Accident case histories

Accident case history ACA, AIA, AICliE, API, FIA, FM, NFPA, NSC, OIA, OSHA, USCG... 

Accident Case History 603, Manufacturing Chemists Association (reported in part in Reference 2). Fleck, E., Merck, Sharp Dobme Company memo, Rahway, NJ, May 11, 1960. 

N. V. Steere. Safety in the Chemical Laboratory, Vol. 2, Accident Case Histories. iV-Methyl Nitrosoureas Improperly Stored, Division of Chemical Education, reprinted from Journal of Chemical Education, Easton, PA, 1971, p. 121. 

Case Histories Following are examples of fatal accidents resulting from lack of oxygen ... 

Case Histories of Accidents in the Chemical Industiy, No. 1807, Manufacturing Chemists Association, Washington, D.C.. Apr. 1975. 

Histories of Accidents in the Chemical Industry , MCA Case History No 1460 (1968) (Manufg Chem Assn, Washington) 13) CondChemDict (1971), 689i 14) Anon, Toxic and Hazard-... 

As mentioned previously, the study of case histories is an especially important step in the process of accident prevention. To understand these histories, it is helpful to know the definitions of terms that are commonly used in the descriptions (see Table 1-8). 

The study of case histories provides valuable information to chemical engineers involved with safety. This information is used to improve procedures to prevent similar accidents in the future. 

The four most cited accidents (Flixborough, England Bhopal, India Seveso, Italy and Pasadena, Texas) are presented here. All these accidents had a significant impact on public perceptions and the chemical engineering profession that added new emphasis and standards in the practice of safety. Chapter 13 presents case histories in considerably more detail. 

Trevor A. Kletz, Learning from Accidents in Industry, 2d ed. (Boston Butterworth-Heinemann, 1994). Trevor A. Kletz, What Went Wrong Case Histories of Process Plant Disasters (Houston Gulf Publishing, 1985). 

The study of case histories is important in the area of safety. To paraphrase G. Santayana, one learns from history or is doomed to repeat it. This is especially true for safety anyone working in the chemical industry can learn from case histories and avoid hazardous situations or ignore history and be involved in potentially life-threatening accidents. 

The causes of all accidents can ultimately be attributed to a lack of management systems. Case histories that especially demonstrate this problem are illustrated in this section. In the study of these case histories, one must recognize that the existence of procedures is not enough. 

The other root causes were (1) the poor understanding of the chemistry, (2) an inadequate risk analysis, and (3) no safeguard controls to prevent runaway reactions. This EPA case history also summarized seven similar accidents with phenol-formaldehyde reactions during a 10-year period (1988-1997). 

This chapter on case histories is brief and does not include all the lessons relevant to accidents. The references provide excellent information for more studies. There is significant information in the open literature. However, case histories and safety literature are of no value unless they are studied, understood, and used appropriately. 

Review the case histories described in the booklet by Marsh McLennan,31 and document the number of accidents that occurred in refineries and in petrochemical plants. 

There are many databases of accidents as well as books of case histories, but they have been little used. We need better retrieval systems so that we can find, more easily than at present, details of past accidents, in our own and other companies, and the recommendations made afterward. 

The selection process of retrieving these case histories from the 18,000 is based on the availability of rich accident data located within the chemical process industry. A detailed discussion of the selection process can be found in Chapters 3 and 6. 

To analyse the problem posed in Chapter 1 an overview of current literature on tools, methods, and standards concerning safety indicators will be presented in Chapter 3. With this overview a better understanding of the signs currently used to indicate safety will be obtained. These signs will be compared with the signs present prior to recent accidents (1995-2002). From both literature and case histories a hypothesis will be derived that will be especially tested in Chapter 6. Moreover, in Chapter 4, the conclusions will be used to develop some generic concepts and a conceptual practical approach. The approach will consist of several steps and models derived from organizational science and safety literature. 

In Chapter 6 the posed hypothesis of Chapter 3 will be tested and verified on case histories, concerning several well-documented accidents world-wide. Furthermore,... 

Another type of activated double bond is found in isocyanates and isothiocyanates. Methylisocyanate was responsible for a disaster in Bhopal, India, in 1984 when approximately 40 tons of the gas were accidentally released leading to the death of thousands of people and injury to many more. Some have called this the worst industrial accident in history. Methylisocyanate reacts with nucleophiles as shown in Figure 8.18—in this case with a thiol. This reaction is reversible, and therefore a glutathione conjugate can act to... 

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