PHENOTHIAZINES

Editor's Note: This material is not listed in the Emergency Response Guidebook. Based on the material's physical and chemical properties, toxicity, or chemical group, a guide has been assigned. For additional technical information, contact one of the emergency response telephone numbers listed under Public Safety Measures.

MOLECULAR FORMULA

C12-H9-N-S
S(C6H4)2NH

ERG GUIDE NUMBER

134-FLAMMABLE SOLIDS - TOXIC and/or CORROSIVE

SYNONYM REFERENCE

(Ashford, 1994; (HSDB, 1996); NIOSH , 1996; RTECS , 1996)

USES/FORMS/SOURCES

USES

Phenothiazines are used to treat a wide range of problems, including sympathomimetic intoxication, anxiety, behavior problems, depression, nausea and vomiting, dysreflexia, mania, porphyria and schizophrenia.
Phenothiazine is used as an insecticide, in the manufacture of dyes, as a polymerization inhibitor, antioxidant, chain transfer agent in rubber production, as a parent compound for chlorproMAZINE as well as related antipsychotic drugs, as a urinary antiseptic, and as an anthelmintic drug (ACGIH, 1991; (Ashford, 1994; Lewis, 1993).

FORMS

CHLORPROMAZINE: Is available as 25 mg/mL injection solution; 10 mg, 25 mg, 50 mg, 100 mg, and 200 mg oral tablets.
FLUPHENAZINE: Fluphenazine hydrochloride is available as 2.5 mg/mL intramuscular solution; 2.5 mg/5 mL oral elixir; 5 mg/mL oral solution; 1 mg, 2.5 mg, 5 mg, 10 mg oral tablets. Fluphenazine decanoate is available as 25 mg/mL injection oil.
PERPHENAZINE: Is available as 2 mg, 4 mg, 8 mg, and 16 mg oral tablets.
PROCHLORPERAZINE: Is available as 5 mg and 25 mg rectal suppository.
PROMETHAZINE: Refer to "PROMETHAZINE" management for further information.
TRIFLUOPERAZINE: Is available as 1 mg, 2 mg, 5 mg, and 10 mg oral tablets.
THIORIDAZINE: Refer to "THIORIDAZINE" management for further information.

-CLINICAL EFFECTS

GENERAL CLINICAL EFFECTS

USES: Phenothiazines are used to treat a wide range of conditions including anxiety, behavioral problems, nausea and vomiting, and schizophrenia. Some patients experience a feeling of euphoria from IV injection of these medications.

PHARMACOLOGY: These medications are neuroleptic agents that affect adrenergic and/or dopaminergic receptor sites, metabolic inhibition of oxidative phosphorylation, and the excitability of neuronal membranes.

TOXICOLOGY: Toxic effects result from the anticholinergic properties of these drugs (sedation), as well as their alpha blocking effects (hypotension), mild sodium channel blocking effects (QRS prolongation and dysrhythmias). These drugs also lower the seizure threshold.

EPIDEMIOLOGY: Thousands of exposures occur every year to these agents but severe manifestations are relatively rare.

WITH POISONING/EXPOSURE

MILD TO MODERATE TOXICITY: Anticholinergic effects are common and may include sedation, tachycardia, dry mucus membranes, mydriasis, urinary retention, and constipation.
SEVERE TOXICITY: Effects can include severe CNS depression or coma, respiratory depression, pulmonary edema, failure of airway reflexes, agitation, and seizures. Other severe effects can include temperature dysregulation with hypothermia or hyperthermia (more common), and hypertension or hypotension (more concerning). Overdose patients have suffered cardiac arrest and sudden death. Dysrhythmias such as ventricular tachycardia may occur, and may progress to torsades de pointes or ventricular fibrillation. Neuroleptic malignant syndrome is a rare but life-threatening occurrence that may happen in both therapeutic use and overdose. Other serious effects that can be seen in both therapeutic and overdose exposure include hepatic disease such as cholestatic jaundice or a mixed cholestatic and hepatocellular jaundice and hematologic abnormalities including anemia and agranulocytosis.

