Phosphine Exposure Among Emergency Responders - Amarillo, Texas, January 2017.

Emily M Hall,Ketki Patel,Kerton R Victory,Geoffrey M Calvert,Leticia M Nogueira,Heidi K Bojes

doi:10.15585/mmwr.mm6713a2

Abstract

Phosphine is a highly toxic gas that forms when aluminum phosphide, a restricted-use pesticide* typically used in agricultural settings, reacts with water. Acute exposure can lead to a wide range of respiratory, cardiovascular, and gastrointestinal symptoms, and can be fatal (1). On January 2, 2017, the Texas Department of State Health Services (DSHS) was notified by the Texas Panhandle Poison Center of an acute phosphine exposure incident in Amarillo, Texas. DSHS investigated potential occupational phosphine exposures among the 51 on-scene emergency responders; 40 (78.4%) did not use respiratory protection during response operations. Fifteen (37.5%) of these 40 responders received medical care for symptoms or as a precaution after the incident, and seven (17.5%) reported new or worsening symptoms consistent with phosphine exposure within 24 hours of the incident. Emergency response organizations should ensure that appropriate personal protective equipment (PPE) is used during all incidents when an unknown hazardous substance is suspected. Additional evaluation is needed to identify targeted interventions that increase emergency responder PPE use during this type of incident.

Highlights

Forty (78.4%) of 51 emergency personnel responding to an acute phosphine exposure incident in Texas in January 2017 did not use respiratory protection, including 15 (37.5%) who received medical care after the incident and seven (17.5%) who reported new or worsening symptoms consistent with phosphine exposure within 24 hours of the incident
Because protective equipment (PPE) use among emergency personnel who were not injured or ill was not collected, it was not possible to assess the effectiveness of PPE in preventing injuries and illness
Farm, construction, and manufacturing workers have found that individual behavioral interventions alone do not significantly improve respiratory protection use [9]

Summary

Introduction

Forty (78.4%) of 51 emergency personnel responding to an acute phosphine exposure incident in Texas in January 2017 did not use respiratory protection, including 15 (37.5%) who received medical care after the incident and seven (17.5%) who reported new or worsening symptoms consistent with phosphine exposure within 24 hours of the incident. The majority had received standard emergency response training and knew of agency standard operating procedures for responding to incidents involving hazardous substances. Emergency responder risk of exposure during incidents involving unknown hazardous substances is well documented, methods for improving compliance with existing recommendations and regulations for respiratory protection use are not well understood.

Results

Conclusion