Second UK thought-starter on new precautionary statements for medical response (9 November 2017)

The constructive discussions at the last Correspondence Group meeting in July indicated there was general agreement on the principles proposed by the UK to develop a new system of precautionary statements for medical response:

  Keep it simple!

  Look at a simple matrix of urgency vs seriousness, and consider possible medical response for the four possible combinations of high and low (HH, HL, LH, LL). 
 
  Focus HH response on situations where immediate medical treatment needed (acute high hazard). 
 
  To keep it simple, use the same medical response statement for hazard classes/categories within each of the HL, HL, LH and LL situations where possible.

  Distinguish low urgency situations by qualifiers: if you feel unwell, or if exposed or concerned. 
 
We are very grateful to those who contributed additional thoughts after the meeting and we have drawn on these, as well as the comments made in the meeting, in further developing the proposals. 

To show our thinking, this paper sets out the following steps:
     Allocation of the hazard classes and categories into the appropriate quadrants;
     Assignment of new medical response precautionary statement(s) to each quadrant; 
     Amendment of the matrix and associated `IF'; combination statements and text in Annex 3 Section 3. 
 
 Allocation of hazard class / categories to the appropriate urgency/seriousness quadrants:
Taking note of the thoughtful views expressed, we have refined the allocation of hazard classes and categories in the urgency/seriousness quadrants (Figure 1 overleaf).  Some brief explanatory notes follow.  

High Urgency / High Seriousness quadrant (HH):
 This quadrant is only for the highest categories of specific hazard classes that require immediate medical treatment; 
 There seems to be general agreement that acute toxicity (oral (1-3); dermal (1-2) and inhalation (1-2)); skin corrosion (1,1A/B/C); eye damage (1); aspiration (1-2); and gases under pressure (refrigerated liquefied gases) all belonged to the HH quadrant;
 Taking into account comments received we have now included respiratory sensitizers (1,1A/B).

High Urgency / Low Seriousness quadrant (HL):
 The hazard classes and categories in this quadrant are skin sensitizers (1,1A/B), skin irritation (2-3) and eye irritation (2A/B).

Low Urgency / High Seriousness quadrant (LH):
 The hazard classes and categories in this quadrant are acute toxicity inhalation (3); STOT SE (1-2); and CMR (1-2). Several commented that STOT SE (1-2) should be LH;
 Allocation of acute toxicity - inhalation (3) reflects the need for an intermediate response between acute toxicity inhalation (1-2) (HH) and acute toxicity inhalation (4-5) LL.  However, we recognise there may be arguments to group differently.

Low Urgency / Low Seriousness quadrant (LL):
 The hazard classes and categories acute toxicity, oral and inhalation (4-5) and dermal (3-5); STOT RE (1-2); and STOT SE (3) remain in this quadrant.
      
However, we still welcome any further views that you have regarding the proposed allocation of hazard class / categories, particularly in relation to respiratory and skin sensitisers, and for acute toxicity inhalation (3).

                                       
                                   Figure 1

                                      HL
HH
                                     High
                                    Urgency
                                      Low
                                 Seriousnesss
                                      LL
                                      LH
                                      Low
                                    Urgency
                                     High
                                  Seriousness
                                          Acute Toxicity
      - Oral (1-3)
      - Dermal & Inhalation (1-2)
Skin Corrosion (1,1A/B/C)
Eye Damage (1)
Aspiration (1-2)
Respiratory Sensitisers (1,1A/B)
Gases under pressure 
(refrigerated liquefied gas)
Acute Toxicity  -  Inhalation (3) 
STOT SE (1-2) 
CMR (1-2)
Acute Toxicity
  - Oral& Inhalation (4-5)
  - Dermal (3-5)
STOT RE (1-2)
STOT SE (respiratory irritation or 
narcotic effects) (3)
Skin Sensitisers (1,1A/B)
Skin Irritation (2-3) 
Eye Irritation (2A/B) 































Question 1: Do Correspondence Group members agree with the allocation of hazard classes and hazard categories to the quadrants? 


 Proposed medical response statements:

2.1	The objective is to frame simple, succinct, translatable and universally understood precautionary statements that are applicable in all jurisdictions, and that clearly distinguish the hazard classes and categories that require immediate/urgent medical treatment from those that require less urgent medical help.

