Podcast: Lessons Learned from the Explosion at the Phillips Petroleum Complex

You worked alongside Mike at the Process Safety Center. Can you talk a little bit about your relationship and experience with him?

Trish: Yeah, so my interactions with him really focused each year around the annual symposium that they held, so the Mary Kay O'Connor Process Safety Center annual symposium event that happens in the week of the 23rd of October each year to honor the passing of Mary Kay and that tragic event.

And I would look forward to getting to Texas, getting to College Station and seeing Mike. He was very quiet. He was always very quiet and measured in everything he did in my interactions with him. But he also, at the same time, when you got him talking about process safety and talking about the importance of it, was deeply passionate about it. It had become effectively his life's calling, and he was so dedicated to that.

And because of his generosity, out of the tragedy we have today the Mary Kay O'Connor Process Safety Center, which I think has saved countless lives around the world by the education of future process safety engineers to go out into the workforce and make our workforces safer. And as they say at that center, making safety second nature.

Traci: And exactly what you do as well and what we try to do here is to highlight some of these incidents and some of these beacons of hope and champions. So I'm glad we're talking about it today. And we've discussed this incident in past podcasts, but to set the scene for today's conversation, can you give us a little bit of an overview of what happened that day?

Explosion at the Phillips Petroleum Complex Oct. 23, 1989

Trish: Yeah, so there was some routine maintenance that was taking place at the facility, and it was basically a facility that produced high-density polyethylene. They were doing some maintenance, so they'd isolated some valves, and those valves were air actuated. So part of the isolation that disconnected the air actuation.

What they didn't realize at the time was that the previous time the air lines had been connected, they'd been reversed. And so when they thought a valve was closed, it was actually open. And so when they did the maintenance activity and opened up, they had a massive release of highly flammable gas. So some 85,000 pound of highly flammable gas was released almost instantly.

That then found an ignition source and there was a series of explosions and fires, I think the first of which was estimated to have been something like registering a blast at 3.5 on the Richter scale. So massive, massive blast.

Now, tragically, that event killed 23 people and injured another 314 people, so a really significant event that we saw. And as we'd mentioned, Mary Kay O'Connor was a process superintendent at that facility, and she died as a result of that particular incident occurring, and that led Mike to establish the center in her name.

EPA's Risk Management Program and OSHA's Process Safety Management standard

Traci: Now, a lot of good work has come out of the learnings that we've gotten from this incident. How did this incident specifically influence the development of the EPA's Risk Management Program and OSHA's Process Safety Management standard?

Trish: It certainly, I think, went into some of the thinking of the development of those particular pieces of legislation in the US. There are detailed aspects requiring adequate isolation, the proving of isolation, the permit to work process to make sure that all of that is done adequately so that we can be sure when we're about to open up a piece of process equipment that we're not going to get a massive release of flammable substance coming out of that or toxic substance as well.

The determination of the different elements required to work towards the OSHA PSM standard I think had a lot to do with the learnings that came out of this event to make sure that we certainly saw that we've got the planning in place, that we've got the risk assessment in place, that we've got appropriate procedures in place, that we have adequate isolations. All of these things were certainly found as being major findings in the investigation by OSHA at the time.

And it is important to note that, as you said, it led to some of the development of the PSM standard, because the PSM standard was only introduced in 1992, so it didn't exist when this incident happened. Obviously OSHA existed, but the PSM standard wasn't there.

The other things that also came after this that I think had an influence, or that this incident influenced, was when the CSB, the Chemical Safety Board, was finally established. So that actually started its work in 1998. So again, that was nine years after this event took place. And I think some of the detail around the investigation around looking at things was probably part of that particular process as well.

It's also interesting that undoubtedly there were other influences on the particular legislation, EPA's RMP as well as OSHA PSM. And Bhopal is definitely one of those significant influences that was really the triggering event for the development of the standards. But without doubt, the Phillip 66 Pasadena incident sort of cemented the importance of it in the United States, and some of the detail around how that standard actually looks today is because of the findings of this incident. 

Lockout/Tagout Procedures

Traci: You talked about some of the procedures. What improvements have been made? For example, the lockout/tagout procedures. What types of improvements have been made? What did they do with that information?

