title: Acute phosphine poisoning on board a bulk carrier: analysis of factors leading to a fatal case.
abstract: OBJECTIVE
  To determine accidental factors, clinical presentation and medical care in cases of seafarers presenting phosphine poisoning symptoms on board a bulk carrier. To consider primary prevention of this pathology, which can have extremely severe consequences.
  
  
  METHODS
  To analyse circumstances resulting in toxic exposure to phosphine in the sea transport sector. To obtain information from medical reports regarding the seafarer's rescue. To identify the causes of this accidental poisoning and how to establish an early, appropriate diagnosis thus avoiding other cases.
  
  
  RESULTS
  In February 2008, on board a bulk carrier with a cargo of peas, a 56-year-old seafarer with intense abdominal and chest pains, associated with dizziness, was rescued by helicopter 80 miles away from the coast. Despite being admitted rapidly to hospital, his heart rate decreased associated with respiratory distress. He lost consciousness and convulsed. He finally died of pulmonary oedema, major metabolic acidosis and acute multi organ failure. The following day, the captain issued a rescue call from the same vessel for a 41-year-old man also with abdominal pain, vomiting and dizziness. The ECG only revealed type 1 Brugada syndrome. Then 11 other seafarers were evacuated for observation. 3 showed clinical abnormalities. Collective poisoning was suspected. Medical team found out that aluminium phosphide pellets had been put in the ship's hold for pest control before the vessel's departure. Seafarers were poisoned by phosphine gas spreading through cabins above the hold. It was found that the compartments and ducts were not airtight.
  
  
  CONCLUSIONS
  Unfortunately, a seafarer on board a bulk carrier died in 2008 because of acute phosphine poisoning. Fumigation performed using this gas needs to be done with extreme care. Systematic checks need to be carried out before sailing to ensure that the vessel's compartments are airtight.
authors.affiliation: European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; Occupational and Environmental Diseases Department (Service de Santé au Travail et Maladies liées à l'environnement) CHRU Morvan, 2 avenue FOCH, 29609 Brest, Cedex France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France.
authors.forename: Brice
authors.initials: B
authors.lastname: Loddé
authors.affiliation: Occupational Health Service in Iroise (Service de santé au travail en Iroise), 37, rue Voltaire, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France ; European Society for Environmental and Occupational Medicine, Hamburg, Deutschland.
authors.forename: David
authors.initials: D
authors.lastname: Lucas
authors.affiliation: Emergency Department and Maritime Emergencies (Service d'urgences et SAMU de coordination médicale maritime), CHRU La Cavale Blanche, Boulevard Tanguy Prigent, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France.
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Letort
authors.affiliation: Occupational Health Service in Iroise (Service de santé au travail en Iroise), 37, rue Voltaire, 29200 Brest, France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Jegaden
authors.affiliation: European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Pougnet
authors.affiliation: European University of Brest, EA 4686 - CS 93837 - 29238, Brest, Cedex 3 France ; French Society of Maritime Medicine (Société Française de Médecine Maritime), 22, Avenue Camille Desmoulins, 29200 Brest, France.
authors.forename: Jean-Dominique
authors.initials: JD
authors.lastname: Dewitte
keywords: Bulk carrier; Death; Phosphine; Poisoning; Seafarer