2.2	Thoughts on terminology 
 In view of the previous difficulties with medical advice / attention and Poison Centre / Doctor ... we have sought to avoid options in precautionary statements. 
 The terms used in the precautionary statements need to be appropriate regardless of local arrangements and organisation of the health services in individual jurisdictions across the world (but see 2.3 below). 
 As previously discussed, medical treatment is considered to be broadly equivalent to medical attention, i.e. treatment of an individual by someone (e.g. first aider, emergency responder, paramedic, doctor, surgeon) who has been trained to undertake certain functions. 
 The precautionary statement for the HH quadrant should clearly signal the urgency of getting medical treatment.  A suitable phrase might be `Immediately get emergency medical treatment'. A challenge is to find a way to indicate more precisely what to do in the emergency situation where this is considered necessary (see 2.3 below).
 Medical help is a broader term which includes medical advice (i.e. professional advice to an individual about an existing medical condition or concern), as well as medical treatment.  It would appear to be a term that is widely understood as signalling the need to get external assistance so decisions can be made about any further action that may be needed. We have used this for the quadrants with lower seriousness to communicate the message `Get medical help'. In the case of low urgency (LL) the additional qualifier, as now, is `if you feel unwell' (P312).
 However, for the LH quadrant we suggest `Get medical advice' is appropriate, given the more serious potential for the hazards concerned, including CMRs.  Again following current practice for CMRs and STOT SE 1 and 2 the qualifier for the LH quadrant is `If exposed or concerned' (previously P308).
   
 Adding further information on what to do in the emergency situation
 For many jurisdictions the precautionary statement `Immediately get emergency medical treatment' may be sufficient, others may want to give more detail on what to do in the emergency situation in a way that reflects their specific arrangements.  Appropriate actions might be to telephone the emergency response number for a country or region (e.g. 911, 111 or 999), or to refer the individual to a poison centre, emergency centre, doctor etc. in line with the arrangements and organisation of the health services in the country or region concerned.
 Noting that in the past providing options using a forward slash (`/') or three dots (`...') have not been successful in the context of medical response, as often no choice is made and these notations appear on labels, we propose a new approach using Column 5.  We propose that, subject to the requirements of the Competent Authority or to the discretion of the manufacturer or supplier, Column 5 is used to permit use of a supplementary precautionary statement.  This would follow `Immediately get emergency medical treatment', and would start with `Call', followed by the appropriate emergency telephone number for the country or region concerned, or by the appropriate provider of emergency medical treatment, which could be a poison centre, emergency centre, doctor or alternative. If this way forward is agreed some explanatory text could be provided in Annex 3, Section 2.
 To help ensure that the emergency response services worldwide are focussed where they are most needed, we propose to limit this additional statement to the HH quadrant only. 
   
2.4	Proposed medical response precautionary statements
Figure 2 and Table 1 below bring together these considerations for proposed medical response precautionary statements for the hazard classes and hazard categories allocated to the HH, HL, LH and LL quadrants, together with the proposed Column 5 entry for the precautionary statement assigned to the HH quadrant.

                                    Table 1

                                   Quadrant
                   Proposed new medical response statements:
                                Column 5 entry
HH
Immediately get emergency medical treatment.


Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
HL
Get medical help

LH
If exposed or concerned, get medical advice 

LL
Get medical help if you feel unwell




                                   Figure 2

                                      HL
HH
                                     High
                                    Urgency
                                      Low
                                  Seriousness
                                      LL
                                      LH
                                      Low
                                    Urgency
                                     High
                                  Seriousness
                                          Acute Toxicity
      - Oral (1-3)
      - Dermal & Inhalation (1-2)
Skin Corrosion (1,1A/B/C)
Eye Damage (1)
Aspiration (1-2)
Respiratory Sensitisers (1,1A/B)
Gases under pressure 
  (refrigerated liquefied gas)
Acute Toxicity  -  Inhalation (3) 
STOT SE (1-2) 
CMR (1-2)
Acute Toxicity
  - Oral& Inhalation (4-5)
  - Dermal (3-5)
STOT RE (1-2)
STOT SE (respiratory irritation or 
narcotic effects) (3)
Skin Sensitisers (1,1A/B)
Skin Irritation (2-3) 
Eye Irritation (2A/B) 

Get medical help
Immediately get emergency medical treatment*
Get medical help if you feel unwell
If exposed or concerned get medical advice











































*Supplementary provision enabling Competent Authority to require, or manufacturer/supplier to add, `Call' followed by the appropriate emergency telephone number, or the appropriate provider of emergency medical treatment, for example, a Poison Centre, Emergency Centre or Doctor. 

