The Phillips disaster

Timeline: October 23, 1989

Occurrence place: Pasadena, Texas
Originated from: Phillips 66 Company's Houston Chemical Complex (HCC)
facility near the Houston Ship Channel in Pasadena, Texas, United States.
fatalities: The explosions killed 23 employees and injured 314
Strength of disaster: The initial blast registered 3.5 on the Richter scale, and
the conflagration took 10 hours to bring under control.
Plant strength:
• The HCC produced approximately 15,000,000,000 pounds
(6,800,000 t) per year of high-density polyethylene (HDPE)
• a plastic material used to make milk bottles and other containers.
• Approximately 1500 people worked at the facility, including 905
company employees and approximately 600 daily contract
employees, who were engaged primarily in regular maintenance
activities and new plant construction
Causes of the hazard:
• The accident resulted from a release of
extremely flammable process gases that occurred during regular
maintenance operations on one of the plant's polyethylene reactors.
• More than 85,000 pounds (39 t) of highly flammable gases were
released through an open valve almost instantaneously.
• During routine maintenance, isolation valves were closed and
compressed air hoses that actuated them physically disconnected as a
safety measure.
Causes of the hazard:
• The air connections for opening and closing this valve were identical,
and had been improperly reversed when last re-connected.
• As a result, the valve would have been open when the switch in the
control room was in the "valve closed" position. After that, the valve
was opened when it was expected to stay closed, and finally passed
the reactor content into air.[2]
• A vapor cloud formed and traveled rapidly through the polyethylene
plant. Within 90 to 120 seconds, the vapor cloud came into contact
with an ignition source and exploded with the force of 2.4 tons
of TNT.[1]
Causes of the hazard:
• Ten to fifteen minutes later, that was followed by the explosion of the
20,000-U.S.-gallon (76,000 L) isobutane storage tank, then by the
catastrophic failure of another polyethylene reactor, and finally by
other explosions,
• probably about six in total
Explosion:
• The incident started at approximately 1:05 PM local time on October 23, 1989, at 1400 Jefferson
Road, Pasadena, Texas.
• A powerful and devastating explosion and fire ripped through the HCC, killing 23 persons—all
working at the facility—and injuring 314 other (185 Phillips 66 employees and 129 contract
employees).
• In addition to the loss of life and injuries, the explosion affected all facilities within the complex,
causing $715.5 million worth of damage plus an additional business disruption loss estimated at
$700 million.
• The two polyethylene production plants nearest the source of the blast were destroyed, and in
the HCC administration building nearly 0.5 mile away, windows were shattered and bricks ripped
out.
• The initial explosion was equivalent to an earthquake registering 3.5 on the Richter scale and
threw debris as far away as six miles.
OSHA investigation report:
OSHA's major findings included:
• Lack of process hazard analysis
• Inadequate standard operating procedures (SOPs)
• Non-fail-safe block valve
• Inadequate maintenance permitting system
• Inadequate lockout/tagout procedures
• Lack of combustible gas detection and alarm system
• Presence of ignition sources
• Inadequate ventilation systems for nearby buildings
• Fire protection system not maintained in an adequate state of readiness.
Additional investigation:
• Additional factors found by OSHA included:[2]
• Proximity of high-occupancy structures (control rooms) to hazardous
operations
• Inadequate separation between buildings
• Crowded process equipment
• Insufficient separation between the reactors and the control room for
emergency shutdown procedures.