Phosgene is another of the original chemical agents used in WWI, used under the designation CG. Its use currently is limited to industrial applications where organic compounds such as isocyanates are produced; it is formed from the combustion of organochlorine compounds and may be present at fire scenes, particularly in the industrial setting. It is best known for its odor of "freshly mown hay" and such an agreeable fragrance may not prompt exposed individuals to evacuate. As it is heavier than air, phosgene can cause asphyxiation if victims are found in low-lying areas. Children are more vulnerable to its toxic effects for the reasons described above.
Phosgene undergoes slow hydrolysis in the distal portions of the lungs to produce hydrochloric acid, crosslinking of cellular structures, and reactive oxygen species.
Delayed onset (up to 24 hours) of acute lung injury is the chief manifestation of toxicity, although battlefield exposures have been reported to have onset of symptoms within 2-6 hours. As in the case of chlorine, pulmonary edema is noncardiogenic. Systemic illness and death occur because of hypoxia. Long-term effects of phosgene exposure include pulmonary scarring, emphysema, and airway reactivity.
Treatment again consists of airway support and oxygenation. Positive pressure may be warranted. Bronchodilators should be administered if the patients exhibit any signs of respiratory distress. Patients with known exposure should be observed for a prolonged period (i.e., up to 48 hours) due to the risk of delayed-onset ALI.
Rescuers should use positive pressure demand SCBA. Phosgene may cause skin burns, so chemical suits are required (Responder, Tychem 10000, or Teflon brands). If liquid phosgene is involved, then the victims' clothing should be removed and double bagged to prevent off gassing.
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