Registration Dossier
Registration Dossier
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The new ECHA CHEM database has been released by ECHA, and it now contains all REACH registration data. There are more details on the transition of ECHA's published data to ECHA CHEM here.
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EC number: 200-870-3 | CAS number: 75-44-5
Guidance on Safe Use
Guidance on Safe Use
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Administrative data
First-aid measures
General advice:
Remove victims from the danger zone without endangering your own safety.
Remove soaked or gas-contaminated clothing immediately (including underwear and shoes).
If inhaled:
Bring accident victims out into the fresh air. Dexamethason spray must be inhaled as
soon as possible. If patient has difficulty in breathing, administer oxygen, keep the patient calm
and warm. In case of cessation of breathing resuscitation by mouth-to-mouth breathing. Call a
physician immediately.
In case of skin contact:
After contact with skin, wash immediately with plenty of soap and
water. Apply protective bandage with sterile gauze. Call a doctor.
In case of eye contact:
Hold the eyes open and rinse with preferably lukewarm water for a
sufficiently long period of time (at least 10 minutes). Contact an ophthalmologist.
If swallowed:
If accidentally swallowed obtain immediate medical attention.
Therapeutic measures:
Basic first aid, decontamination, symptomatic treatment. Pulmonary
oedema are possible, but may not appear until up to a few hours.
Acute Exposure
Phosgene directly reacts with amine, sulfhydryl, and alcohol groups in cells, thereby adversely affecting cell macromolecules and cell metabolism. Direct toxicity to the cells leads to an increase in capillary permeability, resulting in large shifts of body fluid, decreasing plasma volume. In addition, when phosgene hydrolyzes, it forms hydrochloric acid, which can also damage surface cells and cause cell death in the alveoli and bronchioles. Hydrochloric acid release into the mucosa triggers a systemic inflammatory response. Phosgene stimulates the synthesis of lipoxygenase-derived leukotrienes, which attract neutrophils and causes their massive accumulation in the lungs; this contributes to the development of pulmonary edema. Following phosgene exposure, a patient may be free of symptoms for 30 minutes to 48 hours before respiratory damage becomes evident; the more severe the exposure, the shorter the latency. If the initial concentration of phosgene was high, rapid onset of direct cytotoxicity and enzymatic poisoning may ensue. Because phosgene is not very water soluble and hydrolysis tends to be slow, victims inhaling low concentrations of the gas may experience no irritation or only mild irritation of the upper airway. Lack of irritation allows victims to inhale the gas more deeply into the lungs and for prolonged periods.
Children do not always respond to chemicals in the same way that adults do. Different protocols for managing their care may be needed.
Respiratory
Inhaling low concentrations of phosgene may cause no signs or symptoms initially, or symptoms may be due only to mild irritation of the airways; these symptoms (dryness and burning of the throat and cough) may cease when the patient is removed from exposure. However, after an asymptomatic interval of 30 minutes to 48 hours, in those developing severe pulmonary damage, progressive pulmonary edema develops rapidly with shallow rapid respiration, cyanosis, and a painful paroxysmal cough producing large amounts of frothy white or yellowish liquid. Inadequate, labored respiration, during which abnormal chest sounds are evident, may be accompanied by increased distress and apprehension. Insufficient oxygenation of arterial blood, and massive accumulation of fluid in the lungs may be accompanied by cardiovascular and hematological signs.
Exposure to phosgene has been reported to result in Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma. Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways. Children may also be more vulnerable because of increased minute ventilation per kg and failure to evacuate an area promptly when exposed.
Cardiovascular
Cardiovascular collapse may occur if the patient is severely hypovolemic and hypoxemic from accumulation of fluid in the lungs. Destruction of red blood cells in the pulmonary circulation can cause capillary plugging that leads to strain on the right side of the heart and death.
Dermal
If the skin is wet or moist, contact with phosgene vapor can cause irritation and redness of the skin. Contact with liquid phosgene under pressure can result in frostbite. Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Ocular
High vapor concentrations cause tearing and increased presence of blood in the eye. Contact with liquid phosgene may result in clouding of the cornea and delayed perforation.
Hematologic
In severe cases, phosgene may cause hemolysis that results in the plugging of pulmonary capillaries. Most hematologic changes (e.g., hemolysis, methemoglobinemia, bone marrow suppression, and anemia) can be detected by standard blood tests.
Hepatic
In cases of high exposures, phosgene may be directly cytotoxic to the liver, causing necrosis and loss of function.