WITH THERAPEUTIC USE

Anticholinergic effects are common. Extrapyramidal effects such as dystonia, dyskinesia, akathisia, torticollis, akinesia, chorea, tremor, and rigidity are fairly common. Oculogyric crisis and opisthotonus are rare. Other abnormalities seen with phenothiazine use include priapism, sexual dysfunction, elevated prolactin levels, hypoglycemia, and hyperglycemia. More serious but relatively rare effects that may be seen in therapeutic overdose include hepatic disease, aplastic anemia, and neuroleptic malignant syndrome. Phenothiazines may also cause QT prolongation, which may lead to dysrhythmias even at therapeutic doses.

POTENTIAL HEALTH HAZARDS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)

TOXIC; inhalation, ingestion, or skin contact with material may cause severe injury or death.
Fire will produce irritating, corrosive and/or toxic gases.
Runoff from fire control or dilution water may be corrosive and/or toxic and cause pollution.

-FIRST AID

FIRST AID AND PREHOSPITAL TREATMENT

EMESIS/NOT RECOMMENDED

Emesis is not recommended because of the possibility of a dystonic reaction or CNS depression and subsequent aspiration.

ACTIVATED CHARCOAL

PREHOSPITAL ACTIVATED CHARCOAL ADMINISTRATION

Consider prehospital administration of activated charcoal as an aqueous slurry in patients with a potentially toxic ingestion who are awake and able to protect their airway. Activated charcoal is most effective when administered within one hour of ingestion. Administration in the prehospital setting has the potential to significantly decrease the time from toxin ingestion to activated charcoal administration, although it has not been shown to affect outcome (Alaspaa et al, 2005; Thakore & Murphy, 2002; Spiller & Rogers, 2002).

In patients who are at risk for the abrupt onset of seizures or mental status depression, activated charcoal should not be administered in the prehospital setting, due to the risk of aspiration in the event of spontaneous emesis.
The addition of flavoring agents (cola drinks, chocolate milk, cherry syrup) to activated charcoal improves the palatability for children and may facilitate successful administration (Guenther Skokan et al, 2001; Dagnone et al, 2002).

CHARCOAL DOSE

Use a minimum of 240 milliliters of water per 30 grams charcoal (FDA, 1985). Optimum dose not established; usual dose is 25 to 100 grams in adults and adolescents; 25 to 50 grams in children aged 1 to 12 years (or 0.5 to 1 gram/kilogram body weight) ; and 0.5 to 1 gram/kilogram in infants up to 1 year old (Chyka et al, 2005).

Routine use of a cathartic with activated charcoal is NOT recommended as there is no evidence that cathartics reduce drug absorption and cathartics are known to cause adverse effects such as nausea, vomiting, abdominal cramps, electrolyte imbalances and occasionally hypotension (None Listed, 2004).

ADVERSE EFFECTS/CONTRAINDICATIONS

Complications: emesis, aspiration (Chyka et al, 2005). Aspiration may be complicated by acute respiratory failure, ARDS, bronchiolitis obliterans or chronic lung disease (Golej et al, 2001; Graff et al, 2002; Pollack et al, 1981; Harris & Filandrinos, 1993; Elliot et al, 1989; Rau et al, 1988; Golej et al, 2001; Graff et al, 2002). Refer to the ACTIVATED CHARCOAL/TREATMENT management for further information.
Contraindications: unprotected airway (increases risk/severity of aspiration) , nonfunctioning gastrointestinal tract, uncontrolled vomiting, and ingestion of most hydrocarbons (Chyka et al, 2005).

-MEDICAL TREATMENT

LIFE SUPPORT

Support respiratory and cardiovascular function.