Trish: So some of the key things that we now see within isolation procedures is actually the lockout tag out process. So this is being able to ensure that if I'm working on a piece of equipment, I place my personal lock onto the isolation point, and nobody else can remove my lock. Basically, I won't remove my lock until I know I'm safe and clear of whatever that piece of equipment is.

Now, certainly as we went through historically, I have worked in facilities that were going through implementing the lockout tag out process following this particular incident, and there's always a lot of tension around, "But what if I've finished my work and I go home for the day and I've forgotten to remove my lock? Surely someone else can remove my lock for me." That's not how the process works.

If you go home having forgotten to remove your lock and your lock needs to be removed, you've got to go back to work and remove it. Nobody else can be removing it. And it is, or it should be, a significant disciplinary issue if anybody does take a set of bolt cutters to someone else's lock, because you just can't assure yourself that unless the individual themselves have removed it, that that lock is safe to be removed. So making sure that we have these really strict protocols in place to protect every person working in the process is critical.

But also having things like making sure we test equipment before we actually do any line cracking. So when we do an isolation, making sure that we can adequately test event in between isolation valves to make sure that there is no gas pressure built up in there that potentially will release when we crack open the flange. So that's also that testing procedure that if it's electrical system, the test running, "We've electrically isolated, let's go press the start button and see if it works." All of those sorts of checks are now just so fundamental and basic in what we do.

And making sure that our fitters, when they're about to unbolt anything, understand the proper techniques for unbolting. So if you're unbolting studs on a flange, you never unbolt the studs facing you and you always unbolt the studs facing in a different direction. And you unbolt slowly so you can always, and you unbolt in a certain order so that if you do take out or you are in the process of removing the studs, and all of a sudden you feel that there is something coming, you can quickly nip it up again so that we're not having that release come out. We can rescue the situation quite quickly. All of those sorts of things are now standard practice in what we do, and they're critical life-saving activities.

Dedicated Fire Protection Systems

Traci: Let's talk a little bit about the dedicated fire protection systems and how industry standards have evolved in this area.

Trish: Yeah, the ability of having our dedicated fire systems is incredibly important, because without them, we are reliant on people being able to get close enough to something to take action, and that just may not be a possibility.

And that's something that we need to think about, because if we don't have our firefighting systems available to us, how can we possibly respond? And if we can't actually get to the particular site that we need to get to, then we've got no way of effectively controlling this.

So having things like fixed sprinkler systems to be able to knock down a vapor cloud and contain the vapor cloud within a sprinkler water fog can prevent ignition occurring. Those sorts of systems can actually prevent the explosion happening at all.

It's interesting also, just I'm going to throw in a reference to another incident here. So in 1991 in Melbourne, in the city I live in, there was actually an industrial fire at a chemical facility, and there was a frangible roof on one of the tanks, and that frangible roof flew off. And the fire main was exposed around the facility, and the fire main was actually damaged by debris from the tank roof. And so that facility lost effectively its useful firefighting because the ring main had been sheared and could no longer provide fire water.

So again, we need to have our fixed firefighting systems, but we've got to have them installed so that they're going to survive an incident and then be able to be used to respond as well.

Some of the other aspects around the use of making sure that their fire pumps could be operated. Do you have enough fuel to operate your fire pumps? In this particular incident in Pasadena, I think it was two of the three, or one of the fire pumps of the three fire pumps had been taken out of service and one of them ran out of fuel in an hour. So they effectively then had no way to get water around because their electrical systems had been destroyed, their cabling had been destroyed by the initial fire as well. They couldn't resort to other pumping means either.

They certainly had the instance as well where some of their fire hydrants were sheared off at the ground level in the blast. So again, making your fire system unusable. So how are you not only installing your fixed fire protection, how are you ensuring its survivability in an incident so it's going to be there when you need it?

And I think we talk about survivability a lot in the offshore sector of the equipment to make sure it's available when we need it, but it equally applies onshore. 

Advancing Process Safety Education and Research 

Traci: We talked a lot about the Mary Kay O'Connor Process Safety Center and the great things that it has done, but can we formally talk a little bit about the role it has in advancing process safety education and research?

