Major Accidents in Oil and Gas, Petrochemicals, and Pharmaceutical Plants - The causes, relief measures, consequences and

lesson learnt

GROUP MEMBERS: 1. Mohamad Afif bin Che Aziz (ME) 2. Muhammad Afieq Zakwan (ME) 3. Nurul Aimi Bt Saari (ME, 13656) 4. Angel anak Richard (ME) 5. Nurul Hannah (PGS)

CONTENTS
Introduction Phenomena associated with major accidents: I. Loss of containment II. Reactive incident III. Ignition source: Dust explosion, Vapour cloud explosion Lesson learn Conclusion

INTRODUCTION Accident is an undesired event that results in personal injury and property damage. (National Safety Council ) Major accident is a significant event, which demands a response beyond the routine, resulting from uncontrolled developments in the course of the operation of any establishment or transient work activity. This event may involve death, injuries and illness to the workers and community. Other than that, it can cause serious disruption and damage to property inside or outside the event place. (www.hse.gov.uk) Objective: 1. To understand more on the causes of major accidents 2. The consequences 3. Relieve measures taken 4. Examine lessons to be learned What to achieve? To create awareness on health, safety and environment in plants. To challenge some existing paradigms. Identify opportunities for the future.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Loss of containment

Loss of containment exists of material contained in an

enclose place to atmosphere through a hole, crack or opening valve. Major accidents always start with loss of containment. Causes: Corrosion, mechanical impact or human error The effects depends on: condition of material, its properties, meteorological conditions and measures taken to relieve the leak. Potential to cause major accidents in oil and gas production, pharmaceutical industries and petrochemical industries.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Loss of containment ACCIDENTS

Montora oil spill

CAUSES
Leakage of oil & gas Failure of the operator & regulator :failures by PTT (Petroleum Authority of Thailand) personnel to verify and test the well integrity before BOP (blowout preventer) was removed to the next well which cause the reservoir fluids entered the well bore Leakage in pipe released methanol/peroxide Rise in temperature accelerate decomposition of grid (peroxide) that maintained insulation material on column

CONSEQUENCES
Cause catastrophic marine ecosystems

RELIEF MEASURES
Pumping about 3400 barrels of mud into well Capping the blowout through the wellbore cement Sprayed 10 000 litres of chemical dispersant onto parts of the slick by mobilising Hercules aircraft environmental monitoring program was execute by Australian Government process safety indicators was created Swiss Cheese Model

Linz Austria, 2003 (Pharmaceutical plant)

20 workers suffer burns, bone fractures & bruises Office destroyed Materials in 150m radius perimeter were damage Loss estimated to be 20 million euros

Ozonolysis column was installed in separate cold box in different building with video control Leakage indicator system installed Pressure & temperature measurements added Reactor resist explosion Pressure relief valve installed 2004 replacing ozonolysis with reaction of air and inert gases

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Loss of containment

ACCIDENTS
Flixborough 1974 (Petrochemical plant)

CAUSES
Leakage of nitrates No calculation & concern was voiced out over structural strength of the bellows & bypass No bellows manufacturers published users guide Failed in employed column/ other means to prevent bypass movement

CONSEQUENCES
28 employee were killed & 36 were badly injured 53 injuries outside facility & hundreds more mild injuries Risk from combustion fumes of chemicals substances Property damage Buildings, house & retail business were destroyed & damaged Environment pollution

RELIEF MEASURES
Adopting Seveso directive Rebuilding plant with strict attention. Replacing the process involving cyclohexane oxidation with the use of phenol hydrogenation.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Reactive Incident

ACCIDENTS
Reactive incident occurred in the Catalyst System Inc. Facility in Gnadenhutten, Ohio.

CAUSES
HAZARDOUS Failure of the temperature probe Contamination in the dryer from exposure to metal surface Hot spot in the dryer Contamination in the dryer from exposure to metal surface BPO remaining in the dryer too long Generation of heat energy from friction Failure of the vacuum pump causing loss of evaporative cooling Generation of a spark due to static electricity Violation of good practise in terms of equipment handling and safety measures to be taken

CONSEQUENCES
One employee received small puncture on his shoulder from flying debris A small fire in the southwest corner of the building. Runoff water from the building was also tested in several locations to see if they were hazardous. The dryer propelled through the steel dividing wall and landed 35 feet from the initial location Extensive damaged from the support at the south side of the building. The roof was also badly damaged.