SUMMARY

FIRST AID - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)

Move victim to fresh air.
Call 911 or emergency medical service.
Give artificial respiration if victim is not breathing.
Do not use mouth-to-mouth method if victim ingested or inhaled the substance; give artificial respiration with the aid of a pocket mask equipped with a one-way valve or other proper respiratory medical device.
Administer oxygen if breathing is difficult.
Remove and isolate contaminated clothing and shoes.
In case of contact with substance, immediately flush skin or eyes with running water for at least 20 minutes.
For minor skin contact, avoid spreading material on unaffected skin.
Keep victim warm and quiet.
Effects of exposure (inhalation, ingestion or skin contact) to substance may be delayed.
Ensure that medical personnel are aware of the material(s) involved and take precautions to protect themselves.

FIRST AID

FIRST AID

EYE EXPOSURE: Immediately wash the eyes with large amounts of water, occasionally lifting the lower and upper lids. Get medical attention immediately. Contact lenses should not be worn when working with this chemical.
DERMAL EXPOSURE: Promptly wash the contaminated skin with soap and water. If this chemical penetrates the clothing, promptly remove the clothing and wash the skin with soap and water. Get medical attention promptly.
INHALATION EXPOSURE: Move the exposed person to fresh air at once. If breathing has stopped, perform artificial respiration. Keep the affected person warm and at rest. Get medical attention as soon as possible.
ORAL EXPOSURE: If this chemical has been swallowed, get medical attention immediately.
TARGET ORGANS: Skin, cardiovascular system, liver, and kidneys (National Institute for Occupational Safety and Health, 2007).

EMESIS/NOT RECOMMENDED

Move victims of inhalation exposure from the toxic environment and administer 100% humidified supplemental oxygen with assisted ventilation as required. Exposed skin and eyes should be copiously flushed with water. Ingestion may result in significant esophageal or gastrointestinal tract irritation or burns, and EMESIS SHOULD NOT BE INDUCED. Cautious gastric lavage followed by administration of activated charcoal may be of benefit if the patient is seen soon after the exposure.

INHALATION EXPOSURE

INHALATION: Move patient to fresh air. Monitor for respiratory distress. If cough or difficulty breathing develops, evaluate for respiratory tract irritation, bronchitis, or pneumonitis. Administer oxygen and assist ventilation as required. Treat bronchospasm with an inhaled beta2-adrenergic agonist. Consider systemic corticosteroids in patients with significant bronchospasm.

DERMAL EXPOSURE

DECONTAMINATION: Remove contaminated clothing and jewelry and place them in plastic bags. Wash exposed areas with soap and water for 10 to 15 minutes with gentle sponging to avoid skin breakdown. A physician may need to examine the area if irritation or pain persists (Burgess et al, 1999).
Treat dermal irritation or burns with standard topical therapy. Patients developing dermal hypersensitivity reactions may require treatment with systemic or topical corticosteroids or antihistamines.

EYE EXPOSURE

DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.

ORAL EXPOSURE

Because of the potential for gastrointestinal tract irritation, do not induce emesis.
Significant esophageal or gastrointestinal tract irritation or burns may occur following ingestion. The possible benefit of early removal of some ingested material by cautious gastric lavage must be weighed against potential complications of bleeding or perforation.
GASTRIC LAVAGE: Consider after ingestion of a potentially life-threatening amount of poison if it can be performed soon after ingestion (generally within 1 hour). Protect airway by placement in the head down left lateral decubitus position or by endotracheal intubation. Control any seizures first.

CONTRAINDICATIONS: Loss of airway protective reflexes or decreased level of consciousness in unintubated patients; following ingestion of corrosives; hydrocarbons (high aspiration potential); patients at risk of hemorrhage or gastrointestinal perforation; and trivial or non-toxic ingestion.

ACTIVATED CHARCOAL: Administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
Observe patients with ingestion carefully for the possible development of esophageal or gastrointestinal tract irritation or burns. If signs or symptoms of esophageal irritation or burns are present, consider endoscopy to determine the extent of injury.

-RANGE OF TOXICITY

MINIMUM LETHAL EXPOSURE

SPECIFIC SUBSTANCE

CHLORPROMAZINE

350 mg was lethal in a 4-year-old child (Wallman, 1957). Four deaths were reported in children following 20 to 74 mg/kg (Davis et al, 1968). Adults have survived ingestions of 9.75 g.
The acute fatal dose for chlorproMAZINE reportedly ranges from 15 to 150 mg/kg (Parsons & Buckley, 1997).

