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Accidents in the History

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American University Of Sciences and Technology (AUST)

MBA Program Contemporary Management Course

"Investigation of Large-Magnitude Incidents"

Exxon Valdez Chernobyl Bhopal

by: Monif Loutfy [email protected]

Date: 30 /4/2002



Introduction The process of establishing the primary cause of an incident requires an understanding of human nature in addition to the necessary technical and engineering skills. After a major accident or incident in the chemical industry, it is common practice to ascertain the cause of the event through an investigation. The investigation is done by teams or by company that owes the facility, the insurance company that provides the liability coverage, federal investigators, and the state and local regulatory authorities. In spite of the differing interests that are represented by each investigating teams, cooperation, and fact sharing generally occurs among the investigations teams, which all lead to a wider and clearer image about the event.

Exxon Valdez Accident

Description of the Accident Prince William Sound an irregular inlet of the Gulf of Alaska U.S. lies within Chugach National Forest and has supported considerable fishing and forestry.



It was the site of a massive oil spill in 1989 when the Exxon Corporation tanker ,the Exxon Valdez, ran aground on Bligh Reef at 12:04 am on March 24.

Exxon operated in more than 80 countries and manages or tends interests in about 70 refineries in North America, Latin America, Europe, Africa, the Middle East, the Far East, and the Pacific.

Possible causes of the Accident Because of delayed effort to contain the spill and because of naturally strong winds and waves, about 10.9 million gallons of North Slope crude oil poured into the sound and eventually polluted thousands of kilometers of indented shoreline, as well as adjacent waters, as far south as the southern end of Shelikof strait between Kodiak Island and the Alaskan Peninsula.



The Tanker's Captain had reportedly been Drinking before the accident and had turned control of the ship over the third mate.

Direct outcomes of the Accident

Some of the spilled oil evaporated in the first days after the spill, but much of it stayed in the water and ended up on shore.

Ecological Impacts: There were one and a half million seabirds and ducks of various species in the spill area inside and outside the Sound, the number of birds killed was estimated to be 75 000 and 150 000.

Decreased resident and non-resident Vacation Pleasure visitor traffic. 43% felt that their business had been significantly or completely affected by the oil spill.

Social Responsibility of the Authority of the plant In September 1994, Federal Court jury ordered Exxon to pay $ 5 billion in punitive damages to Alaskan fishermen, natives and property owners.



Exxon led the clean up effort with 11 000 workers in the summer months expending $1.9 billion dollars, where three methods was tried burning, mechanical cleanup, and chemical Dispersants. Exxon stock lost 10% of its value.

Preventative actions take, due to the accident and for the Future.

Present Responsibility of the Authority New regulations required that all new tankers to have two hulls instead of one. Two large Guard Ships will escort the tanker to prevent an accident, and will keep every large spill if occurred from spreading beyond the tanker. All the oil companies that take oil to Alaska must pay a one-time tax for the above ships.



_________________________________________ Bhopal Accident

Two major separate major investigation of the Bhopal event was authorized, one by the Government of India, and the other was conducted by the Union Carbide Corporation.

Description of the Accident On December 3, 1984, Union Carbide pesticide plant in Bhopal ,India was the scene of one of the worst industrial accidents in history when poisonous gas leaked and spread over a populated area.

Union Carbide Corporation (UCC) manufacture diversified products, gases for U.S. military, consumer field products, antifreeze, Eveready Batteries, and was a major contributor to the development of the first atomic bond, petrochemicals, plastics, and industrial gases.



