Introduction: The U.S. Chemical Safety Board is an independent federal agency that is tasked with investigating the major causes of chemical accidents. They provide recommendations on safety improvements and provide lessons learned in hope to protect the community and environment from future incidents.
Material and Energy Balances
Acetone Drum Explosion (Drum Explodes During Welding, Killing Worker)
Class Tested by UM Material and Energy Balances Course in Fall 2018
Rinsed out empty drum, but residual acetone was left behind
Began welding, arc burned throughigniting acetone vapor causing an explosion
Williams Olefins Plant Explosion and Fire, Geismar, LA 06/13/2013 Safety Module
Control of the hot and cold side of the heat exchanger
Restart the reboiler after 16 months in standby without any previous revision
Operator supervisor ignorance about the propene inside the heat exchanger
Module for Material and Energy Balances, Thermo and Fluid Mechanics
Caribbean Petroleum Refining Tank Explosion and Fire, Bayamón, PR 10/23/2009 Safety Module
Class Tested by UM Material and Energy Balances Course in Fall 2018
One old level measurement system
No additional systems in case of failure
Usually cable breakages
Preventing Harm from Sodium Hydrosulfide(NaHs)
Video illustrating ways to prevent harm caused my mishandling sodium hydrosulfide
Sodium Hydrosulfide(NaHs) is extremely dangerous if not handled properly
Thermodynamics
Praxair Flammable Gas Cylinder Fire, St. Louis, MO 6/24/2005 Safety Module
Class Tested by UM Thermodynamics Course in Spring 2018
Propylene gas exposed to outdoor high temperatures
Thermo gas pressure, pressure relief valve acetylene different from propylene too low setting from propylene
Fluid Mechanics
Millard Refrigerated Services Ammonia Release, Theodore, AL 08/23/2010 Safety Module
Hydraulics Shock ruptured pipe and released anhydrous ammonia to yield a toxic vapor cloud
Carry out calculations to model shock and prevent hydraulic shock.
Freedom Industries Chemical Release, Charleston, WV 01/09/2014 Safety Module
1 Minute 43 second video showing dismantling of tanks with corrosion pitted 0.75inch and 0.4inch holes where the leak occurred. Release 11,000 gallons of a mixture of methylcychohexanemethanol (MCHM) and polyglycol ethers. The storage tanks were 20 ft. in diameter and 20 ft. tall
b. 341 question: Estimate the rate of leakage from tank of crude NCHM and Polyglycol. Crude methlycyclohexane methanol and polyglycol ether leaked approximately 10,000 gallons over 12 days
For incident report please see pages 1 - 12
M Deep Water Horizon Macondo Blowout and Explosion, Gulf of Mexico 04/20/2010 Safety Module
Blowout preventer failed.
Good explanation of failures leading to the blowout
Force a bent pipe. Not sure what type of calculation can be done here
Acetylene Service Company Gas Explosion, Perth Amboy, NJ (1/25/2005), Perth Amboy, NJ 01/25/2005 Safety Module
Acetylene generated by reaction of calcium carbide + H2O
A check-valve failure allowing C2H2 to escape to the shed. Calculate amount of gas in plume. Also volume of plume versus explosive “power”
Failure to check valve that allowed flow from acetylene reaction from into shed.
Williams Olefins Plant Explosion and Fire, Geismar, LA 06/13/2013 Safety Module
Control of the hot and cold side of the heat exchanger
Restart the reboiler after 16 months in standby without any previous revision
Operator supervisor ignorance about the propene inside the heat exchanger
Module for Material and Energy Balances, Thermo and Fluid Mechanics
Heat and Mass Transfer
Tesoro Refinery Fatal Explosion and Fire, Anacortes, WA 04/02/2010
Using a forty-year-old heat exchanger
Very old equipment
Determining vulnerability of equipment to HTHA is inadequate
Valero Refinery Asphyxiation Incident, Delaware City, DE 11/05/2005
Operator’s ignorance.
Williams Olefins Plant Explosion and Fire, Geismar, LA 06/13/2013 Safety Module
Class Tested by UM Heat and Mass Transfer Course in Fall 2018
Control of the hot and cold side of the heat exchanger
Restart the reboiler after 16 months in standby without any previous revision
Operator supervisor ignorance about the propene inside the heat exchanger
Module for Material and Energy Balances, Thermo and Fluid Mechanics
Barton Solvents Explosions and Fire, Valley Center, KS 07/17/2007
Could calculate vapor composition and flammable limits
Air got inside a tank during switching of the lines. The tank was electrically charged.
