RCCE messages on white phosphorus exposure: guidance for the public

Target behaviour: to understand white phosphorus, recognize exposure, take immediate action and seek appropriate medical care. 

Single overarching communication objective: that the public can identify white phosphorus, understand its risks, take immediate first aid steps if exposed and know to seek medical attention immediately. 

Key message: white phosphorus is dangerous. Learn to recognize it and what to do if you or someone you know is exposed. 

Supporting messages

• What is white phosphorus?

It is a yellowish or colourless waxy substance used in military and industrial settings that ignites instantly upon contact with oxygen, producing a garlic-like odour. It ignites spontaneously in air at temperatures above 30°C (86°F) and continues to burn until it is fully dissolved or deprived of oxygen.

• How can it harm you?

Once ignited, white phosphorus is very difficult to extinguish. It causes severe, deep burns, penetrating even through bone. It sticks to skin and clothing. The smoke is harmful to eyes and lungs due to the presence of toxic chemicals and corrosive gases. Skin contact, ingestion and inhalation of white phosphorus are extremely dangerous. The effects throughout the body can be delayed for up to 24 hours and in severe cases cause heart and blood vessel problems and collapse, liver and kidney damage, loss of consciousness, coma and death.

• How do you know if you have been exposed?

Deep, painful burns, possibly yellowish, with grayish-white smoke and/or a garlic smell coming from the wound. The skin around the burn might look dead or severely damaged. Small pieces of white phosphorus stuck on your skin can reignite when exposed to oxygen. Your eyes might feel irritated, painful, blurry, sensitive to light or watery. You could also have redness, swelling, burns or even holes in your eyes (corneal perforations). Breathing in the smoke can irritate your airways, causing coughing, headaches and fluid buildup in your lungs.

• What to do if you are exposed
• Stop the burning

Immediately move away from the source. Flood the burn with cool, clean water or saline solution (a mix of salt and water often used for medical purposes). Carefully remove contaminated clothing, which can reignite, and seal it in a water-filled container and clearly label it as hazardous. Cover burns with wet cloths during transport to a medical facility. Never use warm water on the burns as this may reactivate the burning process.

• Remove phosphorus particles

If you see pieces of white phosphorus on the skin, remove them with forceps (never your hands) and submerge them in cold water. Be very careful as they can reignite. Do not remove embedded particles yourself. Let medical professionals at the medical facility know if you suspect any particles are embedded in wounds. They can cause severe internal injuries if not addressed by a professional. Embedded white phosphorus particles may be difficult to see but can be visualized using ultraviolet light.

• Get immediate medical help

Go to a hospital or clinic urgently if you or someone else is exposed.

Target behaviour: safe and effective management of white phosphorus burns and prevention of secondary exposure. 

Single overarching communication objective: that health care providers can safely and effectively treat white phosphorus burns, minimizing complications and preventing secondary contamination. 

Key message: managing white phosphorus burns requires specific precautions to protect both patients and health care providers. 

Supporting messages

• Stop the burning process

This is the top priority. Use large amounts of cool, clean water or medically prepared saline solution. Do not use warm water which may cause the white phosphorus to reignite. Be aware that white phosphorus can reignite on contact with air even after the initial burning has stopped. Cover affected areas with wet cloths to limit oxygen exposure and keep applying cool water.

• Protect yourself and others from secondary exposure

White phosphorus is highly reactive and can reignite easily. Wear appropriate personal protective equipment to avoid secondary exposure from smoke and particles while helping someone exposed. Use any available physical barrier, even a piece of fabric like clothing or a towel, to cover your nose and mouth. Do not expose yourself or the patient to sources of ignition such as naked flames, electrical equipment or the smoking of tobacco products. Remove contaminated clothing from the patient and place it in a water-filled, closable container away from any ignition sources. Clearly label the container as hazardous waste.

• Remove phosphorus particles

Use forceps and cool water or saline solution to remove visible phosphorus particles. Never use your bare hands, even if protected with surgical gloves. Submerge removed phosphorus in cold water to prevent ignition/reignition. Embedded white phosphorus particles may be difficult to see but can be visualized using ultraviolet light if available. Keep in mind that white phosphorus particles that have penetrated the skin such as particles on shrapnel from weapons may ignite once exposed to air.

• Continuously irrigate burns

Flush exposed skin and wounds with cool saline or water continuously or keep the affected areas immersed in water. This will stop the burning, cool the area and dilute any phosphoric acid that may have formed in the wound. Be especially careful to prevent contamination of healthy skin with runoff potentially containing white phosphorous from the affected areas.