Question 2: Do Correspondence Group members agree the proposed medical response precautionary statements for each quadrant and the proposal for a supplementary provision in Column 5 for the statement `Immediately get emergency medical treatment'?

3. Amendment of the matrix:

The proposed changes to the medical response precautionary statements are illustrated in Appendix 1 in `track changes' mode of Table A.3.2.3 (7[th] revision GHS).  The deleted text is shown in strikethrough and the new text in purple.  HH, HL, LH and LL are included at this stage for illustration/discussion purposes only.  A `clean' version of the proposed changes to P301 to P313 in Table A3.2.3 is in Appendix 2. 

Note that P308 If exposed or concerned is now incorporated in a medical response statement in a similar way to if you feel unwell.  P308 can now be deleted.  Application of the new phrase If exposed or concerned, get medical advice includes the same hazard classes and categories as P308.  The combination statements P308+P311 and P308+P313 can also be deleted as they are covered by the new PS If exposed or concerned, get medical advice with the same hazard classes and categories.

Consider deleting P303, IF ON SKIN (or hair), and using P302, IF ON SKIN, instead.




Appendix 1: Proposed changes to P301 to P315 and relevant combined PSs of Table A3.2.3:  Codification of response precautionary statements
                                     Code
                       Response precautionary statements
                                 Hazard class
                                Hazard category
                              Conditions for use
                                      (1)
                                      (2)
                                      (3)
                                      (4)
                                      (5)
                                     P301
IF SWALLOWED:
Acute toxicity, oral (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Aspiration hazard (chapter 3.10)
                                     1, 2

                                     P302
IF ON SKIN:
Flammable liquids (chapter 2.6)
                                    1, 2, 3

                                       

Pyrophoric liquids (chapter 2.9)
                                       1

                                       

Pyrophoric solids (chapter 2.10)
                                       1

                                       

Substances and mixtures which, in contact with water, emit flammable gases (chapter 2.12)
                                     1, 2

                                       

Acute toxicity, dermal (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Skin irritation (chapter 3.2)
                                       2

                                       

Skin sensitization (chapter 3.4)
                                   1, 1A, 1B

                                     P303
IF ON SKIN (or hair):
Flammable liquids (chapter 2.6)
                                    1, 2, 3
[Note: move to P302 above]
                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                     P304
IF INHALED:
Acute toxicity, inhalation (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Respiratory sensitization (chapter 3.4)
                                   1, 1A, 1B

                                       

Specific target organ toxicity, single exposure; respiratory tract irritation (chapter 3.8)
                                       3

                                       

Specific target organ toxicity, single exposure; narcotic effects (chapter 3.8)
                                       3

                                     P305
IF IN EYES:
Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Serious eye damage (chapter 3.3)
                                       1

                                       

Eye irritation (chapter 3.3)
                                    2A, 2B

                                     P306
IF ON CLOTHING:
Oxidizing liquids (chapter 2.13)
                                       1

                                       

Oxidizing solids (chapter 2.14)
                                       1

                                       


                                       

                                     P308
IF exposed or concerned:
Germ cell mutagenicity (chapter 3.5)
                                   1A, 1B, 2
[Note: P308 no longer needed as incorporated in new P313  -  `If exposed or concerned, get medical advice'  -  and applied to the same hazard classes and categories] 
                                       

Carcinogenicity (chapter 3.6)
                                   1A, 1B, 2

                                       

Reproductive toxicity (chapter 3.7)
                                   1A, 1B, 2

                                       

Reproductive toxicity, effects on or via lactation (chapter 3.7)
                              Additional category

                                       

Specific target organ toxicity, single exposure (chapter 3.8)
                                     1, 2

                                       


                                       

