Risk Management in Engineering (49006) Sample

Risk Management in Engineering (49006)

Objectives:

▪ Incorporate the values of culture and history of Indigenous communities in risk analysis studies and the development of risk management plans.

▪ Identify stakeholders, boundaries and uncertainties in engineering projects and systems.

Topics/Themes:

▪ Domino effects: Domino effects are referred to a chain of accidents in which a primary accident starting in a unit spread to adjacent units, causing secondary accidents the total consequence of which could be much more severe than the primary event.

▪ Natechs: Natechs are referred to technological accidents such as release of hazardous materials, fires or explosions in industrial plants which are triggered by natural disasters like earthquakes, floods, and hurricanes. Compared to normal technological accidents, which are a matter of random failures or human error, natechs usually give rise to more catastrophic consequences since the likelihood of simultaneous damage to hazardous units and domino effects is much higher.

▪ Land use planning: Land use planning (LUP) as an effective and crucial safety measure has widely been employed by safety experts and decision makers to mitigate off-site risks posed by major accidents. Accordingly, the concept of LUP in industrial plants has traditionally been considered from two perspectives: (i) land developments around existing industrial plants considering potential off-site risks posed by major accidents and (ii) development of existing industrial plants considering nearby land developments and the level of additional off-site risks the land developments would be exposed to.

▪ Human error: Humans play an important role during the design, installation, production, and maintenance phases of a product or system. Human error may be defined as the failure to scheduled operations or result in damage to property and equipment.

▪ Security: This area involves estimating access and harm caused due to war, terrorism, riot, crime (vandalism, theft, etc.), and misappropriation of information (national security information, intellectual property, etc.).

▪ Environmental damages: This field involves estimating losses due to noise, contamination, and pollution in the ecosystem (water, land, air, and atmosphere) and in space (space debris).

Introduction:

Engineers have an important role in society. They are responsible for designing, building or creating something based on a specification or guideline to meet a need. What they develop must function without any failure for its intended lifetime, especially a catastrophic failure that can result in loss of life and damage to property and environment.

Engineering is about managing risks. It is technically impossible to remove risk altogether and lowering risk commonly involves a substantial cost. Engineering as a profession progresses through both its successes and its failures. As a profession, we need to learn from failures. By analysing failures, engineers can learn what not to do, and how to reduce the chance of failure. This may seem paradoxical but is widely accepted. Failure often can spur on innovation.

In engineering, it is important to review failures, and mistakes. It is harder to learn from success, but you should always learn from failures. This is not the best practice in some engineering projects where the failure results in human and property damage; however, when a failure occurs it is very important to analyse it and learn from it. Failures have elements in common. The lessons that we learn from them can help to predict and avoid failures. A skill that all professional engineers need is the ability to predict and avoid failures no matter what their scale or magnitude, from small or localized to large or widespread. Engineering failures are typically the result of:

• Human factors – both ‘ethical’ and accidental failure.

• Design flaws – typically a result of unprofessional or unethical behavior.

• Material failures.

• Extreme conditions.

Engineering failures can be categorised based on the size of the impacted region, and the level of impact on the region.

Size of impact:

• Localised: Thistype of failure will only have an impact on the immediate area where the incident occurs.

• Widespread: Although the causing incident was localised, it has effects distributed over a large geographical area.

Level of impact:

• Small: Minor injuries and property damage, may not result in loss of life;

• Medium: Some loss of life, multiple serious injuries, or serious property damage;

• Large: Catastrophic failure, with extensive loss of life, and severe irreparable property damage.

By analyzing past failures, engineers can prevent future failures, both minor and catastrophic. It is often the catastrophic failure that receives professional and public attention, but as you will discover, catastrophic failures are comprised of multiple smaller errors in design, communication and/or judgement. Engineering is a constantly evolving discipline due to both advances in technology and the integration of lessons learnt through failures into laws, standards, work practices and technology.

Instructions:

1. Read, research, and select one topic/theme from the list provided above.

2. Find two case studies relevant to your chosen topic. You can use any sources via the library database or the web (For example, you can find real case studies here www.csb.gov, by going to “investigations” tab where you can find final reports for industrial accidents).

