubts in the face of independent tests which demonstrated that in fact there was TNT as well as 2,4 DNT if only in small samples. The question of whether an explosion occurred as a cause or a consequence of the crash is of such critical importance, that all relevant investigations should have been carried out and reported. These include clear descriptions of all bodies especially the condition of the skin. Descriptions of the degrees of burns, the position of bodies as well as body parts (with DNA identification) in relation to the location of any fires are all indispensable components of an investigation. In this case there is no mention of such examinations nor do we know to what extent if at all they were carried out.
There were 8 crew members in total, - aircrew - 4 men including the pilot in command and second pilot (co-pilot), navigator and engineer as well as a cabin crew of 4 women including a purser, a member of BOR* and 2 stewardesses.
The injury patterns of all of the crew members in the cockpit is not clearly described. Insufficient information has been provided to make a concise assessment regarding the extent and implication of their injuries. It seems that only their distal limb parts were x-rayed. There is no clear description of the injuries themselves; only an interpretation was provided.
For example, the report concluded that the left hand of the pilot in command was on the control column with a relatively slight grip, which, according to the report, is not typical in stressful situations. The report assumes that it was related to spatial disorientation of the pilot. Yet the pilot’s leg, in particular his right foot, was pressing on the right rudder to compensate for a left roll, and, according to the report, this is confirmed by the fixed stretched position of the right foot. In such circumstances the leg is pressing hard and the foot is not released. Consequently during a crash, the foot and leg bones are often fractured. Therefore, if the pilot was pressing on the right pedal, one would expect injuries to the right foot.
The report also mentions that the shoes were examined, but no information was given regarding any pedal imprint, as one might expect. The pattern of an injury can sometimes provide a great deal of information regarding impact. For example, in a crash the control column position may be imprinted on the chest of the pilot.
Likewise for the co-pilot, it is stated that he sustained injuries on the back of the hands and outer sides of both forearms, typical of slipping from the control column and hitting the control panel. As well, his right leg was positioned to reach the pedal with his right foot.
Regarding injuries sustained by the navigator and flight engineer, the report only states that on impact their injuries confirm that they were in their working seats fastened (the navigator behind and between the pilots’ seats, flight engineer on the right of the cockpit).
There is not much useful information provided concerning injuries suffered by the passengers. It is stated that some passengers were not buckled in their seat belts based on the lack of marks on their bodies; however, it is possible for passengers to be thrown forward along with their seats; in these cases a seat-belt injury would not be found. Correlations between the condition of bodies and their respective seats are lacking.
G-Forces are mentioned in several places in the report. These can only be estimates and there are too many factors involved in a crash sequence for G-Forces to be considered useful. In this report, G-Forces should be disregarded.
THE PSYCHOLOGICAL STATE OF THE CREW
Medical examinations following an air crash also include an analysis of the psychological state of the aircrew, particularly that of the pilot in command. The report includes psychological test results from the past and concludes that the pilot in command of Tupolev TU-154M was easily influenced, and had a weak character, which resulted in ignoring advice from the control tower not to land. Before such a conclusion can be drawn, the pilot’s behaviour should be reviewed under other circumstances, for example during stressful situations created in a flight simulator test. Interviews should take place with the pilot’s colleagues, commanders, with family and others in his environment. Furthermore, the state of mind preceding the day of the flight as well as on the actual day should be investigated. Only then, with all the information analyzed, can the appropriate conclusion be drawn. It seems that the authors of the report are making assumptions to fit their theories, which in any case lack cohesion and are not based on a complete set of key examinations.
MATERIALS NOT INCLUDED IN THE RUSSIAN REPORT
Apart from the information contained in the Russian report, there is some important additional information that merits attention and careful analysis. For example there is important information in a high resolution photo (Fig 1), which was not included in the Russian report. A close up of one part of the photo, strongly suggests that the crash victim received a bullet wound to the head. The photo was taken on April 10, 2010 at 1450 hr. with a Nikon Coolpix L20.
On the photograph we see one wound, which may be considered an entry wound and another one an exit wound with reddish material under it, which could possibly be brain matter and coagulated blood. In an area of about 2 cm surrounding the entry wound, there appears to be a slight discolouration, which may be powder residue. One can assume that the shot was fired at an angle, such that the circle is somewhat crescent shaped. The shape of the skull could also contribute to a more distinct appearance of the residue on one side. Of course, we do not know what weapon was used, the type of bullet, the distance or the angle from which it was fired. Therefore it is difficult to draw a firm conclusion. The photograph does not permit a conclusive statement, however the possibility that a bullet entered the head warrants examination and confirmation.
After analyzing an incomplete and at times superficial set of medical accounts in the official Russian report, one can conclude that the medical investigation was neither carried out nor reported properly. Routine total body xrays were not done; only a few lower extremities were xrayed. Based on the report, it is unclear how carefully the bodies were examined and there is a lack of correlation between the condition of each body and the state of their respective seats.
The hypothesis of an explosion can neither be confirmed nor excluded on the basis of the information contained in the report. Important, relevant analyses were either not done or not reported.
Elevated levels of carboxyhemoglobin found in some of the victims, suggest that some may have survived the crash, which might be expected in a low level crash.
The psychological state of the pilot is described on the basis of old reports and assumptions about his behaviour during the crash, without the inclusion of indispensable information from additional sources, while the behaviour and psychological state of the rest of the cabin crew is completely ignored.
The accounts of medical examinations in the report are insufficient. They are fragmentary and conclusions are drawn based on presumptions. We believe that given the circumstances of the crash, unresolved issues and unanswered questions, the remains of victims and the behaviour of the flight crew should be re-examined, advisably this time by an international commission of experts.
Information about the authors
Andreas Wielgosz MSc MD PhD is Professor of Medicine in Cardiology at the University of Ottawa and a Consultant to the Civil Aviation Medical Review Board, Transport Canada
François Dubé is a retired pathologist, former jet pilot and aircraft accident investigator, affiliated with the University of Ottawa and Transport Canada
The opinions expressed in this article are those of the authors and do not represent the opinions of either the University of Ottawa or Transport Canada.
* BOR (Biuro Ochrony Rzadu) is the Government Protection Bureau
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