                                     P310
Immediately call a POISON CENTER/doctor/...
Immediately get emergency medical treatment.
Gases under pressure (chapter 2.5) (HH)
                          Refrigerated liquefied gas
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
[Note: Resp Sensitisers moved from P311 and Gases under pressure moved from P315 below]
                                       

Acute toxicity, oral (chapter 3.1) (HH)
                                    1, 2, 3

                                       

Acute toxicity, dermal (chapter 3.1) (HH)
                                     1, 2

                                       

Acute toxicity, inhalation (chapter 3.1) (HH)
                                     1, 2

                                       

Skin corrosion (chapter 3.2) (HH)
                                  1A, 1B, 1C

                                       

Serious eye damage (chapter 3.3) (HH)
                                       1

                                       

Respiratory sensitization (chapter 3.4) (HH)
                                   1, 1A, 1B

                                       

Aspiration hazard (chapter 3.10) (HH)
                                     1, 2

                                     P311
Call a POISON CENTER/doctor/...
Get medical help.
Acute toxicity, inhalation (chapter 3.1) (LH)
                                       3
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
[Note: Acute tox inhalation (3) and STOT SE (1-2) moved to P313 below]
[Note: Resp Sensitisers moved to P310 above]
                                       

Respiratory sensitization (chapter 3.4) (HH)
                                   1, 1A, 1B

                                       

Specific target organ toxicity, single exposure (chapter 3.8) (LH)
                                     1, 2

                                       

Skin irritation (chapter 3.2) (HL)
                                     2, 3
[Note: moved from P313 below]
                                       

Eye irritation (chapter 3.3) (HL)
                                    2A, 2B

                                       

Skin sensitization (chapter 3.4) (HL)
                                   1, 1A, 1B

                                     P312
Call a POISON CENTER/doctor/...if you feel unwell.
Get medical help if you feel unwell.
Acute toxicity, oral (chapter 3.1) (LL)
                                     4, 5
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
                                       

Acute toxicity, dermal (chapter 3.1) (LL)
                                    3, 4, 5

                                       

Acute toxicity, inhalation (chapter 3.1) (LL)
                                     4, 5

                                       

Specific target organ toxicity, single exposure; respiratory tract irritation (chapter 3.8) (LL)
                                       3

                                       

Specific target organ toxicity, single exposure; narcotic effects (chapter 3.8) (LL)
                                       3

                                       

Specific target organ toxicity, repeated exposure (chapter 3.9) (LL)
                                     1, 2
[Note: moved from P314 below]
                                     P313
                                     P313
Get medical advice/attention.
If exposed or concerned, get medical advice.
Skin irritation (chapter 3.2) (HL)
                                     2, 3
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
[Note: moved to P311 above]
                                       

Eye irritation (chapter 3.3) (HL)
                                    2A, 2B

                                       

Skin sensitization (chapter 3.4) (HL)
                                   1, 1A, 1B

                                       

Acute toxicity, inhalation (chapter 3.1) (LH)
                                       3
[Note: Acute tox inhalation (3) moved from P311 above]
                                       

Germ cell mutagenicity (chapter 3.5) (LH)
                                   1A, 1B, 2

                                       

Carcinogenicity (chapter 3.6) (LH)
                                   1A, 1B, 2

                                       

Reproductive toxicity (chapter 3.7) (LH)
                                   1A, 1B, 2

                                       

Reproductive toxicity, effects on or via lactation (chapter 3.7) (LH)
                              Additional category

                                       

Specific target organ toxicity, single exposure; (chapter 3.8) (LH)
                                     1, 2

                                     P314
Get medical advice/attention if you feel unwell.

Specific target organ toxicity, repeated exposure (chapter 3.9) (LL)
                                     1, 2
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
[Note: moved to P312 above]
                                     P315
Get immediate medical advice/attention.

