D.S. drafted manuscript; K.M. edited and revised manuscript; K.T. approved final version of manuscript.Since Virchow reported that stasis of blood flow is one of the risk factors for venous thromboembolism (VTE) in 1856, human beings have experienced venous thromboembolism resulting from immobility caused by unavoidable social circumstances.One representative case was in a subway shelter during the 1940 London air raid called “The Blitz.” At that time, because of the lack of air‐raid shelters in London, the narrow premises of the subway station became a spontaneous shelter, and the evacuees slept on a narrow subway platform. In 1941, Simpson reported that the number of deaths from pulmonary embolism at autopsy was six‐fold higher in 1940 than that in the previous year and appealed for the introduction of cots at evacuation centers.
Other examples include thrombosis after long travel, sleeping in a vehicle during a disaster, and eThrombosis in the COVID‐19 pandemic. We have already reviewed these concepts comprehensively.In the current war in Ukraine, many evacuees are sheltering on subway platforms (Figure 1). Thus, physicians must not disregard the incidence of shelter deaths from pulmonary embolism reported by Simpson 80 years ago.
FIGURE 1
Citizens sleeping while using a subway station as an air raid shelter (Credit: The Associated Press/AFLO with permission)
Citizens sleeping while using a subway station as an air raid shelter (Credit: The Associated Press/AFLO with permission)As physicians, it is our mission to think about what we can do to prevent shelter death. In the Kumamoto earthquakes of 2016, we performed mobile deep vein thrombosis screening using portable ultrasonography at evacuation centers and reported that in 1673 examinees, high age (≥70 years old), use of sleep medication, lower leg edema, and lower leg varix were significant predictors of deep vein thrombosis on multivariable logistic regression analysis.
Awareness by medical teams or public health workers and mass media approaches to education on venous thrombosis in sheltering situations may reduce the burden of venous thrombosis during wartime. The problem with this is that there are other serious priorities for such workers and in war there is often no power. Unfortunately, the effectiveness of such approaches is speculative. The only thing we can do is to convey the wisdom of our ancestors. Is it possible to use the experience of our ancestors?
FIGURE 1