The Accident at Buncefield - Assignment Example

Industrial Industrial Introduction The tank farm Buncefield Oil Storage Depot is located in Hempstead, Hertfordshire, England. In 2005, the Buncefield Oil Storage Depot experienced a series of massive explosions that resulted from the ignition of a vapour cloud that had formed following the overflow of one petrol tank. The tank had been equipped with control measures that not only automatically protected it against dangerous fuel levels but also enabled staff to monitor the levels. However, both a malfunction in the control mechanisms and negligence from various concerned parties led to an unnoticed overfilling and overflowing that led to the formation of a vapour cloud that later ignited and exploded over 80,000 square metres. Over 40 persons were injured, businesses and homes were destroyed and the explosion detected as far as in the Netherlands on seismograph stations. There were investigation into the cause of the accident and the extent of the damage and this attracted legal action in which five companies were found guilty. This research paper will examine the incident at the Buncefield Oil Storage Depot and describe the events that led to the accident, its main causes and the preventive steps that should have been taken. It will further highlight the culture and management at the site in terms of safety systems and procedures implementation as well as the environmental impact and subsequent prosecutions. Sequence of Events Leading to the Accident Design and maintenance shortcomings can be seen to be the aspects that sparked off a sequence of events that led to poor monitoring of this filling process and consequent explosions and fire. In 2005, located within the Buncefield Oil Storage Depot, a tank belonging to the Hertfordshire Oil Storage Ltd (HOSL) was filling with unleaded petrol on the night of 10th December. At around midnight of 11 December, tankers were barred from the terminal during which time stock checks were conducted for one and a half hours, without any reports of abnormalities (Nicholas & Whitfield 2013, p. 460). However, another hour and a half later, tank 912 did not register any changes on its level gauge even though it was still filling up. Initial approximations had indicated that the tank would have filled up and started overflowing by five in the morning, which it did. CCTV footage started showing vapour at 05.38 coming from the fuel that was escaping. Eight minutes later, the cloud of vapour is seen thickening and spreading in all directions. At 05.50 the cloud was already flowing away from the facility and following the topography of the ground, spreading westward and engulfing buildings and car parks. 10 minutes from that observation, the rate of pumping started rising gradually but steadily to almost 900 cubic metres per hour. By this time, the vapour had already engulfed Boundary Way, Fiji building, Northgate building and part of Catherine House. It had also extended to part of British Pipelines Agency Limited’s tank 12 (Nicholas & Whitfield 2013, p. 460). At this time, which was precisely 06.01 as provided by CCTV footage, the first in the series of explosions took place around the car parks between HOSL and the Northgate and Fuji buildings. The ensuing explosions aggravated the situation, with more than 20 storage tanks being engulfed in fire. Main Causes of the Accident Tank 912, which had a holding capacity of six million litres, had two forms of control mechanisms fitted on it. First, the automatic tank gauging system (ATG) facilitated the monitoring of the filling process by staff located in the control room. Second, the independent high level switch (IHLS) automatically closed down the filling process when the tank overfilled. However, on that night, the ATG stuck and the IHLS became inoperable, essentially meaning there was no way of warning the employees in the control room that the petrol was getting to dangerous levels. Although the controls were not showing any changes in volume in the petrol in that particular tank, it still continued filling. This may be viewed as the initial loss of control that led to the overflow of thousands of litres of fuel from the tank without the awareness of the staff in the control room. After the first overfilling that led to the spillover went unnoticed, containment was next reverted to secondary means in the form of a retaining wall, which was further supported by a tertiary means in the form of a system of catchment areas and drains. Although these were all designed and intended to prevent any overflowing petrol from finding its way into the environment, they were found to be inferior in design and maintenance was poor. Therefore, while the petrol was finding its way past the secondary and tertiary containment measures, the cloud of vapour also continued forming and spreading further away from the facility. From this observation, the main causes of the accident were the two control mechanisms (Fanelli 2012, p. 14). The ATG failed to shut down delivery automatically even after the stipulated ultimate shut-down level had been reached. The tank also had deflector plates that directed water to its side for the purpose of cooling. However, as the petrol overflowed, it was directed by the deflector to the wall of the tank while some went over it and fragmented into droplets in the air. Some of the petrol directed to the tank’s sides detached from it and created a secondary cloud of droplets, facilitating the evaporation of hexanes, pentanes and butanes, which are petrol’s lighter