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11057 Chemical accident in Netherlands with dicyclopentadiene (dcpd)
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General accident information
Class/Quality * * * * *
Year 1992
Summary Wrong mixture in reactor caused run away reaction
Overheating, overpressure, explosion, fire and 14
Casualties among with several firefighters
Country NL
Activity PROCESSING
Location CHEMICAL FACTORY
Chemicals Boron trifluoride, Cyclopentadiene (cpd), Dicyclopentadiene (dcpd), Dicyclopentadiene (dcpd),
Resin solution
Cause Management-failure
Fatalities/Injuries 3 / 11
Occurrences or events Blow-away, Burst/Rupture, Burst/Rupture, Chemical reaction,
Chemical reaction, Clean-up, Defective-working, Defective-working,
Defective-working, Defective-working, Dismount/Disconnect, Evacuation,
Explosion, Explosion, Fire, Fire fighting/Emergency response,
Fire fighting/Emergency response, Fireball, Human-operations, Human-operations,
Human-operations, Human-operations, Human-operations, Human-operations,
Ignition, Ignore-signal, Management-failure, Mix,
Mount/Connect, No-action, Operators error, Overheating,
Overheating, Overpressure, Physical-explosion, Pollution/Contamination,
Pump-over, Pump-over, Pump-over, Release,
Release, Remove, Run-away-reaction, Safety-measures,
Smoke-emission, Stench-emission, Traffic-interruption, Wrong-action,
Wrong-action, Wrong-action, Wrong-composition
 
 
Full accident information 
download accident report Click here to view a document containing the full accident information

Country: NETHERLANDS (NL)
Date : 1992 0708


A heavy explosion occurred at a chemical factory, which caused the death of 3 firemen of the works fire brigade and injured 11 workers, including 4 firemen of the works fire brigade.
The explosion was followed by a very serious fire.
The total loss was estimated to be 44 million NL guilders. Reactor fragments were found at a distance of 1/km.

Company
Months before the disaster several experienced operators left the company for various reasons. There was also some discussion about the overwork between the company and the trades-union.

Safety report (AVR)
About one year before the accident, the company had to make a safety report on account of the Health and Safety Act. During a review of the report, in the presence of the officials of the Labour Inspectorate, the question about wrong mixtures in the reactor came up for discussion. No satisfactory response had been received on the day of the accident.

Emergency response plan
In October 1983, the community, the police, the fire brigade, the Labour Inspectorate, and other organisations, concluded that an emergency response plan for the company was not necessary. Indeed all the parties were convinced that several attack plans had to be made. Ultimate only one attack plan was made by the fire brigade.
In June 1992 a new official for the emergency response was appointed to put new live into the local disaster planning.

Works fire brigade
The works fire brigade consisted of a score of specific trained workers.
Once in the fortnight the works fire brigade trained, of which several times with the local fire brigade.

The accident started with a typing error in a recipe by a laboratory worker. The following materials were to be used in the processing of the desired hydrocarbon resin:
. dicyclopentadiene (20,000 liters) - tank 631
. resin oil 1 (20,000 liters) - tank 632
. resin oil 2 ( 1,300 liters) - tank 630
Instead of tank 632 he typed tank 634.
Tank 632 stored resin feed classic (UN-1268), normally used in the batch process.
Tank 634 also stored DCDP (dicyclopentadiene).
The DCPD material in tank 631 and tank 634 had been delivered by several suppliers. The material safety data sheet (MSDS) of DCDP, made by one of the suppliers did not contain a warning of the reactivity of DCDP.
The operator, who had to check if the tank content was similar to the recipe, filled the reactor with the wrong chemical.
The batch process started with steam heating via the coil in the reactor.
When the temperature rose, the operator tried first to cool the reactor with more water from the water mains; later, the works fire brigade was alarmed to cool the reactor.
Then the process engineer and the production manager verified with what chemicals the reactor had been filled. Only the total number of liters and the ratio of the chemicals were verified. At the same time the production manager phoned the laboratory for a gas chromatographic analysis of the feeding sample.
Although the process engineer received a phone call from the deputy head of the laboratory that the analysis of the feeding sample showed a deviating density (almost 100% DCPD), it was decided to analyze the blend as soon as possible with the gas chromatograph. An administrator, who checked the recipes every morning, found the error and tried to contact the operator, but it was too late.
Because the works fire brigade expected that the contents of the reactor would slowly be released via the bursting disc and the two safety valves, they were connecting deluge guns to prevent spreading of the expected fire.
The firemen did not wear the prescribed personal safety equipment, such as clothing, hand gloves and breathing apparatus, because they expected a relatively, easy job.
After releasing chemicals via the bursting disc and the two safety valves, the reactor ruptured within several seconds, the contents of the reactor was released and an explosion followed.
The local fire brigade was alarmed and together with the works fire brigade, they tried to prevent the fire from spreading to the other installations, such as cylinders filled with boron trifluoride.
To prevent serious damage to the environment as a consequence of polluted fire fighting water, it was decided to let the fire burn out by itself.
Residents in the surroundings of the chemical factory formed a pressure group and carried on a campaign to have the factory move to a safer place.
The judgment of the court was that the management of the company had given insufficient attention to safety and environment and the company was fined 220000 NL guilders.
The production of the thermic polymerization of the hydrocarbons was allowed only 17/months after the accident. The external pressure group has had an important contribution in the delayed re-operations of the installations.

Lessons learned (measures taken after the accident investigation)
1.
Improved training and attendance of operators.
2.
Heat polymerization installations were protected with both pressure devices and temperature devices.
3.
Rising of temperature and pressure per time were also protected.
4.
Buffer tank installed and before pumping the mixture from buffer tank into the reactor, a sample had to be approved.
5.
Introduction of a safety management system (SMS).


Dans une usine p??trochimique, une explosion suivie d???un gigantesque incendie se produisent lors de la polym??risation du dicyclopentadi??ne (DCPD). Parmi les employ??s, 3 personnes sont tu??es et 11 sont bless??es. Des d??bris de l???usine sont retrouv??s jusqu????? 1 km aux alentours. Le quartier est ??vacu?? dans un rayon de 600 m. Les pompiers du site (12 personnes) sont assist??s par une brigade externe (environ 50 pompiers). La violence de l???incendie rend difficile leur intervention. Les eaux d???extinction provoquent une pollution des eaux. En raison d???une erreur de l???op??rateur (proc??dures et formations inadapt??es) lors du remplissage du r??acteur de polym??risation, le r??servoir a ??t?? charg?? avec environ 40 t d???un m??lange de monom??res contenant environ 75% de DCPD, au lieu de 50%. La forte concentration en DCPD a caus?? un emballement de la r??action qui a provoqu?? l?????clatement du r??acteur (??quip?? d???une soupape de s??curit?? mais de mauvaise capacit??) et a donn?? lieu ?? une explosion suivie d???un gigantesque incendie.



 
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