Possible causes of the Accident Pressure has risen in Tank 610 during the third shift of that Sunday night, and that MIC had been released into the atmosphere. However, others say that the methyl isocyanate product has been shut down six week prior to the incident and the storage tank (Tank 610) has been isolated at that time, A second tank (Tank 611) containing some 20 tons of MIC remained. UCC issued report in March 1985, after more than 500 experiment and extensive analysis of the residue of Tank 610 that the incident was caused when 1000 to 2000 pounds of water entered the tank, later the amount of water was to determined to be even greater. This large quantity of water reacted with MIC in the tank causing its temperature to rise to 100 degree centigrade leading to vigorous exothermic trimerization of MIC, resulting in rapid rises in temperature and pressure, and ultimately causing the major release. The investigation team was not able to interview the plant employees and don't have full access to the record, thus the theory ,of direct connection of water to the tank or through plant's piping system, was unable to develop January 1986 Plant's employee was allowed to be interviewed, and a theory called Water-Washing Theory was raised were an MIC operator was told to wash a section of a sub-header of the relief valve vent header, failing to apply plant standard procedures and thus water found its way in to the process. This theory was refused due to the fact that the washing was by 1/2" hose that it is under sufficient pressure to enable climbing 10.4 feet, the intermediate valves to reach tank was closed and leak-tight, and the 6" connecting pipe was totally dry. Further investigations proved that Bhopal incident was caused by the entry of water to the tank through a hose that has been connected directly to the tank, and this done by a disgruntled operator entered the storage area and hooked up one of the readily available rubber hose to Tank 610, with intention of contaminating and spoiling the Tank's Content. Lack of effective warning system

Direct outcomes of the Accident Killed 2 500 people and injuring many more.

50 000 people were temporarily disabled by respiratory problems and eye irritation resulting from exposure to the toxic gas.



45 tons of the dangerous gas methyl isocyanate escaped, drifted over the densely populated neighborhoods around the plant.

Social Responsibility of the Authority of the plant Substandard operation and safety procedures, at the understaffed plant have led to the catastrophe.

India lack the infrastructure, they attract multinational companies, who often tend to ignore the safety and health violations that the government requires.

Civil Suits for damages were brought against the company by the Indian Government, and in 1989 India’s Supreme Court ordered Union Carbide to pay $470 million in compensation to the victims of the accident.

Minor incidents of process sabotage by employees had occurred previously at the Bhopal Plant.

Shortly after disaster, manufacturers looked at alternative methods of manufacturing pesticides to avoid use of toxic raw materials such as MIC.

Preventative actions take, due to the accident and for the Future. UCC has stringent safety internal standards back to 1930, the first corporation to respond to the tough regulatory climate by U.S government, it established a corporate-level department to oversee activities that ranged from product safety and on-the-job safety measuring the environmental impact of its operations. UCC sent medical and technical experts to aid the people of Bhopal. Halt production of MIC at other plants in Institute: West Virginia. Many news conferences and hundreds of inquire from all the world were dealt and responded. Management Task Force was set up to deal with the crisis. Great care was taken to include employees in our overall communication effort. The company was rated as the best worker safety records.

Present Responsibility of the Authority The Contemporary Union Carbide Corporation is a different company from what it was at the time of Bhopal incident in 1984. It is smaller.



In 1992, 75th anniversary spun off its gases division. It discovered that there are still more than we could accomplish in maintaining safer operations. UCC is an active participant in Community Action Emergency Response. Accept full moral responsibility. The Government has not set up any effective mechanism to ensure that compensation reaches the survivors before it is too late. The Government now is building hospitals for the welfare of the gas-affected people. Safe drinking water, and sanitation and healthy living environment remain inaccessible to the majority of the gas victims in spite of the expenditures.

_________________________________________ Chernobyl Accident

Description of the Accident Chernobyl Nuclear Power Plant located about 104km north of Kiev at the settlement of Pripyat 16 km of Chernobyl, in Ukraine in the previous Soviet Union.

The Power Plant consists of 4 reactors each producing 1 000 megawatts of electric power which came on line in 1977-1983.

The above site was the world’s worst nuclear-reactor disaster on April 26,1986 when the plant’s No.4 reactor exploded.



Possible causes of the Accident The accident occurred while an experiment, in the event of power cut, the declining momentum of the turbines could generate enough electricity, was being conducted with the graphite- moderated reactor running but its emergency water-cooling system turned off. A series of miscalculations, due to its emergency shutdown system, and its power regulating system and almost all the control rods from its core was withdrawn, while allowing the reactor to continue running at 7% power, permitted neutron buildup in one area of the core, where the nuclear reaction at 1:23 suddenly went out of control. The power surge shattered the fuel.

This and a second steam-induced explosion blew the lid off the reactor, whose containment structure was not designed for such pressures.

A third, chemical explosion followed, and scattered fragments caused further local fires.



Direct outcomes of the Accident

Immediately or shortly thereafter, the disaster killed 31 persons (2 from blast and 29 from exposure to radiation), and caused the hospitalization of about 500 others. Eight tons of radioactive material escaped to the atmosphere.

