MASS CASUALTIES FROM ACUTE INHALATION OF CHLORAMINE GAS

Mass exposure to chloramine gas has not been reported. We report two g roups of 36 patients (72 total) suffering from acute inhalation of chl oramine gas. Chloramine gas is produced from mixing common household c leaning agents containing sodium hypochlorite (bleach) and ammonia. Th e first mass casualty event occurred when 36 male soldiers mere expose d during a ''cleaning party'' in their barracks. Ten days later, 36 fe male soldiers were exposed in a similar manner and presented to our em ergency department. In each event, commonly available cleaning agents - liquid bleach and ammonia - were mixed together, liberating toxic ch loramine gas. Nebulized sodium bicarbonate solution has been suggested for treatment of chlorine gas inhalation, but no report of nebulized sodium bicarbonate for treatment of chloramine gas inhalation injury e xists. In our series, 22 patients exposed to chloramine gas were treat ed with a nebulized solution of 3.75% sodium bicarbonate. This treatme nt made no significant statistical or clinical difference in outcome. We present the largest case series of patients presenting to an emerge ncy department for treatment of acute inhalation of chloramine gas.