Phosgene decontamination

Skin Contact Remove victim from the source immediately decontaminate the skin immediately by flushing with copious amounts of water to remove any phosgene oxime which has not yet reacted with tissue seek medical attention immediately. Ingestion Do not induce vomiting seek medical attention immediately. 

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. 

Phosgene oxime is the only member of this class. It is believed to have originated in the Soviet Union where it was a byproduct of research on insecticides for cockroaches. Exposed individuals should be decontaminated immediately and given medical attention. 

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). 

The animal should be bathed with copious amounts of water and a mild soap. Phosgene oxime reacts quickly with tissue and decontamination is not expected to be entirely effective after pain has been produced. Sodium hypochlorite (0.5%) or isotonic sodium bicarbonate can help neutralize phosgene oxime that has not yet reacted with tissue. Bums should be managed with topical silver sulfadiazine and systemic antibiotics as needed (Roberts, 1988). Horses and sheep should receive tetanus prophylaxis. Other species should be vaccinated on a case by case basis. 

Phosgene. Transient irritation (eyes, nose, throat, and sinus). Bronchospasm. Pulmonary edema. Apnea. Hypoxia Decontamination Wash away all residual liquid with copious water, remove clothing Symptomatic care ABCs, hydrate, positive pressure O2 for pulmonary edema Bronchospasm Beta-agonists (albuterol), corticosteroids INH/IV, furosemide contraindicated Hypoxia Oxygen... 

Chlorine and phosgene are two chemicals that can cause severe pulmonary toxicity due to pulmonary edema and direct damage to the lungs. Treatment involves decontamination and supportive care. Special care needs to be... 

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

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. 

Owing to the poor warning properties of the gas to the human senses, automatic continuous monitors equipped with alarm systems are recommended [36,1486,1893], and a detailed specification for such devices has been provided [1484]. Skin and eye contact with phosgene should be avoided, but contaminated clothing should be removed immediately and decontamination effected by washing. Emergency showers should be provided [1893] in any facility in which phosgene is stored, used or manufactured. 

Solutions of phosgene in water-immiscible solvents should be destroyed with ethanolic ammonia [1C121]. Decontamination of rubber tubing may be carried out by immersion into aqueous ammonia before disposal [1C121]. 

The casualty should be removed from the source of the phosgene. Rescue workers should wear adequate respiratory protection. Decontamination of casualties is not necessary. 

F. Chemical inactivation using alkalis is effective, whereas chlorinating is ineffective against phosgene oxide. The eyes should be flushed immediately using water or isotonic sodium bicarbonate solution if available. Physical decontamination of the skin using adsorbent powders, e.g., fullers earth, is advised. 

It must be remembered that triage refers to priority for medical or surgical care, not priority for decontamination. All chemical casualties require decontamination. One might argue that a casualty exposed to vapor from a volatile agent, such as cyanide or phosgene, or from some of the volatile nerve agents does not need to be decontaminated. However, one can seldom be certain that in a situation in which vapor and liquid both exist, some liquid is not also present on the casualty. 

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. 

Before starting laboratory work with phosgene, it is recommended that the individual is equipped with fresh-air breathing apparatus, a bottle of strong ammonia (or an alternative reagent) for leak testing, and a supply of 10% aqueous ammonia solution (or 15% sodium hydroxide solution) for decontamination purposes [Ij. 

Some have suggested that phosgene played a role. Considering that the MIC had already been produced long before the incident, and that phosgene was not in use at the time, makes this less likely. However, it is possible that phosgene was present in limited amounts as a decontaminant, or in side reactions with MIC and water. 

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