Gases under pressure (chapter 2.5) (HH)
                          Refrigerated liquefied gas
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
[Note: moved to P310 above]
                                       
                                       
                                       


                                       

                                  P301
+
P310
IF SWALLOWED:  Immediately get emergency medical treatment. Immediately call a POISON CENTER/doctor/...
Acute toxicity, oral (chapter 3.1)
                                    1, 2, 3
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
                                       

Aspiration hazard (chapter 3.10)
                                     1, 2

                                  P301
+
P312
IF SWALLOWED:  Get medical help if you feel unwell. Call a POISON CENTER/ doctor/...if you feel unwell.
Acute toxicity, oral (chapter 3.1)
                                     4, 5
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
                                  P302
+
P334
IF ON SKIN:  Immerse in cool water or wrap in wet bandages.
Pyrophoric liquids (chapter 2.9)
                                       1

                                 P302 
+ 
P352
IF ON SKIN:  Wash with plenty of water/...
Acute toxicity, dermal (chapter 3.1)
                                 1, 2, 3, 4, 5
...Manufacturer/supplier or the competent authority may specify a cleansing agent if appropriate, or may recommend an alternative agent in exceptional cases if water is clearly inappropriate.
                                       

Skin irritation (chapter 3.2)
                                       2

                                       

Skin sensitization (chapter 3.4)
                                   1, 1A, 1B

                                 P304 
+ 
P312
IF INHALED:  Get medical help if you feel unwell. Call a POISON CENTER/doctor/...if you feel unwell.
Acute toxicity, inhalation (chapter 3.1)
                                       5
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
                                 P304 
+ 
P340
IF INHALED:  Remove person to fresh air and keep comfortable for breathing.
Acute toxicity, inhalation (chapter 3.1)
                                  1, 2, 3, 4

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Respiratory sensitization (chapter 3.4)
                                   1, 1A, 1B

                                       

Specific target organ toxicity, single exposure; respiratory tract irritation (chapter 3.8)
                                       3

                                       

Specific target organ toxicity, single exposure; narcotic effects (chapter 3.8)
                                       3

                                 P306 
+ 
P360
IF ON CLOTHING:  Rinse immediately contaminated clothing and skin with plenty of water before removing clothes.
Oxidizing liquids (chapter 2.13)
                                       1

                                       

Oxidizing solids (chapter 2.14)
                                       1

                                 P308 
+ 
P311
IF exposed or concerned:  Call a POISON CENTER/doctor/...
Specific target organ toxicity, single exposure (chapter 3.8)
                                     1, 2
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
                                 P308 
+ 
P313
IF exposed or concerned:  Get medical advice/ attention.
Germ cell mutagenicity (chapter 3.5)
                                   1A, 1B, 2
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
                                       

Carcinogenicity (chapter 3.6)
                                   1A, 1B, 2

                                       

Reproductive toxicity (chapter 3.7)
                                   1A, 1B, 2

                                       

Reproductive toxicity, effects on or via lactation (chapter 3.7)
                              Additional category

                              P332 
+ 
P313 P311
If skin irritation occurs:  Get medical help. Get medical advice/attention.
Skin irritation (chapter 3.2)
                                     2, 3
 -  may be omitted when P333+P313 is given on the label.
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
                                P333 
+ 
P3113
If skin irritation or rash occurs:  Get medical help. Get medical advice/attention. 
Skin sensitization (chapter 3.4)
                                   1, 1A, 1B
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
                                P336 
+
P3105
Thaw frosted parts with lukewarm water.  Do not rub affected area.  Immediately get emergency medical treatment. Get immediate medical advice/attention
Gases under pressure (chapter 2.5)
                          Refrigerated liquefied gas
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
                                P337 
+ 
P3113
If eye irritation persists:  Get medical help.  Get medical advice/attention.
Eye irritation (chapter 3.3)
                                    2A, 2B
Manufacturer/supplier or the competent authority to select medical advice or attention as appropriate.
                                 P342 
+ 
P311
                                     P310
If experiencing respiratory symptoms:  Immediately get emergency medical treatment.   Call a POISON CENTER/doctor/...
Respiratory sensitization (chapter 3.4)
                                   1, 1A, 1B
...Manufacturer/supplier or the competent authority to specify the appropriate source of emergency medical advice.
Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
                                 P361 
+ 
P364
Take off immediately all contaminated clothing and wash it before reuse.
Acute toxicity, dermal (chapter 3.1)
                                    1, 2, 3

                                 P362 
+ 
P364
Take off contaminated clothing and wash it before reuse.
Acute toxicity, dermal (chapter 3.1)
                                       4

                                       

Skin irritation (chapter 3.2)
                                       2

                                       