Renal
In cases of high exposures, phosgene may be directly cytotoxic to the kidneys, causing necrosis and loss of function.
Gastrointestinal
Nausea and vomiting may occur following exposure to phosgene.
Potential Sequelae
If the patient survives the initial 48 hours after exposure, recovery is likely. Sensitivity to irritants may persist, causing bronchospasm and chronic inflammation of the bronchioles. Pulmonary tissue destruction and scarring may lead to chronic dilation of the bronchi, lobular emphysema, regions of atelectasis, and increased susceptibility to infection.
Exposure to phosgene has been reported to result in Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma.
Chronic Exposure
A group of workers who were exposed daily to high levels of phosgene showed an increase in mortality and morbidity from inflammation of the lungs, chronic inflammation of the bronchioles, destruction of alveoli, and impaired pulmonary function. Chronic exposures to low levels of phosgene may lead to chronic pneumonitis, which may resolve or lead to pulmonary edema. Chronic exposure may be more serious for children because of their potential longer latency period.
Carcinogenicity
Phosgene has not been classified for carcinogenic effects.
Reproductive and Developmental Effects
No information was found pertaining to reproductive or developmental hazards caused by phosgene exposure. Phosgene is not included in Reproductive and Developmental Toxicants, a 1991 report published by the U.S. General Accounting Office (GAO) that lists 30 chemicals of concern because of widely acknowledged reproductive and developmental consequences.
Prehospital Management
Hot Zone
Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained in its use, assistance should be obtained from a local or regional HAZMAT team or other properly equipped response organization.
Rescuer Protection
Phosgene is a severe respiratory tract irritant and skin irritant; contact with the liquid will cause frostbite.
Respiratory Protection: Positive-pressure-demand, self-contained breathing apparatus (SCBA) is recommended in response situations that involve exposure to potentially unsafe levels of phosgene.
Skin Protection: Chemical-protective clothing is recommended because phosgene gas can cause skin irritation and burns. NIOSH recommends protective suites made from Responder™ (Kappler Co.), Tychem 10000™ (DuPont Co.), or Teflon™ (DuPont Co.).
ABC Reminders
Quickly access for a patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available, carefully carry or drag victims to safety.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
Consider appropriate management of chemically contaminated children, such as measures to reduce separation anxiety if a child is separated from a parent or other adult.
Victims exposed only to phosgene gas who have no evidence of skin or eye irritation may be transferred immediately to the Support Zone. Other patients will require decontamination as described below.
If exposure levels are determined to be safe, decontamination may be conducted by personnel wearing a lower level of protection than that worn in the Hot Zone (described above).
Quickly access for a patent airway, ensure adequate respiration and pulse. Stabilize the cervical spine with a collar and a backboard if trauma is suspected. Administer supplemental oxygen as required. Assist ventilation with a bag-valve-mask device if necessary.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
Victims who are able may assist with their own decontamination. If the exposure involved liquid phosgene (ambient temperature below 47 EF [8 EC]) and if clothing is contaminated, remove and double-bag the clothing.
Flush exposed skin and hair with plain water for 3 to 5 minutes. Wash thoroughly with soap and water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.
Flush exposed or irritated eyes with plain water or saline for at least 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue irrigation while transferring the victim to the Support Zone.
Consider appropriate management of chemically contaminated children at the exposure site. Provide reassurance to the child during decontamination, especially if separation from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete, move the victim to the Support Zone.
Be certain that victims have been decontaminated properly (see Decontamination Zone above). Victims who have undergone decontamination or have been exposed only to phosgene gas generally pose no serious risks of secondary contamination. In such cases, Support Zone personnel require no specialized protective gear.
Quickly access for a patent airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Ensure adequate respiration and pulse. Administer supplemental oxygen as required and establish intravenous access if necessary. Place on a cardiac monitor. Watch for signs of airway swelling and obstruction such as progressive hoarseness, stridor, or cyanosis.
Continue irrigating exposed skin and eyes, as appropriate.
In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, perform cricothyroidotomy if equipped and trained to do so.
Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive, or are having seizures or cardiac arrhythmias should be treated according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or patients not requiring decontamination should be transported to a medical facility. “Body bags” are not recommended.
Report to the base station and the receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility.
Multi-Casualty Triage
Consult with the base station physician or the regional poison control center for advice regarding triage of multiple victims.
Phosgene has relatively little odor or irritating effects at moderately toxic air concentrations; serious health effects may occur without warning or symptoms. Because serious complications may be delayed up to 48 hours after exposure, all patients who have suspected phosgene exposure should be transported to a medical facility for evaluation.