3. You will also use these case studies for assessments 2 and 3. Therefore, please read assessments 2 and 3 instructions carefully to make sure you select the case studies with enough information for other assessments.

4. For each case study:

▪ Set a system boundary of investigation.

▪ Analyse the stakeholders (internal and external) and explore if the case study affected or was affected by Indigenous communities.

▪ Define the inherent risk.

▪ Describe in detail the causal chain (i.e., show causality from the root cause(s) to the failure event) and provide a causal loop diagram for each failure.

5. All content must be written without grammatical errors and should be fully referenced in IEEE style. You must have in-text referencing and include a list of references at the end of report.

Solution

1 Introduction

Engineering, as a profession, is tasked with designing, constructing, and maintaining systems, structures, and processes that affect numerous people and the environment [1]. Engineers are responsible with developing solutions that not only conform to strict norms and requirements, but also perform effectively over their intended lives. According to the MBA assignment expert overview, However, as our research will show, the search of technical excellence comes with risk. To avoid possible disasters, these risks must be acknowledged, analysed, and reduced, whether they are caused by human factors, design defects, material failures, or harsh circumstances.

The article looks into the crucial issue of learning from engineering mistakes, with a special emphasis on the concept of "Domino Effects". Domino effects in engineering refer to a sequence of failures that can result in larger, more widespread consequences [2]. The report will explore two case studies: the Bio-Lab Lake Charles Chemical Fire and Release and the LyondellBasell La Porte Fatal Chemical Release, both of which exemplify the domino effect’s theme.

The report will identify the system boundaries of the incidents, analyse the stakeholders involved (internal and external), assess the inherent risks connected with the incidents, and offer an in-depth examination of the causal chain leading to the failure occurrences for each case study. We hope to get a better knowledge of how engineering failures occur, the reasons that contribute to them, and the lessons that can be derived to prevent future failures by investigating these examples. Finally, this work emphasises the significance of ongoing failure learning in order to improve the safety and dependability of engineering endeavours. By reflecting on these lessons and incorporating them into engineering practices, we help to shape engineering profession, making it more robust, accountable, and prepared for future problems.

2 Case Study 1: Bio-Lab Lake Charles Chemical Fire and Release

2.1 Case Description

A fire occurred at Bio-Lab's Lake Charles plant in Westlake, Louisiana, on August 27, 2020 [3]. Bio-Lab is a pool & spa treatment product producer. Extreme winds from Category 4 Hurricane Laura triggered the event, causing considerable damage to structures at the Bio-Lab site. These structures contained trichloroisocyanuric acid (TCCA), a chlorinating substance used to keep swimming pools and hot tubs clean. When hurricane rainfall came into contact with the stored TCCA, it caused a chemical reaction and subsequent decomposition of the chemical. This reaction created heat, resulting in a fire, and discharged harmful gases into the air, including poisonous chlorine [4].

Figure 1 Chemical Fire at Bio-Lab Lake Charles and emitting poisonous cloud, Image Source: [4]

The dangerous gas cloud went beyond the plant, harming a large amount of the surrounding neighbourhood. The incident resulted in the destruction of a manufacturing facility, damage to other properties, the protracted closure of a part of Interstate 10, and the Calcasieu Parish Office of Homeland Security and Emergency Preparedness issuing a shelter-in-place order. Fortunately, no injuries were recorded as a result of this incident.

2.2 Setting the Boundaries of the Incident

The geographic scope of the incident includes the events that occurred at Bio-Lab's Lake Charles plant. The boundaries include the plant itself, the neighbouring neighbourhood impacted by the gas plume, and the temporary closure of a stretch of Interstate 10 as a result of the event. The inquiry focuses largely on the events that led up to the catastrophe, the effects it caused, and the systemic faults that contributed to its severity.

2.3 Stakeholder Analysis

Several prominent stakeholders emerged as critical participants in the incident, owing to their strong influence and considerable impact on the incident's result (Table 1). To begin with, Bio-Lab, Inc. is a critical player in this context. As the facility owner, Bio-Lab was directly responsible for assuring the safety of its operations and regulatory compliance. The company's interests were inextricably linked to the incident's outcomes, particularly in terms of possible legal and financial ramifications. Similarly, Bio-Lab staff were intimately involved in the incident. Given the incident's possible impact on the company's operations, the primary concerns were worker safety and job security.