Skin sensitization (chapter 3.4)
                                   1, 1A, 1B

                                 P370 
+ 
P376
In case of fire:  Stop leak if safe to do so.
Oxidizing gases (chapter 2.4)
                                       1

                                 P370 
+ 
P378
In case of fire:  Use ... to extinguish.
Flammable liquids (chapter 2.6)
                                  1, 2, 3, 4
 -  if water increases risk.
... Manufacturer/supplier or the competent authority to specify appropriate media.
                                       

Flammable solids (chapter 2.7)
                                     1, 2

                                       

Self-reactive substances and mixtures (chapter 2.8)
                               Types C, D, E, F

                                       

Pyrophoric liquids (chapter 2.9)
                                       1

                                       

Pyrophoric solids (chapter 2.10)
                                       1

                                       

Substances and mixtures which, in contact with water, emit flammable gases (chapter 2.12)
                                    1, 2, 3

                                       

Oxidizing liquids (chapter 2.13)
                                    1, 2, 3

                                       

Oxidizing solids (chapter 2.14)
                                    1, 2, 3

                                       

Organic peroxides (chapter 2.15)
                               Types C, D, E, F

                                       


                                       

                              P301
+
P330 
+
P331
IF SWALLOWED:  Rinse mouth.  Do NOT induce vomiting.
Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                             P302
+
P335
 + 
P334
IF ON SKIN:  Brush off loose particles from skin.  Immerse in cool water [or wrap in wet bandages].
Pyrophoric solids (chapter 2.10)
                                       1
 -  text in square brackets to be used for pyrophoric solids
                                       

Substances and mixtures which, in contact with water, emit flammable gases (chapter 2.12)
                                     1, 2
 -  use only "Immerse in cool water." Text in square brackets should not be used.
                            P3023 
+ 
P361 
+ 
P353
IF ON SKIN (or hair):  Take off immediately all contaminated clothing.  Rinse skin with water [or shower].
Flammable liquids (chapter 2.6)
                                    1, 2, 3
 -  text in square brackets to be included where the manufacturer/supplier or the competent authority considers it appropriate for the specific chemical.
                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                            P305 
+ 
P351 
+ 
P338
IF IN EYES:  Rinse cautiously with water for several minutes.  Remove contact lenses, if present and easy to do.  Continue rinsing.
Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Serious eye damage (chapter 3.3)
                                       1

                                       

Eye irritation (chapter 3.3)
                                    2A, 2B

                            P370 
+ 
P380 
+ 
P375
In case of fire:  Evacuate area.  Fight fire remotely due to the risk of explosion.

Explosives (chapter 2.1)
                                 Division 1.4
 -  for explosives of division 1.4 (compatibility group S) in transport packaging
                                       

Desensitized explosives (chapter 2.17)
                                    1, 2, 3

                            P371 
+ 
P380 
+ 
P375
In case of major fire and large quantities:  Evacuate area.  Fight fire remotely due to the risk of explosion.

Oxidizing liquids (chapter 2.13)
                                       1

                                       

Oxidizing solids (chapter 2.14)
                                       1

                                       

Desensitized explosives (chapter 2.17)
                                       4

                                       


                                       

                        P370 
+ 
P372 
+ 
P380 
+ 
P373
In case of fire:  Explosion risk. Evacuate area. DO NOT fight fire when fire reaches explosives.
Explosives (chapter 2.1)
             Unstable explosives and divisions 1.1, 1.2, 1.3, 1.5

                                       


                                 Division 1.4
 -  except for explosives of division 1.4 (compatibility group S) in transport packaging.
                                       

Self-reactive substances and mixtures (chapter 2.8)
                                    Type A

                                       

Organic peroxides (chapter 2.15)
                                    Type A

                        P370 
+ 
P380 
+ 
P375
[+
P378]
In case of fire:  Evacuate area.  Fight fire remotely due to the risk of explosion. [Use...to extinguish].
Self-reactive substances and mixtures (chapter 2.8)
                                    Type B
 -  text in square brackets to be used if water increases risk.
... Manufacturer/supplier or the competent authority to specify appropriate media.
                                       

