You know, sometimes we need to have our efforts validated. I put myself out there on a daily basis to try my best to educate those who are willing to listen to my ideas and rationale. I take a lot of hits and it gets to me every once in a while. But with over 20,000 faithful members and subcribers I can always count on one of you to pick me up, dust me off, and slap the @#$% out of me, and to put me back on track. Recently, a fellow who I have immense respect for in chemical process safety, saw somethings going on and thought he should back up some of my recent posts. Here is one of his e-mails (posted with his permission).
Bryan,
Glad to know you are still promoting practical safety and sharing useful information. Your website sure is great and full of valuable lessons. Did you have a chance to read the recent Chem Safety Board report on the Bayer Crop Science incident (Aug 2008, Institute West Va)? It was a sad duplication of several other process safety incidents. We seem to make two steps forward, then one backwards. The industry is changing, and many of the old timers are not around to pass along the experience they learned the hard way. I noted the following highlights when I read the CSB report:
Here is a sadly familiar process safety incident investigation report, detailing multiple Process Safety system failures, and many unlearned lessons from the BP Texas City disaster. The plant was restarting after a major turnaround, August 2008. Two employees were killed, when a vessel exploded due to an internal runaway reaction. There was a methyl isocyanate storage tank 70 feet away that was exposed to blast, extended fire, and shrapnel, but fortunately it did not leak. Highlights include:
1. Operators failed to follow established procedure, and intentionally by-passed safety interlocks (pg 68-73).
2. Organizational changes had significantly reduced on-shift resources (pg 76).
3. Shift change communication was incomplete and inadequate (pg 63).
4. Pre-startup safety review was conducted improperly (pg 57).
5. Operator training was inadequate for the newly installed computer control system (pg 60).
6. The quality of the process hazard analysis was poor (pg 53).
7. Written operating procedures were poor – the one procedure being used was over 1000 pages long, was complex, and was routinely deviated.
8. Emergency response was poorly executed (pg 83).
9. Pressure relief was inadequate and did not use proper sizing basis (pg 68).
The Chem Safety Board recently released a 16 minute video (Fire in the Valley), that highlights this incident. This video can be downloaded free from the CSB website (csb.gov, go to video room).
Keep charging man, you are making more of a difference than you might realize.
Jack Philley
Process Safety Specialist
Baker Hughes
(281) 275-7262
Integrity, Teamwork, Performance, Learning