Dear Editor,

We have recently read with great interest the article by Aslan et al., titled “Thermodynamic Assessment of the Causes of the Death of the People Under the Debris in an Earthquake.”Reference Aslan, Olgun and Yavuz ¹ We believe that this article provides valuable evidence-based data on understanding mortality among individuals trapped under rubble during earthquakes, and on identifying body positions that may help reduce the risk of death when facing the possibility of entrapment during such events.

To date, many official international search and rescue teams, emergency managers, researchers, and school safety advocates in the US and around the world continue to recommend the “Drop, Cover, and Hold On” position as the appropriate action to reduce injury and death during earthquakes. ² However, evidence-based research supporting the efficacy of this position remains limited in the literature. Recently, earthquake studies conducted with experienced medical search and rescue teams in Türkiye have suggested that the fetal position may be more beneficial, particularly in buildings with a high risk of collapse.Reference Celikmen, Yilmaz and Tatliparmak ^{3 –}Reference Yılmaz, Karakayali and Yilmaz ⁵

Türkiye has recently experienced a catastrophic earthquake that resulted in the loss of 53 000 lives. Thousands of individuals were trapped under rubble, many sustained severe injuries, and search and rescue operations continued for an extended period.

Advantages of the Fetal Position (within a Survival Triangle):

• • Although heat loss is higher in a lying position, reduced metabolic activity may aid energy conservation.

• • In a compact, curled posture with minimal surface contact (e.g., the fetal position), heat loss may be further minimized.

• • Higher survival rates in children are often associated with their smaller body surface area and better thermoregulation — advantages that may also apply to the compact nature of the fetal position.

• • Limited mobility in this position may reduce the risk of injury and restrict entropy production.

Advantages of the Drop-Cover-Hold Position:

• • This posture provides more mechanical protection, particularly for shielding the head and neck from falling objects within a collapsing structure.

• • Transitioning from a standing or seated position to a crouched state reduces body volume, though heat loss may be greater compared to the fetal position.

• • This technique is standardized in training and widely recognized, enhancing its applicability in panic situations.

Considering Environmental Factors (Cold Weather, Nighttime Conditions):

• • If heat loss is minimal (e.g., in summer), the choice of position may not be critical.

• • In cold environments (e.g., temperatures around 3°C), adopting a compact position that conserves energy could significantly improve survival.

• • The fetal position may support better thermal regulation and promote long-term survival under rubble.

  In conclusion, especially in buildings at risk of collapse, if the primary goal is to minimize heat and energy loss — particularly in cold weather conditions and scenarios involving prolonged entrapment — the fetal position within a survival triangle may offer a distinct survival advantage.