Phosgene exposures

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. 

Diller and Zante (1982) performed an extensive literature review concerning human phosgene exposure, and found that a great majority of data were... 

TABLE 1-3 Effect of Phosgene Exposure in Healthy Humans... 

In their literature review, Diller and Zante (1982) also identified nonlethal effects from phosgene exposure (lethal effects are described in Section 2.1). Nonlethal information synthesized from this review is presented in Table 1-4. From the above data and from animal data for initial lung damage, Diller and Zante (1982) synthesized information for nonlethal effects of phosgene in humans (Table 1-5). 

TABLE 1-4 Acute Irritative Effects of Phosgene Exposure in Humans... 

In another report, Sandall (1922) examined 83 British soldiers 3 y after phosgene exposure. Shortness of breath upon exertion (70%), cough with expectoration (54%), tight feeling in chest (25%), sporadic giddiness (14%), and nausea (12%) were the most frequently reported complaints. No physical lung abnormalities were noted in 53% of the men. 

The concept of a death product was introduced by Haber to explain the relationship between the extent of exposure to phosgene and death (Haber 1924). According to Haber s law, the biological effect of phosgene is directly proportional to the exposure, expressed as the product of the atmospheric concentration (C) and the time of exposure (T), or CT=k, where k can be death, pulmonary edema, or other biological effects of phosgene exposure (EPA 1986). Haber s law has subsequently been shown by other investigators to be valid for both nonlethal and lethal effects within certain limits. 

For example, Rinehart (1962) and Rinehart and Hatch (1964) showed that the CT product appears to be a valid way to express pulmonary irritation due to phosgene exposure in rats. This is based on the finding of equal degrees of respiratory response, as measured by reduction in pulmonary gas exchange... 

Currie, W.D., Hatch, G.E., and Frosolono, M.F. 1987b. Changes in lung ATP concentration in the rat after low-level phosgene exposure. J. Biol. Toxicol. 2 105-114. 

Diller, W.F., Bruch, J., and Dehnen, W. 1985. Pulmonary changes in the rats following low phosgene exposure. Arch. Toxicol. 57 184—190. 

Regan, R.A. 1985. Review of clinical experience in handling phosgene exposure cases. Toxicol. Ind. Health. 1 69-71. 

Selgrade, M.K., Starnes, D.M., Illing, J.W., Daniels, M.J., and Graham, J.A. 1989. Effects of phosgene exposure on bacterial, viral, and neoplastic lung disease susceptability in mice. Inhalation Toxicol. 1 243-259. 

Cucinell SA Review of the toxicity of longterm phosgene exposure. Arch Environ Health 28 272-275, 1974... 

Borak, J., Diller, W.F. (2001). Phosgene exposure mechanisms of injury and treatment strategies. J. Occup. Environ. Med. 43 110-19. 

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