constituents. This explains the cloud of vapour, which is also a main cause of the accident because its ignition is primarily caused the fire (Fanelli 2012, p. 19). However, the manufacturer, installer and maintenance team responsible for the mechanisms are also largely to blame for a fault in the ATG that went unreported. Steps That Should Have Been Taken To Prevent The Accident The accident at Buncefield could have been prevented by considering three key areas including the way storage sites are designed and operated; how emergencies, incidents and accidents are responded to; and how the planning authorities are adviced. From the perspective of storage site design and operation, they should have considered enhancing containment measures at all the three levels which are tertiary, secondary and primary. In this sense, the most important step should have been reporting the recurrent failure of the ATG first to the depot’s management, then the installer who should have in turn reported it to the manufacturer. The management should have prioritised and ensured that the on-site equipment used to electronically monitor tanks, pipe work and alarms was in working condition at any time (Fanelli 2012, p. 69). From eventual investigations, it was found that the manufacturer failed to deliver an essential padlock that was part of the IHLS to the installer and, through its usage the gadget had stuck 14 times in a period of three months. All along, it was only reinstated to working conditions manually without actually establishing the exact cause of the recurrence. Therefore, a procedure should have been put in place on how to respond to such scenarios where abnormal conditions are detected, like the failure of the delivery automatic closure, and not reported. Another step should have been ideally a management concern in which equipment delivered and installed within the plant must be accompanied by relevant maintenance manuals and spare parts list. This way, it could have been known to the management at the very initial delivery that a padlock was missing on the IHLS (Fanelli 2012, p. 72). From this observation, a crucial step should have been carrying out maintenance practices that are guided by manuals from the manufacturer and frequently updated. Risk assessments must be conducted in such a way that potential worst-case scenarios are sufficiently covered and prepared for. At Buncefield, it is evident that their risk assessment had not covered, or in the least did not cover sufficiently, scenarios that involve multiple bunds and tanks. There is no other way to explain how the overflow managed to get past three levels of containment and end up in such loss of business. Therefore, another step that could have prevented the accident would have been having contracts, as well as measures, in place that would respond to spills of such magnitude. Such contracts are not only designed to respond to occurring events but, more significantly, include preventive measures as well. Culture And Management At The Site, In Particular The Implementation Of Safety Systems Procedures The culture and management at the site and in particular the implementation of safety systems can be viewed from the way the highly flammable liquid was handled, or rather, mishandled. If the management, and even maintenance staff, really knew the nature of the liquid they were working with, the accident could not have occurred under such largely ignorant circumstances. It was revealed that out of the five directors on the board of Buncefield, three were from Total UK and HOSL, yet there were five significant companies working permanently on the site. Further, most of the site workers were employed by the three directors. This is the first sign of the lack of the failure to adhere to the fundamental provisions of good practice and ethics guidelines. Consequently, there was considerable lack of awareness regarding the possibility of an accident in an environment that also lacked systems that could properly investigate regular mishaps. This is further seen from the previous reports that provided evidence of the knowledge of the maintenance team that the ATG on tank 912 had stuck on several occasions and, in a particular one, when just back from servicing. The management did not create an organisational culture that promoted work ethics to such an extent that even supervisors were not receiving help or being protected in their roles (BMIIB 2006, p. 23). Primarily, the supervisors are the ones to report any incidents that require investigating, but ironically, they were not even conversant with basic principles such as how to fill the tanks and empty them. The training manuals available to them were also outdated, and existing contracts with other companies that worked within the site were vague, leaving no clear lines and terms of responsibility. All these are indications of failure on the part of the management and they do not in any way facilitate the adequate implementation of safety systems and procedure. Traditionally, safety and planning assumptions among fuel depots, including Buncefield, have been known to be founded on fires that occur in pools of fuel that has escaped. These pools were held by bunds while control was being established by emergency service personnel. However, at Buncefield, the escaped fuel was still able to get beyond the bunds, meaning no emergency drills had been conducted earlier to establish their functionality and effective, which are further indication of a failed organisational culture (BMIIB 2006, p. 19). Further, which is also