Emergency Department Management
Decontamination Area
Unless previously decontaminated, all patients suspected of contact with phosgene liquid and all victims with skin or eye irritation require decontamination as described below. Because contact with liquid phosgene may cause burns, don butyl rubber gloves and apron and eye protection before treating patients. All other patients may be transferred immediately to the Critical Care Area.
Be aware that use of protective equipment by the provider may cause fear in children, resulting in decreased compliance with further management efforts.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin. Also, emergency room personnel should examine children’s mouths because of the frequency of hand-to-mouth activity among children.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
ABC Reminders
Evaluate and support airway, breathing, and circulation. Children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, surgically create an airway.
Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive, or have seizures or ventricular arrhythmias or renal failure should be treated in the conventional manner.
Victims who are able may assist with their own decontamination. If the exposure involved liquid phosgene (ambient temperature below 47EF [8 EC]) and if clothing is contaminated, remove and double-bag the clothing.
Flush exposed skin and hair with plain water for 3 to 5 minutes. Wash thoroughly with soap and water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.
Flush exposed or irritated eyes with plain water or saline for at least 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue eye irrigation while transferring the patient to the Critical Care Area.
An ophthalmic anesthetic, such as 0.5% tetracaine, may be necessary to alleviate blepharospasm, and lid retractors may be required to allow adequate irrigation under the eyelids.
Be certain that appropriate decontamination has been carried out (see Decontamination Area above).
Evaluate and support airway, breathing, and circulation as in ABC Reminders above. Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways. Establish intravenous access in seriously ill patients if this has not been done previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive, or have seizures or cardiac arrhythmias should be treated in the conventional manner.
Administer supplemental oxygen by mask to patients who have respiratory complaints. Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Observe patients who are in respiratory distress for up to 48 hours and periodically reexamine their chests and order other appropriate studies. Follow up as clinically indicated.
Corticosteroids are suggested for intense inflammation, especially inflammation of the respiratory epithelium. If the patient experienced severe exposure, consider initiating intravenous steroid therapy while the patient is asymptomatic.
Prophylactic antibiotics are not routinely recommended but may be used based on the results of sputum cultures. Pneumonia can complicate severe pulmonary edema and may cause death up to 48 hours after onset of pulmonary edema.
Diuretics are contraindicated. Pulmonary edema due to phosgene inhalation is not hypervolemic in origin; patients tend to be hypovolemic and hypotensive. Dopamine may be required for treatment of hypotension, bradycardia, or renal failure. Initiate fluid resuscitation as needed.
If phosgene was in contact with the skin, chemical burns may result; treat as thermal burns.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Continue irrigation for at least 15 minutes. Test visual acuity. Examine the eyes for corneal damage and treat appropriately. Immediately consult an ophthalmologist for patients who have corneal injuries.
There is no antidote for phosgene. Treatment is supportive.
The diagnosis of acute phosgene toxicity is primarily clinical, based on symptoms of irritation and breathing difficulty. However, laboratory testing is useful for monitoring the patient and evaluating complications. Routine laboratory studies for all exposed patients include CBC, glucose, and electrolyte determinations. ECG monitoring is useful for patients exposed to phosgene. Chest radiography and pulse oximetry (or ABG measurements) are also recommended for severe inhalation exposure. Evidence of pulmonary edema—hilar enlargement, and ill-defined, central-patch infiltrates on chest radiography—is a late finding that may occur 6 to 8 hours after exposure.
Plasma phosgene levels are not clinically useful.
Consider hospitalizing all patients who have suspected phosgene exposure. Patients who have respiratory compromise should be admitted to an intensive care unit.
Because pulmonary edema may not occur for up to 48 hours after exposure, patients who have known exposure should be observed and reexamined periodically before confirming the absence of toxic effects. Patients who have bronchospasm or pulmonary edema should be watched carefully for signs of impending respiratory failure and should be managed accordingly. Patients who survive for 48 hours usually recover.
Asymptomatic patients who have normal initial examinations and no signs of toxicity after observation for 48 hours may be discharged with instructions to seek medical care promptly if symptoms develop (see the Phosgene—Patient Information Sheet below).
Obtain the name of the patient’s primary care physician so that the hospital can send a copy of the ED visit to the patient’s doctor.
Patients may have long term damage to the lungs and increased susceptibility to infection. Sensitivity to irritants may persist, causing bronchospasm, chronic inflammation of the bronchioles and
Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma.
Patients who have corneal injuries should be reexamined in 24 hours.
