Abstract
This paper performs an in-depth investigation and analysis on a catastrophic hazardous chemical accident involving domino effects in China based on an emerging accident causation model—the 24Model. The triggers and roots of the incident from the individual and organizational levels have been identified and several useful lessons have been summarized to avoid similar mistakes. This accident began with a leak of vinyl chloride caused by the failure of the gas holder’s bell housing and the operators’ mishandling. Leaked vinyl chloride was ignited by a high-temperature device in the process of diffusion and the fire quickly spread to the illegally parked vehicles. Several organizations were involved in this accident, and the chemical company should bear the main responsibility for it, and shall establish and implement an effective safety management system in its organizational structure and staffing, facilities management, hazards identification, emergency disposal, etc., to improve safety performance in a systematic way. Enterprises in the chemical industry park shall enhance the communication to clarify major hazard installations in their domains, and conduct regular safety evaluation for the plant as the external environment changed. Government agencies shall plan the layout of the chemical industry park scientifically and ensure safety starts with the design stage. The case study provides a practical procedure for accident investigation and analysis, and thus, preventive measures can be made according to the various causations at different levels.
Highlights
At 0:36:53 a.m. on 28 November, 2018, the operational data in the Distributed Control System (DCS) of Shenghua Company's polyvinyl chloride (PVC) workshop showed that the inlet pressure of the compressor connected with 1# chloroethylene gas holder suddenly dropped from 0.19 kPa to in order to realize the real-time monitoring for the leak of vinyl chloride, both the 1#
(DCS) of Shenghua Company's polyvinyl chloride (PVC) workshop showed that the inlet pressure of (DCS) of Shenghua Company’s polyvinyl chloride (PVC) workshop showed that the inlet pressure the compressor connected with 1# chloroethylene gas holder suddenly dropped from 0.19 kPa to of the compressor connected with 1# chloroethylene gas holder suddenly dropped from 0.19 kPa to
This further confirmed that a large amount of leaks of vinyl chloride occurred in this gas holder
Summary
Hazardous chemicals have the characteristics of inflammability, explosiveness, toxicity, and corrosiveness. The case selected to be discussed in the present paper is just the Zhangjiakou leak and explosion accident, which is one of the most severe accident in recent years and is the latest to be investigated and published an official report This disastrous hazardous chemical accident occurred in Hebei Shenghua Chemical Company (hereinafter, Shenghua Company, Zhangjiakou, China) on 28 November, 2018, and it caused 24 deaths, 21 injuries, more than 50 vehicles damage, and lots of building fires due to the domino effect [11]. The public could not understand why the impact scope of the explosion was so extensive and wanted to find out how the accident was triggered—as well as what causes the mass casualties and losses all the time This accident, once again, stresses the importance of acknowledging the hazards of the process industry as well as the need for continually updating the knowledge and awareness required for preventing such catastrophes in the future [12,13]
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