RELIEF MEASURES
Instantly after the explosion, the automatic building sprinkler activated and the employees went to the designated evacuation area. Gnadenhutten Police and Fire Departments helped in preventing a bigger consequence of the incident. The fire brigade extinguished the fire and several other fire departments were called to assist.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Ignition source

Ignition: process or event capable of causing a fire or explosion. - happened whenever flammable or combustible materials or substance involved 19 possible ignition source by Health and Safety Executives : - Flames; Direct fired space and process heating; Use of cigarettes/matches etc; - Cutting and welding flames; Spontaneous heating; - Hot surfaces; Heated process vessels such as dryers and furnaces; hot process vessels; Space heating equipment; - Mechanical machinery; Electrical equipment and lights; Impact sparks; Friction heating or sparks; Sparks from electrical equipment; - Stray currents from electrical equipment Electrostatic discharge sparks: Lightning strikes; - Electromagnetic radiation of different wavelengths Vehicles, unless specially designed or modified are likely to contain a range of potential ignition sources

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Ignition source: dust explosion Dust explosion: combustible liquids, combustible or flammable powder could be ignited whenever they are dispersed or finely divided into specific concentration and make contact with an ignition source. - Primary explosion : confined space or atmosphere such as vessel and chamber, part of manufacturing plant and equipment - Secondary explosion: involve dust clouds of flammable dust, finely distributed in contact with the oxygen & ignition source which cause wide explosion ACCIDENTS
Masterton Dust Explosion (1965)

CAUSES
Plastic dusts which has accumulated under the floor of the button ornamenting room short circuit of an under floor electrical socket

CONSEQUENCES

Demolished a locker room Four people died and six were injured in the incident

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Ignition source: dust explosion ACCIDENTS
Kinston Accidents (2003) West Pharmaceutical explosion

CAUSES
Explosion Failure on behalf of facility management to conform the standards that would reduce or prevented the effects of explosion to NFPA (National Fire Protection Agency). Failures to identified dust explosion hazards or recommend protective measures by company personnel, government standards enforcement officials, insurance underwriters and health and safety professionals that inspecting the facilities. The housekeeping procedure was inadequate for the unsafe accumulations of combustible dust in the facilities. Lack of awareness on dust explosion hazards among workers and managers. The elimination or control combustible dust hazards procedures and training were inadequate. The causes of previous fires and other warning events were not identified and resolved. The maintenance and designed of dust collectors to minimize explosions were inadequate.

CONSEQUENCES
6 employee were killed and 38 people suffered from injuries The shattered glass from more than half a mile away injured a student at a school. two 7,500-gallon plastic tanks of mineral oil collapsed The flaming debris caused the forest on fire. The rubber storage warehouse was burned for more than two days and many buildings are collapsed. loss of jobs in Kinston.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Ignition source: vapour cloud explosion Vapour cloud explosion: due to rupture or crack in vessel and pipes which released combustible substance such as gasses, highly flammable exposed to ignition source. Similar to dust explosion except the consequences are more catastrophic. ACCIDENTS
Flixborough Accidents - 1974

CAUSES
Vertical crack on the reactor which caused a leak of a flammable substance, cyclohexane. The substance found a source of ignition thus caused the explosion.

CONSEQUENCES
28 employee were killed & 36 were badly injured 53 injuries outside facility & hundreds more mild injuries Risk from combustion fumes of chemicals substances Property damage Buildings, house & retail business were destroyed & damaged Environment pollution Explosion radius of 2 km. 43 reported injuries Damage of property

Buncefield, UK 2005

Overpressure of liquid contributes to high magnitude concentration of vapour cloud under stable wind conditions failure of automatic safety switch alarm causes the tank to fill twice its maximum capacity High speed rotating machine in the pump house is identified as the source of ignition.

PHENOMENA ASSOCIATED WITH MAJOR ACCIDENT Ignition source

RELIEF MEASURES: Segregating dust-producing operations, sealing walls, ceilings, and partitions to prevent the accumulation of dust. Only the electrical equipment that are suitable for potentially explosive atmospheres can be used Regular training on the combustible dust hazards. Conduct educational outreach programme to avoid future accidents Encourage training of North Carolina fire and building code officials on combustible dust Improve the material safety review procedures

LESSONS LEARNT Mechanical (Loss of containment)

Instillation design Control room must be located away from hazardous region Limit hazard potential present onsite Management of facility modification, personnel interventions and maintenance Use official standards on construction, designs and modifications Mechanical Lessons Structural reliability must always be inspected Human Factor High skilled workers are important Technical knowledge prevents accident Responsibility for Environmental Issues

LESSONS LEARNT Chemical

Technical Aspects Sealed ceilings at area which contain hazardous dust Monitor not to accumulate and reach explosive environment Dust Control Effective and Efficient Filtration System Cleaning methods that inhibit accumulation of explosive dust Training to the employees on HSE Proper cleanouts Require high skilled workers Always implement systematic documentations Importance of Waste Generator Satellite Accumulation Area (SAA)

LESSONS LEARNT Ignition source

Health & Safety Awareness Long Term Investment Create a safe environment Standard Safety Board for Chemical and Dust Explosion

CONCLUSION The case study in context is something that we and people all around the globe as industrial workers face throughout our daily lives and all these accidents are very real and took place around us. Via observation and analysis of some examples of major accidents that involved the industry, we can see these potential hazards certainly pose a lot of risks to the safety of the workers. We have been able to outline the causes of these catastrophic events, the consequences that had been resulted from the accidents and relief measures taken in order to cope with such events. Throughout the analysis of these case studies, we have enlisted few lessons that are learnt via coping with these accidents. We came to conclude that solutions that have been suggested before can really contribute in minimizing the risk of accidents in the industry. At the end of the day, it is still up to the efforts, responsibility and integrity of the management especially and also the workers to ensure a safe working environment of the oil and gas, petrochemicals, and pharmaceutical industries.