Organic peroxides (chapter 2.15)
                                    Type B



Appendix 2: `Clean' version of the proposed revised medical response precautionary statements P301 to P313 in Table A3.2.3
                                     Code
                       Response precautionary statements
                                 Hazard class
                                Hazard category
                              Conditions for use
                                      (1)
                                      (2)
                                      (3)
                                      (4)
                                      (5)
                                     P301
IF SWALLOWED:
Acute toxicity, oral (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Aspiration hazard (chapter 3.10)
                                     1, 2

                                     P302
IF ON SKIN:
Flammable liquids (chapter 2.6)
                                    1, 2, 3

                                       

Pyrophoric liquids (chapter 2.9)
                                       1

                                       

Pyrophoric solids (chapter 2.10)
                                       1

                                       

Substances and mixtures which, in contact with water, emit flammable gases (chapter 2.12)
                                     1, 2

                                       

Acute toxicity, dermal (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Skin irritation (chapter 3.2)
                                       2

                                       

Skin sensitization (chapter 3.4)
                                   1, 1A, 1B

                                       


                                       

                                     P304
IF INHALED:
Acute toxicity, inhalation (chapter 3.1)
                                 1, 2, 3, 4, 5

                                       

Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Respiratory sensitization (chapter 3.4)
                                   1, 1A, 1B

                                       

Specific target organ toxicity, single exposure; respiratory tract irritation (chapter 3.8)
                                       3

                                       

Specific target organ toxicity, single exposure; narcotic effects (chapter 3.8)
                                       3

                                     P305
IF IN EYES:
Skin corrosion (chapter 3.2)
                                  1A, 1B, 1C

                                       

Serious eye damage (chapter 3.3)
                                       1

                                       

Eye irritation (chapter 3.3)
                                    2A, 2B

                                     P306
IF ON CLOTHING:
Oxidizing liquids (chapter 2.13)
                                       1

                                       

Oxidizing solids (chapter 2.14)
                                       1






                                       

                                     P310
Immediately get emergency medical treatment.
Gases under pressure (chapter 2.5) 
                          Refrigerated liquefied gas
Competent Authority may require, or manufacturer / supplier may add, `Call' followed by the appropriate emergency telephone number, or the appropriate emergency medical treatment provider, for example, a Poison Centre, Emergency Centre or Doctor.
                                       

Acute toxicity, oral (chapter 3.1) 
                                    1, 2, 3

                                       

Acute toxicity, dermal (chapter 3.1) 
                                     1, 2

                                       

Acute toxicity, inhalation (chapter 3.1) 
                                     1, 2

                                       

Skin corrosion (chapter 3.2) 
                                  1A, 1B, 1C

                                       

Serious eye damage (chapter 3.3) 
                                       1

                                       

Respiratory sensitization (chapter 3.4) 
                                   1, 1A, 1B

                                       

Aspiration hazard (chapter 3.10) 
                                     1, 2

                                     P311
Get medical help.
Skin irritation (chapter 3.2) 
                                     2, 3

                                       

Eye irritation (chapter 3.3) 
                                    2A, 2B

                                       

Skin sensitization (chapter 3.4) 
                                   1, 1A, 1B

                                     P312
Get medical help if you feel unwell.
Acute toxicity, oral (chapter 3.1) 
                                     4, 5

                                       

Acute toxicity, dermal (chapter 3.1) 
                                    3, 4, 5

                                       

Acute toxicity, inhalation (chapter 3.1) 
                                     4, 5

                                       

Specific target organ toxicity, single exposure; respiratory tract irritation (chapter 3.8) 
                                       3

                                       

Specific target organ toxicity, single exposure; narcotic effects (chapter 3.8) 
                                       3

                                     P313
If exposed or concerned, get medical advice.
Acute toxicity, inhalation (chapter 3.1) 
                                       3

                                       

Germ cell mutagenicity (chapter 3.5) 
                                   1A, 1B, 2

                                       

Carcinogenicity (chapter 3.6) 
                                   1A, 1B, 2

                                       

Reproductive toxicity (chapter 3.7) (
                                   1A, 1B, 2

                                       

Reproductive toxicity, effects on or via lactation (chapter 3.7) 
                              Additional category

                                       

Specific target organ toxicity, single exposure (chapter 3.8) 
                                     1, 2


