Choking Agent Poisoning

GENERAL INFORMATION:

What is it?

• There are two common choking or lung agents. They are phosgene (FOS-jean) and chlorine (KLOR-een). Both may be in liquid, solid, or gas form. Gas is the most dangerous form. Fumes from a liquid may also be dangerous. Phosgene and chlorine may be used by a person or group of people to do harm to others. Both phosgene and chlorine are heavier than air. Indoors, they will drift down into basements or crawl spaces. Outdoors, phosgene or chlorine will drift into low-lying areas like ditches or trenches.
  
  
• Phosgene is a colorless gas. It was used to poison soldiers in the trenches in World War I. Phosgene smells like newly mown hay, or green corn, from a distance. Closer up the smell is sharp and suffocating.
  
  
• Chlorine has a "swimming pool" odor. Chlorine is one of the chemicals used to keep swimming pool water clean and safe to swim in.

What is phosgene used for?

• Phosgene is used as part of the process of making things like dyes for coloring cloth and plastics. It is also used to make some insecticides (bug-killers) and to remove metals from rock.
  
  
  • Because phosgene is used in the process of making items, it is stored. The storage of phosgene becomes a problem if it gets spilled near people, or if it is exposed to heat or fire. Phosgene catches fire easily and the fumes (smoke) will cause choking if they are breathed in.
    
    
  
  
• Phosgene may also be a result of a chemical reaction. Phosgene is one of the gases given off as a result of welding. It is also given off when some substances catch fire. Some of these substances are: paint removers, dry cleaning fluids, home and office furnishings, floor coverings, and electrical insulation. When Teflon gets too hot and burns, it gives off phosgene gas.

How do phosgene and chlorine poison you? Phosgene and chlorine work in the same way to poison you. Both work by combining with the water in your mucous membranes. Mucous membranes are the wet, soft, tissue on the insides of your eyelids, the lining of your mouth, your throat, and your lungs.

• Chlorine binds with water almost immediately. Phosgene binds with water more slowly. Because of this difference in bonding time, symptoms from chlorine poisoning will happen quickly, in minutes. Symptoms of phosgene poisoning may not happen for a day or two.
  
  
• The combination of water and phosgene or water and chlorine makes hydrochloric (hy-drow-KLOR-ik) acid. Hydrochloric acid is a very strong acid. This acid burns your mucous membranes. Phosgene and chlorine gas will not burn intact skin, but they may cause reddening or burns of wet skin. As a liquid, phosgene may cause frostbite on skin.
  
  
• At its strongest, phosgene combined with the fluid in your body is able to damage the tiniest air sacs deep in your lungs. These tiny air sacs are the place where oxygen brought into your lungs is absorbed into your blood.
  
  
• When these tiny air sacs are damaged, fluid from your blood called plasma (PLAZ-muh) can get into your lungs. If enough fluid gets into your lungs from plasma, it has the same effect as drowning. Phosgene poisoning is sometimes called "dry land drowning".

What are the symptoms of choking agent poisoning? Symptoms depend on how much phosgene or chlorine gets into your body. You may have no signs and symptoms for a few days. The longer before signs and symptoms begin from the time of exposure, the less sick you are likely to become.

• A burning sensation in your eyes and nose.
  
  
• A dry, burning feeling in your throat that makes you feel very thirsty.
  
  
• Nausea (feeling sick to your stomach) and vomiting (throwing up).

• Teary eyes.
  
  
• A wet, croupy-sounding cough.
  
  
• A wheeze or a high pitched sound when you breathe.
  
  
• It may hurt to breathe, and you may be short of breath.
  
  
• Your heart may beat more quickly than normal.
  
  
• You may cough up clear, foamy phlegm (flem).

How is choking agent poisoning diagnosed?

• Caregivers at a fire where chemicals are stored may look for signs and symptoms of phosgene poisoning. This is especially true if certain kinds of chemicals or goods caught fire.
  
  
• If gas chlorine was used in a swimming pool and the container was damaged or leaking gas, caregivers would look for signs of chlorine poisoning.

What should I do if I am exposed to phosgene?

• Leave the area.
  
  
  • If you are outside, go to the highest ground you can find. Phosgene is heavier than air and it will sink into low-lying areas.
    
    
  • If you are inside, get out of the building. If for some reason you cannot get out of the building, go to the highest floor you can get to. Turn off the heat or air conditioning to keep phosgene from circulating in the building. Phosgene will settle into the basement or lowest level of the building.
  
  
• Remove your clothing.
  
  
  • Take off any clothes that have liquid phosgene on them. Do not pull clothing with phosgene on them over your head. Cut or rip contaminated (kun-TAM-in-ate-ted) clothing off that is usually pulled over your head.
    
    
  • If you were wearing contact lenses, take them out. Place clothing (and contact lenses if you were wearing them) in a plastic bag and tie the top. If possible, put the plastic bag containing your clothing into another plastic bag and tie the top of that bag, too. Do not touch the bags again.
  
  
• Wash your body. As soon as you can, take a shower and wash your entire body. Shampoo your hair. If a shower is not available wash as best you can using soap and clean water. If your eyes are burning or your vision is blurry, rinse your eyes under plain running water for 10 to 15 minutes. Eyeglasses may be washed and put back on.
  
  
• Do not induce vomiting. If you have swallowed phosgene, do not induce vomiting (throwing up) and do not drink more liquids.
  
  
• Seek medical attention right away. You may not have symptoms for a few days. You should not wait for the onset of symptoms to seek medical attention. Call 9-1-1 and explain what happened.

What can I do to prevent choking agent poisoning?

• If you work in a place where phosgene is stored, know the correct way to store and handle it.
  
  
• If you are outside a burning building, avoid breathing in fumes from the fire.
  
  
• If you are welding, wear a mask designed especially for welding.
  
  
• Store chemicals in your home correctly.
  
  
• If there is a fire in your home, get out quickly.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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