MESORIDAZINE: Adults have died following 2.5 to 8 g overdoses (Donlon & Tupin, 1977) (Vertrees & Siebel, 1987).

MAXIMUM TOLERATED EXPOSURE

SPECIFIC SUBSTANCE

SUMMARY

In a review of the literature, inadvertent exposure of 1 to 2 tablets from exposure to medium- (eg, perphenazine) or high-potency (eg, fluphenazine, trifluoperazine) agents which are available at lower strengths, resulted in no serious toxic effects in toddlers. In rare cases, serious toxicity has been observed following 1 to 2 tablets of low-potency agents available at higher strengths, which were exclusively associated with chlorproMAZINE exposure.

Based on current literature, no well documented cases of serious morbidity or mortality have been reported following exposure to small doses of antiemetic phenothiazines like promethazine (high potency; available tablet strengths range from 12.5 to 50 mg) or prochlorperazine (high potency; available tablet strengths range from 5 to 25 mg). Therefore, exposure to 1 to 2 tablets of antiemetic phenothiazines represents a minimal risk to a toddler and they may be safely observed at home. However, close monitoring is indicated in a very young child (less than 2 years) or those patients that have ingested higher strength doses of either promethazine or prochlorperazine. Exposure to an uncertain amount or exposure to a low-potency agent requires observation in a healthcare facility for a minimum of 4 hours (Love et al, 2006).

ACEPROMAZINE

Berns & Wright (1993) reported a case of a 2.5-year-old boy who survived, experiencing only loss of consciousness, after ingesting 75 to 100 mg of acepromazine which had been prescribed for the family dog. The boy received prompt medical care.
Clutton (1985) reported a case of an adult who survived, experiencing only sedation and sinus tachycardia, after ingesting 1.25 g acepromazine (Clutton, 1985).

CHLORPROMAZINE

Coma and respiratory arrest developed in a 1-year-old toddler ingesting 200 mg of chlorproMAZINE (Cann & Verhulst, 1960). Adults have survived 9.75 g. Two adults became comatose after 0.8 and 17 g (Cann & Verhulst, 1960).

MESORIDAZINE

Ingestion of 3.1 g of mesoridazine resulted in ventricular tachycardia, severe hypotension, and cardiac arrest in a 20-year-old woman (Marrs-Simon et al, 1987). With medical treatment, an adult survived an ingestion of 6 g (Niemann et al, 1981).

OCCUPATIONAL

ACGIH reports a number of occupational exposures to this substance (ACGIH, 1991):

In one instance, workers exposed to 15 to 48 mg/m(3) of phenothiazine dust developed skin irritation as well as discolored hair and fingernails (due to a dyeing effect of this compound). Tolerance to the skin irritation generally developed after 1 to 4 weeks of exposure.
In other instances, photosensitization with direct sunlight has been noted. No systemic toxicity has been reported at exposure concentrations associated with hair and fingernail discoloration.

TOXICITY AND RISK ASSESSMENT VALUES

TOXICITY VALUES

LD50- (ORAL)CATTLE:
- 500 mg/kg (RTECS, 2006)
LD50- (INTRAVENOUS)MOUSE:
- 178 mg/kg (RTECS, 2006)
LD50- (ORAL)MOUSE:
- 5 g/kg (RTECS, 2006)
LD50- (ORAL)RABBIT:
- 4 g/kg (RTECS, 2006)
LDLo- (ORAL)HUMAN:
- Child, 425 mg/kg for 5D (RTECS, 2006)
TDLo- (ORAL)RAT:
- 1-22D preg, 1250 mg/kg -- REP

-STANDARDS AND LABELS

SHIPPING REGULATIONS

SURFACE

DOT -- Table of Hazardous Materials and Special Provisions (49 CFR 172.101, 2005):

Not Listed

ICAO International Shipping Name (ICAO, 2002):

Not Listed

-PERSONAL PROTECTION

SUMMARY

RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)

Wear positive pressure self-contained breathing apparatus (SCBA).
Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection.
Structural firefighters' protective clothing provides limited protection in fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.