Trish: Mary Kay O'Connor Center does several things from the education perspective. So first of all, if you are an Aggie and you go and study chemical engineering at Texas A&M University, you have the option to take certain classes in your degree on process safety or on industrial safety. So you can actually learn some specific classes and get credit for those as part of your chemical engineering undergraduate degree. And Mary Kay O'Connor Center provide those classes. So they are training the next generation of engineers at that university.

In addition to that, they offer a master's in safety as well. And so you can go and do some postgraduate work specifically in specializing in process safety at Texas A&M, and really start to delve in and get to do some research in some of the latest means and methods to either control or predict risk, which is some of the work that they're doing.

And then lastly, they also have a PhD program, and they have graduated a number of PhDs over the years since the center formed that have gone on to work in industry and take their research knowledge that they have developed and apply those learnings in industry today for improving real-life process safety and making safety second nature for industry.

So no matter what sort of level of degree you're focusing on or qualifying for, whether it's a Bachelor's of Engineering, a master's, or indeed a PhD, there's an enormous amount of work there that you can do and research that is being done.

And their research is not only in pure engineering, their research is also in things like human factors. So they work with the School of Public Health and some of the PhD lecturers there in terms of understanding and working with human factors and psychology to see how we can improve things as well.

So they truly focus on process safety as being this very broad discipline. It's not just about the engineering aspects, it's also about the people aspects. And so they do a lot of detailed research in that field today as well.

They also do some work with the Ocean Energy Safety Institute, so that's where that's housed. And so they do a lot of activity and research in the offshore sector as well. So it's not just the onshore facilities that they work with and do research with, they also do a lot of research in the offshore field as well.

Lessons From the Past Prepare the Future Generations

Traci: The folks benefiting from this, those folks down at Texas A&M that can participate, they may not even know why the center was started. So what are some of the lessons that are still relevant for the industry professionals that are going through these programs, and especially those that are going to be new to the field?

Trish: I think it's always important. As you said, we've got the 35th anniversary here. No matter how old some of these incidents get, there's always a learning out of them, because I'll tell you, there has been numerous incidents already this year as a result of inadequate isolation that have killed people around the world.

Whilst we have these wonderful lockout tag out processes, not everybody is following them, not all companies are implementing them. Indeed, smaller companies, a lot of them don't even understand that they exist or understand they need to be implementing them.

And that's why we need to continue to talk about these incidents that for a lot of people, they weren't even born when this happened. But the learnings that we have from this incident go beyond the immediate impact of the incident. The lessons we can take out of this, focusing on that isolation, understanding that isolation in detail, and making sure that we adequately maintain our plant, because anytime we interfere with the plant or interact with the plant is an opportunity for it to go wrong.

And so I think it's really important that we continue to talk about these historic incidents. And sadly, this year is a year of a number of significant milestone events that have occurred, and we'll talk about a few more of them, before the year's out, in this podcast. And we started talking about them earlier in the year with the 50th anniversary of Flixborough.

We need to keep talking about these so that people that weren't around at the time understand and can learn those lessons without having to learn them the hard way, without having to bear the scars of another repeat incident, because we know how to do this right, we just have to implement it right, which is a challenge, but that's a challenge for us.

Traci: Trish, is there anything you'd like to add that we didn't touch on?

Trish: Really just, if you've never heard of this incident before, take a moment to go and read something about it and take a moment to think about how you would've responded in that particular event. If you were Mike O'Connor, how would you have responded to your wife dying as a result of an industrial workplace incident like this? And I think honor the role that both he and Mary Kay have played in making safety second nature in high-hazard industries all over the world.

Traci: Well, Trish, as always, you do help us make safety second nature, and we appreciate all of your insight. Unfortunate events happen all over the world, and we will be here to discuss and learn from them.

Subscribe to this free podcast so you can stay on top of best practices. You can also visit us at chemicalprocessing.com for more tools and resources aimed at helping you run efficient and safe facilities. On behalf of Trish, I'm Traci, and this is Process Safety With Trish and Traci. Thanks, Trish.

Trish: Stay safe.