CAI / Arnel Chemical Plant Explosion, Danvers, MA 11/22/2006
Flammable vapor accumulation due to
1) Exhaust fans turned off
2) Steam valve left open that continued to heat mixture of heptane and proply alcohols for 8 hours. Vapor continued to escape and exploded
EQ Hazardous Waste Plant Explosions and Fire, Apex, NC 10/05/2006
The storage of chemicals such as pool chlorination tablets.
Propane Fire at Herrig Brothers Poultry Farm, Albert City, IA 04/09/1998 Safety Module
18,000 gallon propane tank exploded due to teenagers running into the line with an ATV
Excess flow valves failed trying to stop the propane leak
The explosion was due to boiling liquid vapor expanding inside the tank
The firefighters were unaware of the hazard and never trained for an event like this
Separations
Little General Store Propane Explosion, Ghent, WV 01/30/2007
To use propane as fuel inside a building
BP America Refinery Explosion, Texas City, TX 03/23/2005 Safety Module
Very high pressure, causing a geyser-like release from the vent stack
DPC Enterprises Festus Chlorine Release, Festus, MO 08/14/2002
Excess flow. Wrong design of the excess flow valve
ExxonMobil Refinery Explosion, Torrance, CA 2/18/2015
Fluid cracking unit (STTR) vapor and catalyst separated and coke on catalyst burned in regnerator. Coke particles found their way into electrostatic precipitator and explosion occurred
One of the slide valves malfunctioned
Hydrocarbon flammability unknown
Bad decision taken by the team with regard to steam injection
Chemical Reaction Engineering
Synthron Chemical Explosion, Morganton, NC 1/31/2003 Safety Module
Sterilize with ethylene oxide in chambers filled with medical instruments. Flow water into chambers to a eliminated gas. However, the operator skipped washer steps resulting in trace levels of ethylene oxide gas being passed over a flame heated catalyst to be removed oxidizers
What is heat of reaction? What is amplitude of the pressure waves?
BP Amoco Thermal Decomposition Incident, Augusta, GA 03/13/2001
4 major accidents
Vapor explosion example 13-2 increase amount semibatch -> slow addition easy to remove heat
Point of no return
BP Polymers. Waste Plastic into tank molten plastic sealed relief valve secondary reaction in molten plastic to produce gas. Molten polymer sprayed onto workers
Marton International
MFG Plant. Release of toxic vapors. Did semibatch -> batch -> explosion not scale up properly Alyl alochol U. Point of no return
Distillation of MM Toluene. Runaway reaction in column. Anhydrous ammonia
Preventing Harm from Sodium Hydrosulfide(NaHs)
Video illustrating ways to prevent harm caused my mishandling sodium hydrosulfide
Sodium Hydrosulfide(NaHs) is extremely dangerous if not handled properly
Process Control
Formosa Plastics Propylene Explosion, Point Comfort, TX 10/06/2005
Class Tested by UM Process Control Course in Fall 2018
Vehicle stack valve releasing falmmable liquid proplyene and vapor cloud
How would one instrument control system
Marcus Oil and Chemical Tank Explosion, Houston, TX 12/03/2004
High pressure. No relief system
Operator Error, Improper Procedure, Equipment Malfunction, Hot Work
Arkema Inc. Chemical Plant Fire, Crosby, TX 8/29/2017
Manufactures organic peroxides
Hurricane Harvey Flooding disabled the refrigeration
Formosa Plastics Vinyl Chloride Explosion, Illiopolis, IL 04/23/2004
Opened valve of wrong reactor releasing vinyl chloride that reached an ignition source and exploded
Donaldson Enterprises Inc. Fatal Firework Disassembly and Explosion, Waipahu, HI 4/8/2013
Change in procedures to disassemble and dispose of fireworks. An explosion resulted from not analyzing change with regard to PPA
No analysis of the hazards
Friction of the chairs
Hazard of the black powder
NDK Crystal Inc. Explosion with Offsite Fatality, Belvidere, IL 10/7/2009
Recommended inspections not performed
Vessels corrosion
High pressures and temperatures and vessels did not meet code
Oil Site Safety, Weleetka, OK 4/14/2010
Never really illustrated what happened. Suggests that an ignition source was provided by two high school students playing in a tank half filled with crude oil that exploded
Flammable vapor
Proximity of the location
Silver Eagle Refinery Flash Fire and Explosion and Catastrophic Pipe Explosion, Woods Cross, UT 1/12/2009
Pipe corrosion
The component that failed had no record of ever being inspected for corrosion as it thinned over the years
Bad inspection strategies
Caribbean Petroleum Refining Tank & Explosion, San Juan, PR 10/23/2009
Gasoline overflowed in storage tanks
Malfunction of tank level measurement
Gasoline overflowed in storage tanks
Malfunction of tank level measurements