Appropriate protective clothing should be worn to prevent skin contact. If skin contact occurs, washing with soap and water should be done immediately. In addition, persons working with this compound should wash thoroughly at the end of each work shift and change into uncontaminated clothing before leaving the job site. Contaminated or wet clothing should be removed and replaced (ITI, 1988; NIOSH , 1996).

Protective shoes, butyl rubber gloves, and full protective clothing in conjunction with a self-contained breathing apparatus should be worn when handling phenothiazine (ITI, 1988).

Persons with existing medical conditions affecting the blood, skin, liver, and kidneys, as well as those developing photosensitization should not be exposed to this compound (ITI, 1988).

RESPIRATORY PROTECTION

Refer to "Recommendations for respirator selection" in the NIOSH Pocket Guide to Chemical Hazards on TOMES Plus(R) for respirator information.

-PHYSICAL HAZARDS

FIRE HAZARD

SUMMARY

Editor's Note: This material is not listed in the Emergency Response Guidebook. Based on the material's physical and chemical properties, toxicity, or chemical group, a guide has been assigned. For additional technical information, contact one of the emergency response telephone numbers listed under Public Safety Measures.
POTENTIAL FIRE OR EXPLOSION HAZARDS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Flammable/combustible material.
- May be ignited by heat, sparks or flames.
- When heated, vapors may form explosive mixtures with air: indoors, outdoors and sewers explosion hazards.
- Contact with metals may evolve flammable hydrogen gas.
- Containers may explode when heated.
Phenothiazine is a flammable solid, although it is not considered a great fire risk (NIOSH , 1996).
Toxic fumes of nitrogen and sulfur oxides are emitted by phenothiazine when heated to decomposition or exposed to acid or acid fumes (Lewis, 1992).

FIRE CONTROL/EXTINGUISHING AGENTS

SMALL FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Dry chemical, CO2, water spray or alcohol-resistant foam.
LARGE FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Water spray, fog or alcohol-resistant foam.
- Move containers from fire area if you can do it without risk.
- Use water spray or fog; do not use straight streams.
- Do not get water inside containers.
- Dike fire control water for later disposal; do not scatter the material.
TANK OR CAR/TRAILER LOAD FIRE PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Fight fire from maximum distance or use unmanned hose holders or monitor nozzles.
- Cool containers with flooding quantities of water until well after fire is out.
- Withdraw immediately in case of rising sound from venting safety devices or discoloration of tank.
- ALWAYS stay away from tanks engulfed in fire.

DUST/VAPOR HAZARD

Toxic fumes of nitrogen and sulfur oxides are emitted by phenothiazine when heated to decomposition or exposed to acid or acid fumes (Lewis, 1992).

REACTIVITY HAZARD

Toxic fumes of nitrogen and sulfur oxides are emitted by phenothiazine when heated to decomposition or exposed to acid or acid fumes (Lewis, 1992).

EVACUATION PROCEDURES

SUMMARY

Editor's Note: This material is not listed in the Table of Initial Isolation and Protective Action Distances.
LARGE SPILL - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Consider initial downwind evacuation for at least 100 meters (330 feet).
FIRE - PUBLIC SAFETY EVACUATION DISTANCES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- If tank, rail car or tank truck is involved in a fire, ISOLATE for 800 meters (1/2 mile) in all directions; also, consider initial evacuation for 800 meters (1/2 mile) in all directions.
PUBLIC SAFETY MEASURES - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- CALL Emergency Response Telephone Number on Shipping Paper first. If Shipping Paper not available or no answer, refer to appropriate telephone number:
- For additional details see the section entitled "WHO TO CALL FOR ASSISTANCE" under the ERG Instructions.
- As an immediate precautionary measure, isolate spill or leak area for at least 25 meters (75 feet) in all directions.
- Stay upwind.
- Keep unauthorized personnel away.
- Keep out of low areas.
- Ventilate enclosed areas.