Reporting If a work-related incident has occurred, you may be legally required to file a report; contact your state or local health department.
Other persons may still be at risk in the setting where this incident occurred. If the incident occurred in the workplace, discussing it with company personnel may prevent future incidents. If a public health risk exists, notify your state or local health department or other responsible public agency. When appropriate, inform patients that they may request an evaluation of their workplace from OSHA or NIOSH. See Appendices III and IV for a list of agencies that may be of assistance.
Remove victims from the danger zone without endangering your own safety.
Remove soaked or gas-contaminated clothing immediately (including underwear and shoes).
If inhaled:
Bring accident victims out into the fresh air. Dexamethason spray must be inhaled as
soon as possible. If patient has difficulty in breathing, administer oxygen, keep the patient calm
and warm. In case of cessation of breathing resuscitation by mouth-to-mouth breathing. Call a
physician immediately.
In case of skin contact:
After contact with skin, wash immediately with plenty of soap and
water. Apply protective bandage with sterile gauze. Call a doctor.
In case of eye contact:
Hold the eyes open and rinse with preferably lukewarm water for a
sufficiently long period of time (at least 10 minutes). Contact an ophthalmologist.
If swallowed:
If accidentally swallowed obtain immediate medical attention.
Therapeutic measures:
Basic first aid, decontamination, symptomatic treatment. Pulmonary
oedema are possible, but may not appear until up to a few hours.
Acute Exposure
Phosgene directly reacts with amine, sulfhydryl, and alcohol groups in cells, thereby adversely affecting cell macromolecules and cell metabolism. Direct toxicity to the cells leads to an increase in capillary permeability, resulting in large shifts of body fluid, decreasing plasma volume. In addition, when phosgene hydrolyzes, it forms hydrochloric acid, which can also damage surface cells and cause cell death in the alveoli and bronchioles. Hydrochloric acid release into the mucosa triggers a systemic inflammatory response. Phosgene stimulates the synthesis of lipoxygenase-derived leukotrienes, which attract neutrophils and causes their massive accumulation in the lungs; this contributes to the development of pulmonary edema. Following phosgene exposure, a patient may be free of symptoms for 30 minutes to 48 hours before respiratory damage becomes evident; the more severe the exposure, the shorter the latency. If the initial concentration of phosgene was high, rapid onset of direct cytotoxicity and enzymatic poisoning may ensue. Because phosgene is not very water soluble and hydrolysis tends to be slow, victims inhaling low concentrations of the gas may experience no irritation or only mild irritation of the upper airway. Lack of irritation allows victims to inhale the gas more deeply into the lungs and for prolonged periods.
Children do not always respond to chemicals in the same way that adults do. Different protocols for managing their care may be needed.
Respiratory
Inhaling low concentrations of phosgene may cause no signs or symptoms initially, or symptoms may be due only to mild irritation of the airways; these symptoms (dryness and burning of the throat and cough) may cease when the patient is removed from exposure. However, after an asymptomatic interval of 30 minutes to 48 hours, in those developing severe pulmonary damage, progressive pulmonary edema develops rapidly with shallow rapid respiration, cyanosis, and a painful paroxysmal cough producing large amounts of frothy white or yellowish liquid. Inadequate, labored respiration, during which abnormal chest sounds are evident, may be accompanied by increased distress and apprehension. Insufficient oxygenation of arterial blood, and massive accumulation of fluid in the lungs may be accompanied by cardiovascular and hematological signs.
Exposure to phosgene has been reported to result in Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma. Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways. Children may also be more vulnerable because of increased minute ventilation per kg and failure to evacuate an area promptly when exposed.
Cardiovascular
Cardiovascular collapse may occur if the patient is severely hypovolemic and hypoxemic from accumulation of fluid in the lungs. Destruction of red blood cells in the pulmonary circulation can cause capillary plugging that leads to strain on the right side of the heart and death.
Dermal
If the skin is wet or moist, contact with phosgene vapor can cause irritation and redness of the skin. Contact with liquid phosgene under pressure can result in frostbite. Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Ocular
High vapor concentrations cause tearing and increased presence of blood in the eye. Contact with liquid phosgene may result in clouding of the cornea and delayed perforation.
Hematologic
In severe cases, phosgene may cause hemolysis that results in the plugging of pulmonary capillaries. Most hematologic changes (e.g., hemolysis, methemoglobinemia, bone marrow suppression, and anemia) can be detected by standard blood tests.
Hepatic
In cases of high exposures, phosgene may be directly cytotoxic to the liver, causing necrosis and loss of function.
