Mass Occupational Phosphine Poisoning of a Dry-Cargo Ship Crew: A Case Report

Abstract

Fumigation of grain cargoes in the ship holds with phosphorus hydrogen-based substances has been widely introduced into the daily practice of the fleet. We present a case of mass occupational phosphine poisoning in the crew of the cargo ship. On October 18, 2018, the “Nazmehr” cargo ship transporting grain from Kazakhstan to Azerbaijan by the Caspian Sea has sent a SOS signal. The Azerbaijani patrol ship was found with 12 seafarers on board with signs of poisoning and evacuated them onshore. Upon admission to the hospital the patients were diagnosed with "phosphine poisoning" based on clinical symptoms and positive chemical-toxicology test. Because phosphine has no antidote, supportive care and symptomatic therapy was administered. In 36 hours, all patients were discharged without complications. Three seafarers died on board before the patrol ship arrived. The autopsy showed that death occurred due to profound shock, acute myocarditis, pulmonary edema and multi-organ failure. The cause of this mass poisoning in seafarers was the failure in the ship safety requirements, decrepitude of the vehicle and the lack of tightness of the holds. The incident showed the necessity for strengthening of control over the observance of safety rules during transportation of fumigated goods.