• Eye exposure

If a patient’s eyes have been exposed, flush them with plenty of water or 0.9% saline for 10–15 minutes. Remove contact lenses during irrigation if you can do so easily. A topical local anaesthetic can help reduce discomfort (blepharospasm – blinking or other eyelid movements, like twitching, that cannot be controlled) during irrigation but do not delay irrigation if one is not available. While flushing, check for and remove any particles of phosphorus, placing them under water in a container. Conduct a thorough eye exam after irrigation and refer urgently to an ophthalmologist if needed.

• Inhalation

Monitor the patient if you suspect they have breathed in phosphorus smoke. It can lead to severe respiratory distress.

• Further medical management

If possible, consult a burn specialist for ongoing care. Because it easily penetrates fatty tissues, white phosphorus burns can be deep and slow to heal. Be aware that systemic toxicity is possible. Monitor ECG and other vitals closely and provide life support as needed. Systemic effects can include cardiovascular issues, liver and kidney damage and decreased consciousness or coma.

• Follow-up care

Caution must be exercised around spontaneous reignition of white phosphorus particles remaining in damaged tissue and any smoke coming from the wound. 

Target behaviour: to teach children about the dangers of white phosphorus, what to do if they encounter it and how to recognize signs of exposure in themselves and others. 

Single overarching communication objective: that children are aware of the dangers of white phosphorus, can identify it, know to avoid it and understand that they must seek help from a trusted adult if they or other children are exposed. 

Key message: white phosphorus is very dangerous. If you see it, do not touch it and tell an adult immediately. 

Supporting messages for parents

• Teach your children that white phosphorus is dangerous and should never be touched. Explain that it looks like wax but can cause severe burns.
• Emphasize the importance of telling an adult immediately if they see anything that looks like white phosphorus.
• Make sure they know the signs of exposure: deep burns, yellowish skin, smoke from the wound, eye irritation, coughing and difficulty breathing.
• If your child is exposed, seek immediate medical attention. Inform medical professionals immediatelyif you or your child has come into contact with or inhaled white phosphorus particles and smoke. Prompt medical attention is urgently needed in such emergencies.

Supporting messages for children

• White phosphorus looks like wax but can burn your skin very badly. It may sometimes look yellow or colourless. It may smell like garlic. Never touch it.
• If you see anything that looks like white phosphorus, do not touch it. Stay away and tell a grown-up immediately.
• If you get white phosphorus on your skin, clothes or in your eyes, tell a grown-up so they can get you help quickly. 

Messages for people with white phosphorus burns

Target behaviour: to minimize the risk of secondary contamination of others, particularly children. 

Single overarching communication objective: that individuals with white phosphorus burns understand how to protect others from exposure, especially children, can confidently take the necessary precautions and communicate these to the people around them. 

Key message: if you have white phosphorus burns, take precautions to protect others from becoming exposed and injured. 

Supporting messages

• White phosphorus can easily spread

White phosphorus can stick to clothing, skin and other surfaces and reignite when exposed to oxygen. Because of this, it can easily transfer to others, causing burns. The smoke emanating from your wounds is also dangerous. Keep your injuries covered with a clean, damp cloth to minimize the danger, change the cloth frequently and dispose of cloths in a sealed container filled with water and clearly marked hazardous. 

• Follow medical guidance

Health care professionals will use specific safety procedures for your treatment. Cooperate fully and ask for guidance on how best to interact with others, including children, without putting them at risk. Ask your health care professional about how to reduce contamination, especially if you have been advised to continuously irrigate the wounds – always use clean cool water or medically prepared saline – to prevent reignition, how to manage pain and how to engage in any other activity that might expose or risk exposing others.

• Avoid close contact with children and minimize contamination

Because children are naturally curious and more likely to touch things, come into close contact with you or touch contaminated items, they are at greater risk of secondary exposure to white phosphorus. Avoid close physical contact and sharing personal items with children until your health care provider confirms it is safe. Seek assistance and support with childcare responsibilities during your treatment and strictly follow medical professionals' instructions to reduce contamination risks. Ask health care providers to share these precautions with family and friends who may visit to ensure they understand how to protect themselves and you. 

Target behaviour: to seek immediate medical attention if exposed to white phosphorus. 

Single overarching communication objective: that pregnant and breastfeeding women understand the importance of seeking immediate medical care following exposure to white phosphorus. 

Key message: if you are pregnant or breastfeeding and exposed to white phosphorus or the smoke from white phosphorus, seek immediate medical attention. 

Supporting messages

• If exposed to even a small amount of white phosphorus or its smoke, get medical help immediately. Health care providers will give you the first aid you need and ongoing care, taking necessary precautions and your pregnancy and breastfeeding status into consideration.
• Let health care providers know that you are pregnant or breastfeeding as soon as possible to guide their treatment decisions.