Renal
In cases of high exposures, phosgene may be directly cytotoxic to the kidneys, causing necrosis and loss of function.
Gastrointestinal
Nausea and vomiting may occur following exposure to phosgene.
Potential Sequelae
If the patient survives the initial 48 hours after exposure, recovery is likely. Sensitivity to irritants may persist, causing bronchospasm and chronic inflammation of the bronchioles. Pulmonary tissue destruction and scarring may lead to chronic dilation of the bronchi, lobular emphysema, regions of atelectasis, and increased susceptibility to infection.
Exposure to phosgene has been reported to result in Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma.
Chronic Exposure
A group of workers who were exposed daily to high levels of phosgene showed an increase in mortality and morbidity from inflammation of the lungs, chronic inflammation of the bronchioles, destruction of alveoli, and impaired pulmonary function. Chronic exposures to low levels of phosgene may lead to chronic pneumonitis, which may resolve or lead to pulmonary edema. Chronic exposure may be more serious for children because of their potential longer latency period.
Carcinogenicity
Phosgene has not been classified for carcinogenic effects.
Reproductive and Developmental Effects
No information was found pertaining to reproductive or developmental hazards caused by phosgene exposure. Phosgene is not included in Reproductive and Developmental Toxicants, a 1991 report published by the U.S. General Accounting Office (GAO) that lists 30 chemicals of concern because of widely acknowledged reproductive and developmental consequences.
Prehospital Management
Hot Zone
Rescuers should be trained and appropriately attired before entering the Hot Zone. If the proper equipment is not available, or if rescuers have not been trained in its use, assistance should be obtained from a local or regional HAZMAT team or other properly equipped response organization.
Rescuer Protection
Phosgene is a severe respiratory tract irritant and skin irritant; contact with the liquid will cause frostbite.
Respiratory Protection: Positive-pressure-demand, self-contained breathing apparatus (SCBA) is recommended in response situations that involve exposure to potentially unsafe levels of phosgene.
Skin Protection: Chemical-protective clothing is recommended because phosgene gas can cause skin irritation and burns. NIOSH recommends protective suites made from Responder™ (Kappler Co.), Tychem 10000™ (DuPont Co.), or Teflon™ (DuPont Co.).
ABC Reminders
Quickly access for a patent airway, ensure adequate respiration and pulse. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible.
Victim Removal
If victims can walk, lead them out of the Hot Zone to the Decontamination Zone. Victims who are unable to walk may be removed on backboards or gurneys; if these are not available, carefully carry or drag victims to safety.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
Consider appropriate management of chemically contaminated children, such as measures to reduce separation anxiety if a child is separated from a parent or other adult.
Victims exposed only to phosgene gas who have no evidence of skin or eye irritation may be transferred immediately to the Support Zone. Other patients will require decontamination as described below.
If exposure levels are determined to be safe, decontamination may be conducted by personnel wearing a lower level of protection than that worn in the Hot Zone (described above).
Quickly access for a patent airway, ensure adequate respiration and pulse. Stabilize the cervical spine with a collar and a backboard if trauma is suspected. Administer supplemental oxygen as required. Assist ventilation with a bag-valve-mask device if necessary.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
Victims who are able may assist with their own decontamination. If the exposure involved liquid phosgene (ambient temperature below 47 EF [8 EC]) and if clothing is contaminated, remove and double-bag the clothing.
Flush exposed skin and hair with plain water for 3 to 5 minutes. Wash thoroughly with soap and water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.
Flush exposed or irritated eyes with plain water or saline for at least 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue irrigation while transferring the victim to the Support Zone.
Consider appropriate management of chemically contaminated children at the exposure site. Provide reassurance to the child during decontamination, especially if separation from a parent occurs.
Transfer to Support Zone
As soon as basic decontamination is complete, move the victim to the Support Zone.
Be certain that victims have been decontaminated properly (see Decontamination Zone above). Victims who have undergone decontamination or have been exposed only to phosgene gas generally pose no serious risks of secondary contamination. In such cases, Support Zone personnel require no specialized protective gear.
Quickly access for a patent airway. If trauma is suspected, maintain cervical immobilization manually and apply a cervical collar and a backboard when feasible. Ensure adequate respiration and pulse. Administer supplemental oxygen as required and establish intravenous access if necessary. Place on a cardiac monitor. Watch for signs of airway swelling and obstruction such as progressive hoarseness, stridor, or cyanosis.
Continue irrigating exposed skin and eyes, as appropriate.