CONTAINMENT/WASTE TREATMENT OPTIONS

SUMMARY

SPILL OR LEAK PRECAUTIONS - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Fully encapsulating, vapor protective clothing should be worn for spills and leaks with no fire.
- ELIMINATE all ignition sources (no smoking, flares, sparks or flames in immediate area).
- Stop leak if you can do it without risk.
- Do not touch damaged containers or spilled material unless wearing appropriate protective clothing.
- Prevent entry into waterways, sewers, basements or confined areas.
- Use clean non-sparking tools to collect material and place it into loosely covered plastic containers for later disposal.
RECOMMENDED PROTECTIVE CLOTHING - EMERGENCY RESPONSE GUIDEBOOK, GUIDE 134 (ERG, 2004)
- Wear positive pressure self-contained breathing apparatus (SCBA).
- Wear chemical protective clothing that is specifically recommended by the manufacturer. It may provide little or no thermal protection.
- Structural firefighters' protective clothing provides limited protection in fire situations ONLY; it is not effective in spill situations where direct contact with the substance is possible.
For spilled material, cover with a 9:1 mixture of sand and soda ash. Combine these and then transfer into a paper carton stuffed with ruffled paper (ITI, 1988).

WASTE TREATMENT OPTIONS

PHYSICAL TREATMENT

This compound can be disposed of by incineration. Small quantities mixed with sand as well as soda ash and placed in a carton stuffed with packing paper can be burned in any furnace: Be sure to stay upwind. Larger amounts can be dissolved in a flammable solvent and then sprayed into a furnace equipped with an afterburner and scrubber (ITI, 1988).
Waste management activities associated with material disposition are unique to individual situations. Proper waste characterization and decisions regarding waste management should be coordinated with the appropriate local, state, or federal authorities to ensure compliance with all applicable rules and regulations.

-PHYSICAL/CHEMICAL PROPERTIES

MOLECULAR WEIGHT

199.28

DESCRIPTION/PHYSICAL STATE

Phenothiazine is a grayish green to yellow solid (powder, granules, flakes): Yellow diamond-shaped plates or rhombic leaflets from toluene or butanol (Budavari, 1989) ACGIH, 1991; (Lewis, 1992; Lewis, 1993).

It is reported to be tasteless, with a slight odor (Lewis, 1993).
This compound is readily oxidized by sunlight (Budavari, 1989; ITI, 1988).

VAPOR PRESSURE

0 mmHg (approximately) (NIOSH , 1996)

FREEZING/MELTING POINT

MELTING POINT

175-185 degrees C (Lewis, 1993)
182-185 degrees C (Ashford, 1994)
185.1 degrees C (sublimes at 130 degrees C at 1 mmHg) (Budavari, 1989; Lewis, 1992)
365 degrees F (NIOSH , 1996)

BOILING POINT

371 degrees C (at 760 mmHg) (Budavari, 1989; Lewis, 1992)

290 degrees C (at 40 mmHg) (Budavari, 1989; ITI, 1988)

700 degrees F (NIOSH , 1996)

SOLUBILITY

IN WATER

This compound is practically insoluble in water; (ACGIH, 1991; ((HSDB, 1996); Lewis, 1992).

IN ORGANIC SOLVENTS

Phenothiazine is insoluble in carbon tetrachloride, chloroform and petroleum ether (ACGIH, 1991; ((HSDB, 1996); Lewis, 1992).
It is soluble in acetone, benzene, ether, and hot acetic acid; and is slightly soluble in mineral oils and alcohol (ACGIH, 1991; ((HSDB, 1996); Lewis, 1992).
It is soluble in aromatic solvents (Ashford, 1994).

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GENERAL BIBLIOGRAPHY

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Information to evaluate chemical incidents

Information to evaluate chemical incidents

Information to evaluate chemical incidents