a worrying observation, even the formation of the vapour cloud was not deemed as a significant occurrence that could initiate planning for the purposes of use of land. Had the management been frequently updating its emergency preparedness as well as training its staff, it could have been foreseen that while a vapour cloud is forming, more fuel could simultaneously be seeping through the containment measures. Environmental Impact And Subsequent Prosecutions Generally, apart from the physical damage cause by the fire to the physical environment and the pollution of ground water, the environment was not otherwise affected to extremes (Nicholas & Whitfield 2013, p. 459). The groundwater pollution in the chalk aquifer beneath the site was beyond the threshold of one hectare for reporting environmental impacts as stipulated by the EU. This is a public water supply aquifer used for supplying drinking water in a borehole located three kilometres away but had to be shut down. Presently, pumping out of polluted groundwater through boreholes is ongoing as well as treating the boreholes to remove fuel. This is essentially a costly remedy as it costs £1 million annually yet is expected to go on for many years. Apart from the aquifers, there was also expected to be toxic fallout as particulate matter would be driven by rain back to earth from smoke. However, the extent of this was not expected to be much and indeed was not, because the smoke was dispersed over a very wide area. Following the legal proceedings, five companies who were part of Buncefield were found guilty and charged accordingly. On its part, Total UK gave a guilty plea. The first one was with regards to the failure to ensuring that their employees worked in sufficiently safe and healthy environments, for which they paid a fine of £1 million (HSE 2010, p. 1). These are appropriate prices to pay and also act as relevant eye-openers to other industry players. In similar manner, the following cases served to intensify global concerns about safety in multinational organisations. The second charge was the failure to ensure environmental safety of persons who were not its employees in as practicable ways as stipulated by the Health and Safety Act, for which a further fine of £1 million was imposed. Thirdly, for polluting controlled water in contradiction to the Water Resources Act, they were fined a further £600,000. HOSL also pleaded guilty to charges of polluting controlled water for which they were fined £450,000. On another count, they were found guilty of failing to prevent major incidents and accidents as well as constrain their consequences to life and the environment. For this, they were fined £1 million. British Pipeline Agency Limited was charged with two counts to which they pleaded guilty. On the fist count, just like HOSL, they also pleaded guilty to charges of polluting controlled water for which they were fined £150,000. On the second count, they pleaded guilty of failing to prevent major incidents and accidents as well as constrain their consequences to life and the environment and were fined £150,000 as well. Motherwell Control Systems was found guilty of failure to ensure environmental safety of persons not its employment in as practicable ways as stipulated by the Health and Safety Act and fined £1,000. Finally, TAV Engineering was also found guilty of failure to ensure environmental safety of persons not its employment in as practicable ways as stipulated by the Health and Safety Act and fined £1,000. Conclusion The Buncefield Oil Storage Depot has been seen to be a tank farm that grossly overlooked basic practice ethics in terms of facility safety, employee safety, environmental safety and non-employee safety. From the onset of the events that led to the accident, it incident does not purely pass as an inevitable occurrence but one that was largely fueled by negligence and could have been prevented, contained or had minimised consequences. The failed level-limiting gadget was not reported earlier yet the maintenance team had experienced problems with it. Then, even after the fuel started overflowing and moving into the secondary and tertiary control measures, it could still not be contained. This shows lack of professionalism pointing towards lack of emergency and preparedness tests. The culture and management is also seen to be out of sync with the safety, health and environmental measures of the depot and largely the industry. The maintenance procedures are also not as recommended by the manufacturer and installers, who were implicated parties to the incidence mainly due to negligence. Although the environmental impacts are not long-term apart from the aquifer problem, they are all the same significant and the legal penalties handed to the involved were adequate. References Buncefield Major Incident Investigation Board (BMIIB), 2006, Initial report to the Health and Safety Commission and the Environment Agency of the investigation into the explosions and fires at the Buncefield oil storage and transfer depot, HSE, London. Fanelli, P 2012, Safety and environmental standards for fuel storage sites: how to enhance the safety integrity of an overfill protection system for flammable fuel storage tanks, Oxford University Press, New York. HSE, 2010, £9.5m bill for firms behind Britain’s most costly industrial disaster, HSE, London. Nicholas, M & Whitfield, A 2013, ‘The Buncefield Accident and the environmental consequences for fuel storage sites and other sites in the UK’, Chemical Engineering Transactions vol. 31, no. 1, pp. 457-462. Read More