In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, perform cricothyroidotomy if equipped and trained to do so.
Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive, or are having seizures or cardiac arrhythmias should be treated according to advanced life support (ALS) protocols.
Transport to Medical Facility
Only decontaminated patients or patients not requiring decontamination should be transported to a medical facility. “Body bags” are not recommended.
Report to the base station and the receiving medical facility the condition of the patient, treatment given, and estimated time of arrival at the medical facility.
Multi-Casualty Triage
Consult with the base station physician or the regional poison control center for advice regarding triage of multiple victims.
Phosgene has relatively little odor or irritating effects at moderately toxic air concentrations; serious health effects may occur without warning or symptoms. Because serious complications may be delayed up to 48 hours after exposure, all patients who have suspected phosgene exposure should be transported to a medical facility for evaluation.
Emergency Department Management
Decontamination Area
Unless previously decontaminated, all patients suspected of contact with phosgene liquid and all victims with skin or eye irritation require decontamination as described below. Because contact with liquid phosgene may cause burns, don butyl rubber gloves and apron and eye protection before treating patients. All other patients may be transferred immediately to the Critical Care Area.
Be aware that use of protective equipment by the provider may cause fear in children, resulting in decreased compliance with further management efforts.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin. Also, emergency room personnel should examine children’s mouths because of the frequency of hand-to-mouth activity among children.
Victims should be kept warm and quiet; any activity subsequent to exposure may increase the likelihood of death.
ABC Reminders
Evaluate and support airway, breathing, and circulation. Children may be more vulnerable to corrosive agents than adults because of the smaller diameter of their airways. In cases of respiratory compromise secure airway and respiration via endotracheal intubation. If not possible, surgically create an airway.
Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Patients who are comatose, hypotensive, or have seizures or ventricular arrhythmias or renal failure should be treated in the conventional manner.
Victims who are able may assist with their own decontamination. If the exposure involved liquid phosgene (ambient temperature below 47EF [8 EC]) and if clothing is contaminated, remove and double-bag the clothing.
Flush exposed skin and hair with plain water for 3 to 5 minutes. Wash thoroughly with soap and water. Use caution to avoid hypothermia when decontaminating children or the elderly. Use blankets or warmers when appropriate.
Flush exposed or irritated eyes with plain water or saline for at least 15 minutes. Remove contact lenses if easily removable without additional trauma to the eye. If a corrosive material is suspected or if pain or injury is evident, continue eye irrigation while transferring the patient to the Critical Care Area.
An ophthalmic anesthetic, such as 0.5% tetracaine, may be necessary to alleviate blepharospasm, and lid retractors may be required to allow adequate irrigation under the eyelids.
Be certain that appropriate decontamination has been carried out (see Decontamination Area above).
Evaluate and support airway, breathing, and circulation as in ABC Reminders above. Children may be more vulnerable to corrosive agents than adults because of the relatively smaller diameter of their airways. Establish intravenous access in seriously ill patients if this has not been done previously. Continuously monitor cardiac rhythm.
Patients who are comatose, hypotensive, or have seizures or cardiac arrhythmias should be treated in the conventional manner.
Administer supplemental oxygen by mask to patients who have respiratory complaints. Treat patients who have bronchospasm with aerosolized bronchodilators. The use of bronchial sensitizing agents in situations of multiple chemical exposures may pose additional risks. Consider the health of the myocardium before choosing which type of bronchodilator should be administered. Cardiac sensitizing agents may be appropriate; however, the use of cardiac sensitizing agents after exposure to certain chemicals may pose enhanced risk of cardiac arrhythmias (especially in the elderly). Phosgene poisoning is not known to pose additional risk during the use of bronchial or cardiac sensitizing agents.
Consider racemic epinephrine aerosol for children who develop stridor. Dose 0.25–0.75 mL of 2.25% racemic epinephrine solution in 2.5 cc water, repeat every 20 minutes as needed, cautioning for myocardial variability.
Observe patients who are in respiratory distress for up to 48 hours and periodically reexamine their chests and order other appropriate studies. Follow up as clinically indicated.
Corticosteroids are suggested for intense inflammation, especially inflammation of the respiratory epithelium. If the patient experienced severe exposure, consider initiating intravenous steroid therapy while the patient is asymptomatic.
Prophylactic antibiotics are not routinely recommended but may be used based on the results of sputum cultures. Pneumonia can complicate severe pulmonary edema and may cause death up to 48 hours after onset of pulmonary edema.