No additional systems in case of failure
Buncefield Terminal, United Kingdom 12/11/2005
Gasoline overflow
Liquid level measurement failed
Chevron Refinery Fire, Bayamón, PR 10/23/2009
The refinery used obsolete equipment rather than the safest modern designs
Analysis of the effectiveness of safeguards inteded to control hazards was missing
CRE - Dust Explosions
Imperial Sugar Company, Dust Explosion and Fire, Port Wentworth, GA 2/7/2008
Spilled fine sugar on floor. Dust collection system was not working properly. Spilled sugar on floor. Trapped sugar in belt system. Large surface area of fine granulated sugar
Also power plant in Connecticut. CH4 gas flows in pipes confined space
Iron dust carried on buckets ignited. High surface area of dust particles leading to rapid burning role. Malfunction of bucket elevator, which formed dust particles in air that found a spark and dust collectors were often down for maintenance. Calculated heat of reaction for iron dust of O2
Also example of gas leak example. Assumed it was an N2 leak and it was really H2. Metal on metal spark ignite hydrogen, which then ignited iron dust. Did not test for flammable gas
AL Solutions Fatal Dust Explosion, New Cumberland, WV 12/9/2010
Combustible zirconium and titanium dust and spark needed dust collector no standard for dust
Engineering controls for metal dust missing
Titanium powder high flammability
Hot Work
Bethune Point Wastewater Explosion, Daytona Beach, FL 1/11/2006
Hydrocarbon heated by sun and vaporize and flow through line. Find spark from welding
Partridge Raleigh Oilfield Explosions, Raleigh, MS 6/5/2006
Welding accident
The lessons to avoid not work accidents
Conduct Hazard Evaluation. THINK! KTPPA
3000 gallons of methanol
Shows effects of accident on victim's family
Delaware River
<ul><li>Water sulfuric acid and hydrocarbons</li><li>Heating up hydrocarbons during day</li><li>Con Agra loads</li></ul>
Did not repeat flammable gas testing
What hazard assessment should be performed?
BP Texas City Refinery Accident, Texas City, TX 03/23/2005
Flammable liquids fed to isomerization unit
Malfunctions cause the unit to over flow with flammable liquid
What is the TNT equivalent of 1.5 meters diameter by 3 meters high plume and a 42 meter high tank explodes
Need to translate Spanish
Motiva Enterprises Sulfuric Acid Tank Explosion, Delaware City, DE 7/17/2001
Hot Work used acetylene touch on crude oil line
Same as one of others
Issued 7 lessons to prevent Hot work accident volume at gas vs. heating of vessels by sum to produce flammable gas
E. I. DuPont De Nemours Co. Fatal Hotwork Equipment, Buffalo, NY 11/9/2010
Good description of process
February 2010 Issued Bulletin Seven Key Lessoned to Prevent Deaths in Hot Works. Also the need in and around tanks to monitor for flammable gasses in tanks vinyl fluoride gas was present in flowed into tank 1. What was pressure drop to cause flow?
Flammable gas contained in the tank
No testing of the flammability of the gas inside the tank
Deficiencies in the safety management hot work
MISC
Valero Refinery Propane Fire(Fire from Ice), Sunray, TX 02/16/2007
Massive fire erupted due to a water leak
Leak caused crack in out-of-service piping releasing high-pressure liquid propane
Lack of program to identify and freeze-protect out-of-service equipment
Insufficient fireproofing of structural steel
DuPont LaPorte Facility Toxic Chemical Release (Incident Animation of DuPont La Porte Gas Leak that Killed Four Workers)
Tried to clear blockage in piping and had a failed start up, but caused high pressure in other piping
Drained piping to deal with pressure, didn’t realize pipes actually unblocked
Liquid methyl mercaptan was released
Inadequate toxic gas detection system in building
Rooftop ventilation fans were not working also
KMTEX Chemical Plant Explosion (Oil Tank Explosion Animation)
Caused due to welding of a pipeline that still contained the solvent, coal tar naphtha
It was believed the solvent was removed prior to work
Fuel Tank Truck Explodes on Detroit Highway (Oil Tanker Explosion: Fuel Tanker Truck Bursts into Flames on Detroit Highway)
Truck suffered mechanical problems causing it to overturn
A crash caused the explosion sent thick plumes of smoke into air
Bayer CropScience Pesticide Waste Tank Explosion (Animation of Bayer CropScience Pesticide Waste Tank Explosion)
Replaced Methomyl-Larvin unit pressure vessel that solvent could be used as fuel
Needed to prevent any possible runaway reactions in vessel
Restarted unit prematurely, making start up risky
Operators bypassed safety lock causing temperature to climb in vessel
Could not control the runaway reaction they created, causing an explosion of the vessel