Decontamination phosgene exposure

Quickly access for a victim airway, and ensure adequate respiration and pulse. If trauma is suspected, maintain cervical immobilization manually and apply cervical collar and a backboard if feasible. Victims should be kept warm and quiet as any activity subsequent to phosgene exposure may lead to death. If exposure levels are determined to be safe, decontamination should be conducted by personnel wearing a lower level of protection than that worn in the hot zone. If the exposure involved liquid phosgene, and the temperature is less than 47 degrees F., and the victim s clothing has been contaminated, remove and double-bag the clothing. 

Materials which have been exposed to phosgene may be decontaminated by exposure to air and, if necessary, washing with a io% solution of soda. ... 

Irrigate eyes with tepid water until pH returns to neutral and remains so for 30 min after irrigation is discontinued (Brodovsky et al, 2000). Time until decontamination after ocular exposure is important since phosgene oxime is absorbed within seconds. Corneal ulcers should be treated with atropine ophthahnics to prevent synechiae formation and other ophthahnics to aid in re-epithelialization (Brodovsky et al, 2000 Grant and Schuman, 1993). 

After completing decontamination, the only effective management consists of close observation for the development of respiratory distress and supportive care. There are no known antidotes for pulmonary agent exposure. Patients exposed to phosgene or diphosgene require monitoring for a minimum of 12h because of the possibility of delayed symptoms (2). Strict bed rest is essential for patients with mild and moderate exposmes, because any exertion, even minimal exertion, can shorten the clinical latent period and inaease the severity of respiratory symptoms (8). In symptomatic patients, physical activity can cause clinical deterioration and even death (8). Supportive care consists of managing secretions, bronchospasm, hypoxia, and pulmonary edema. 

Lewisite and phosgene oxime (GX) are also vesicants but are different from sulfur mustard and have never been used militarily. In liquid or vapor form they produce immediate pain and injury. Because of the immediate pain, the victims tend to run away from the exposure and immediately begin self-decontamination. 

Breathing phosgene causes pulmonary edema, which may be characterized by a delayed onset. Tbe onset of pulmonary edema is a function of both concentration and length of exposure. Typically exposure above 50 ppm-minutes can lead to pulmonary edema (67). Exposed persons must be removed immediately from the contaminated area and decontaminated. Rescue workers should wear self-contained breathing apparatus. Injured persons should not be allowed any physical activity, and a physician should be consulted immediately. It is advisable to keep an exposed individual under the observation of a physician for 6-24 h, depending on the circumstances of exposure. In some instances this can be accomplished at the plant medical facility, or the exposed individual may require hospitalization. 

The casualty must be removed from further exposure and decontaminated as soon as possible. Initial resuscitation may be needed with supplemental oxygen and airway maintenance. Clothing should be removed and skin irrigated with copious quantities of water. Overall treatment is similar to phosgene (p. 286-287). 

Appropriate PPE must be worn by members of emergency services treating casualties of phosgene oxime exposure. Inadequate decontamination may result in secondary cases from exposure to primary cases. 

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