Diuretics are contraindicated. Pulmonary edema due to phosgene inhalation is not hypervolemic in origin; patients tend to be hypovolemic and hypotensive. Dopamine may be required for treatment of hypotension, bradycardia, or renal failure. Initiate fluid resuscitation as needed.
If phosgene was in contact with the skin, chemical burns may result; treat as thermal burns.
Because of their relatively larger surface area:body weight ratio, children are more vulnerable to toxicants affecting the skin.
Continue irrigation for at least 15 minutes. Test visual acuity. Examine the eyes for corneal damage and treat appropriately. Immediately consult an ophthalmologist for patients who have corneal injuries.
There is no antidote for phosgene. Treatment is supportive.
The diagnosis of acute phosgene toxicity is primarily clinical, based on symptoms of irritation and breathing difficulty. However, laboratory testing is useful for monitoring the patient and evaluating complications. Routine laboratory studies for all exposed patients include CBC, glucose, and electrolyte determinations. ECG monitoring is useful for patients exposed to phosgene. Chest radiography and pulse oximetry (or ABG measurements) are also recommended for severe inhalation exposure. Evidence of pulmonary edema—hilar enlargement, and ill-defined, central-patch infiltrates on chest radiography—is a late finding that may occur 6 to 8 hours after exposure.
Plasma phosgene levels are not clinically useful.
Consider hospitalizing all patients who have suspected phosgene exposure. Patients who have respiratory compromise should be admitted to an intensive care unit.
Because pulmonary edema may not occur for up to 48 hours after exposure, patients who have known exposure should be observed and reexamined periodically before confirming the absence of toxic effects. Patients who have bronchospasm or pulmonary edema should be watched carefully for signs of impending respiratory failure and should be managed accordingly. Patients who survive for 48 hours usually recover.
Asymptomatic patients who have normal initial examinations and no signs of toxicity after observation for 48 hours may be discharged with instructions to seek medical care promptly if symptoms develop (see the Phosgene—Patient Information Sheet below).
Obtain the name of the patient’s primary care physician so that the hospital can send a copy of the ED visit to the patient’s doctor.
Patients may have long term damage to the lungs and increased susceptibility to infection. Sensitivity to irritants may persist, causing bronchospasm, chronic inflammation of the bronchioles and
Reactive Airway Dysfunction Syndrome (RADS), a chemically- or irritant-induced type of asthma.
Patients who have corneal injuries should be reexamined in 24 hours.
Reporting If a work-related incident has occurred, you may be legally required to file a report; contact your state or local health department.
Other persons may still be at risk in the setting where this incident occurred. If the incident occurred in the workplace, discussing it with company personnel may prevent future incidents. If a public health risk exists, notify your state or local health department or other responsible public agency. When appropriate, inform patients that they may request an evaluation of their workplace from OSHA or NIOSH. See Appendices III and IV for a list of agencies that may be of assistance.
Fire-fighting measures
Suitable extinguishing media:
Use extinguishing measures that are appropriate to local
circumstances and the surrounding environment.
In the event of fire and/or explosion do not breathe fumes.
Firemen must wear self-contained breathing apparatus.
Fight fire in early stages if safe to do so. Cool undamaged containers or piping with water. Do not
allow contaminated extinguishing water to enter the soil, ground-water or surface waters.
Use extinguishing measures that are appropriate to local
circumstances and the surrounding environment.
In the event of fire and/or explosion do not breathe fumes.
Firemen must wear self-contained breathing apparatus.
Fight fire in early stages if safe to do so. Cool undamaged containers or piping with water. Do not
allow contaminated extinguishing water to enter the soil, ground-water or surface waters.
Accidental release measures
Personal precautions:
Initiate a gas alarm if product escapes; don self-contained respiratory protection for emissions control measures. Put on protective equipment (see below). Ensure adequate ventilation/exhaust extraction. Keep unauthorized persons away.
Stop the escape of gas if possible to do so safely. Use water spray to condense leaked gas.
Environmental precautions:
Do not flush into surface water or sanitary sewer system.
Initiate a gas alarm if product escapes; don self-contained respiratory protection for emissions control measures. Put on protective equipment (see below). Ensure adequate ventilation/exhaust extraction. Keep unauthorized persons away.
Stop the escape of gas if possible to do so safely. Use water spray to condense leaked gas.
Environmental precautions:
Do not flush into surface water or sanitary sewer system.
Handling and storage
Handling:
Handle in closed, grounded apparatus. Ensure proper ventilation and including at floor level.
Make sure all pipelines, tanks and equipment are leakproof. Transport only possible in
pressurized containers. Protect valves with protective caps during transport. Do not throw
containers.