April 27,1986, 30 000 persons living within 30km of the site were evacuated, where force of explosion and fire carried much of the radioactivity away from the site to relatively high altitudes, reached France and Italy

April 28,1986, high levels of wind-transported radioactivity in the air, pressed the soviet government for an explanation, that there had been an accident ,setting off an international outcry over the dangers posed by the radioactive emissions.

Incidences of Thyroid cancer, leukemia and other radiation –related illnesses are higher than normal among the surrounding population, in subsequent years many livestock were born deformed.

Further a lot of Agricultural and environmental impact, and potential residual risks.

Social Responsibility of the Authority of the plant May 6,1986, the Soviet Union began publishing accounts of the accident to the world press.

Since the Chernobyl accident in 1986, there have been various plans to close 20 nuclear power reactors down, while designs that are more modern are improved.

Lack of co-ordination and awareness, resulting from an insufficient level of "safety culture" within the plant stuff. No guidelines were available for such an accident, little information was available, and great political and public pressure to do something were experienced, over precautious decisions were often taken in and outside the Soviet Union

New approaches to emergency management.



Preventative actions take, due to the accident and for the Future.

Heavily contaminated soil and trees were removed from the 30km zone near the power plant, 800 000 worker were involved in clean out.

More than 100 000 persons were evacuated during the first few weeks. Reactor No.4 in the plant was entombed in concrete.

The accident was a severe blow to the Soviet Union’s nuclear power program.

It heightened resistance in the rest of Europe to the building of more such plants.

Immediate Safety Changes to improve operational reactivity margin where number of manual control rods was increased, additional absorbers were installed, and increase in fuel enrichment. Extensive Psychological effects are apparent in the affected regions of the former Soviet Union

Ukraine’s parliament, in 1991, press for a complete shutdown.

Present Responsibility of the Authority Several million persons were still living on contaminated ground. Requirements for countries to join the European Union have renewed the focus on the old designed reactor types.

The Chernobyl unit 4 is now enclosed in a large concrete shelter, which was erected quickly to allow continuing operation of the other reactors at the plant. Damaged image of nuclear energy.

______________________________________________ Conclusion Although no two major disasters are the same, our involvement will lead that there are certain salient features that are common to most.

This accident has a significant impact on human society, and they are learning lessons, and cases to be generalized. All the features and process of an incident or an accident are affected by media pressure, psychological issues, eyewitness accounts, contradictory accounts, time perception, which makes the event more than a purely technical exercise Employee sabotage occurs from time to time in industrial plants all over the world.



______________________________________________ References

1996 Grolier Encyclopedia on CD: Gould, Peter, Fire in the Rain(1990); Medvedev, Georgii, the Truth about Chernobyl(1991); Medvedev,Zhores, Legacy of Chernobyl(1990); Scherbak, Lurrii, Chernobyl (1989). Anderson, M. K., Oil in Troubled Waters (1983); Carines, J., and Buikene, A.L., Restoration of Habitats Impacted by Oil Spills(1984) ;Wheelwright, J., degrees of Disaster (19984).

1995 Encyclopedia Britannica on CD: Chris C. Park, Chernobyl: The Long Shadow(1989). Kalelkar, Ashok, Investigation of Large Magnitude Incidents: Bhopal As A Case Study, May 1998, paper presented at The Institution of Chemical Engineers Conference on Preventing Major Chemical Accidents. Browning, Jackson (Retired Vice President, Health Safety, and Environmental Programs UCC), Union Carbide: Disaster at Bhopal, 1993, reprinted from: Inside stories on managing Under Siege. Facts on the File World News CD-ROM, 1998, Environment: Officials Denounce "Exxon Valdez" Study Online . Keeble, John, Out of the Channel: The Exxon Valdez Oil Spill in Prince William Sound, New York : Harper Collins 1991. Davisdon, Art, In the Wake of Exxon Valdez, San Francisco: Sierra Club Books. UNSCEAR 1988 Report, Exposures from the Chernobyl Accident.

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Bhopal - · PDF fileSocial Responsibility of the Authority of ... Water-Washing Theory was raised were an MIC operator was told to wash a ... disabled by respiratory problems and eye