Protection against fire and explosion: The product is not flammable.
Storage:
Keep container dry and tightly closed in a cool and well ventilated place.
Protect against heat and direct sunlight.
Keep locked up.
Handle in closed, grounded apparatus. Ensure proper ventilation and including at floor level.
Make sure all pipelines, tanks and equipment are leakproof. Transport only possible in
pressurized containers. Protect valves with protective caps during transport. Do not throw
containers.
Protection against fire and explosion: The product is not flammable.
Storage:
Keep container dry and tightly closed in a cool and well ventilated place.
Protect against heat and direct sunlight.
Keep locked up.
Transport information
Land transport (UN RTDG/ADR/RID)
- UN number:
- 1076
Shippingopen allclose all
SpecialProvisionsopen allclose all
Inland waterway transport (UN RTDG/ADN(R))
- UN number:
- 1076
Shippingopen allclose all
Remarksopen allclose all
Marine transport (UN RTDG/IMDG)
- UN number:
- 1076
Shipping information
- Proper shipping name and description:
- PHOSGENE
- Chemical name:
- -
- Labels:
- 2.3 (8)
Remarksopen allclose all
Air transport (UN RTDG/ICAO/IATA)
- UN number:
- -
Shipping information
- Proper shipping name and description:
- -
- Chemical name:
- -
- Labels:
- -
Special provisions / remarks
- Remarks:
- Air transport is not permitted
SpecialProvisionsopen allclose all
Exposure controls / personal protection
Apply technical measures to comply with the occupational exposure limits.
For technical protective measures to limit exposure see also "Handling and storage".
Respiratory protection:
If vapors are released, use a filtered respirator with a combination filter to DIN EN 141 B2-PS as an escape apparatus. A respirator with an independent air supply must be worn when working with the product and during emissions control measures.
Hand protection:
Conditionally suitable materials for protective gloves; EN 374-3:
Laminate glove - PE/EVAL/PE (PE = polyethylene; EVAL = ethylene/vinyl alcohol copolymer)
Breakthrough time not tested; dispose of immediately after contamination.
Eye protection:
Wear eye/face protection.
Skin and body protection:
On possible contact with the product (sampling, product leakage): Personal protection through wearing a tightly closed chemical protection suit and a self-contained breathing apparatus.
Hygiene measures:
Keep away from foodstuffs, drinks and tobacco. Wash hands and face before breaks and at the end of work. Keep working clothes separately. Change contaminated or soaked clothing immediately.
For technical protective measures to limit exposure see also "Handling and storage".
Respiratory protection:
If vapors are released, use a filtered respirator with a combination filter to DIN EN 141 B2-PS as an escape apparatus. A respirator with an independent air supply must be worn when working with the product and during emissions control measures.
Hand protection:
Conditionally suitable materials for protective gloves; EN 374-3:
Laminate glove - PE/EVAL/PE (PE = polyethylene; EVAL = ethylene/vinyl alcohol copolymer)
Breakthrough time not tested; dispose of immediately after contamination.
Eye protection:
Wear eye/face protection.
Skin and body protection:
On possible contact with the product (sampling, product leakage): Personal protection through wearing a tightly closed chemical protection suit and a self-contained breathing apparatus.
Hygiene measures:
Keep away from foodstuffs, drinks and tobacco. Wash hands and face before breaks and at the end of work. Keep working clothes separately. Change contaminated or soaked clothing immediately.
Stability and reactivity
Hazardous reactions:
Reacts violently with amines, ammonia, alcohols.
Hazardous decomposition products:
Carbon monoxide, Chlorine.
Thermal decomposition:
Decomposition begins at 200 °C.
Reacts violently with amines, ammonia, alcohols.
Hazardous decomposition products:
Carbon monoxide, Chlorine.
Thermal decomposition:
Decomposition begins at 200 °C.
Disposal considerations
Phosgene gas can be destroyed with dilute sodium hydroxide in scrubbing towers or with water
in activated carbon towers.
in activated carbon towers.
Information on Registered Substances comes from registration dossiers which have been assigned a registration number. The assignment of a registration number does however not guarantee that the information in the dossier is correct or that the dossier is compliant with Regulation (EC) No 1907/2006 (the REACH Regulation). This information has not been reviewed or verified by the Agency or any other authority. The content is subject to change without prior notice.
Reproduction or further distribution of this information may be subject to copyright protection. Use of the information without obtaining the permission from the owner(s) of the respective information might violate the rights of the owner.