Table 1 List of Stakeholders, their Interests and Concerns, Priority and Classification

The incident had a significant impact on the surrounding community, making them a vital role. Residents in the area felt worried about their health and safety, since the dangerous gas cloud posed a direct threat. The Calcasieu Parish Government and emergency services played critical roles in controlling the situation, preserving lives, and guaranteeing public safety. Their impact and influence were significant as they led catastrophe recovery and response operations. Because of their engagement in managing public safety and regulating environmental damage, government authorities such as environmental protection agencies and the Louisiana State Government held enormous authority. Their concerns centred on public welfare, environmental compliance, and effective catastrophe response.

To reaffirms the central role played by key stakeholders in safeguarding the well-being of society and the environment during critical incidents, Influence Impact Stakeholder Matrix is shown below (Figure 2):

Figure 2 Influence Impact Stakeholder Matrix

The recommendations from CSB are closely aligned with the interests and concerns of several key stakeholders, including Bio-Lab, Inc., Bio-Lab Employees, the Local Community, Emergency Services, and Environmental Protection Agencies. The Process Safety Management (PSM) Standard (OSHA 29 CFR 1910.119) emphasizes the need of Bio-Lab Lake Charles evaluating hurricane dangers and implementing measures. Another set of recommendations refers to adopting the recommendations of the Government Accountability Office (GAO) regarding climate change and natural hazard concerns in regulated facilities. The suggestions provided by the GAO are intended to increase compliance support, clarify rules, and improve inspection methods.

2.4 Inherent Risks of the Bio-Lab Lake Charles Chemical Fire and Release

We have defined following Inherent Risk for case study 1:

Table 2 Inherent Risks of the Bio-Lab Lake Charles Chemical Fire and Release

2.5 Causal Chain Analysis

The event began with the impact of Hurricane Laura, which caused significant winds and structural damage to the facility, as shown in the causal chain analysis flowchart (Figure 3).

Figure 3 Causal chain analysis flowchart

Because the facility's structures were vulnerable to hurricane impacts, rainfall was exposed to stored Trichloroisocyanuric Acid (TCCA), causing a chemical reaction and subsequent TCCA degradation due to moisture. This chemical reaction produced heat, which caused the emission of deadly chlorine gas and explosive nitrogen trichloride, culminating in a fire and the discharge of dangerous gases into the surrounding region. Delays in emergency response exacerbated the issue, resulting in enormous financial costs exceeding $250 million [3]. Identifying these core causes is critical for applying preventative actions and improving safety practises to reduce future occurrences.

3 Case Study 2: LyondellBasell La Porte Fatal Chemical Release

3.1 Case Description

On July 27, 2021, a life-threatening incident happened during a maintenance activity at the LyondellBasell plant in La Porte, Texas [5]. The event occurred during a maintenance work in which three contract employees, from Turn2 Specialty Companies, were employed for disconnecting an actuator from a plug valve inside the acetic acid unit at the LyondellBasell La Porte Complex. The valve was removed with the intention of using it as an energy isolation device for a pipe spool repair work.

Figure 4 LyondellBasell plant in La Porte, post incident inspection, Image Source: [5]

While attempting to extract the actuator, the workmen mistakenly removed pressure-retaining parts of the valve. The abrupt pressure release removed the stopper from the valve body, resulting in the discharge of roughly 164,000 pounds of acetic acid mixture [5]. Tragically, two of the workers died as a result of chemical burns and toxic inhalation caused by acetic acid and methyl iodide exposure. One more employee and a responder were seriously injured, while 29 others were taken to medical facilities for further examination and treatment. The event also cost LyondellBasell an estimated $40 million in property damage [5].

The investigation highlighted crucial safety problems, such as the necessity for valve design modifications to eliminate human mistake and the need of providing personnel with suitable working conditions, procedures, and training. The accident highlights the importance of strong safety standards in the chemical business to safeguard employees, communities, and the environment.

3.2 Setting the Boundaries of the Incident

The incident's boundaries include the LyondellBasell factory in La Porte, Texas. These borders include the maintenance procedure that resulted in the leak of acetic acid, which caused injuries and deaths. The incident focuses mostly on the actions within the plant and the immediate ramifications of the chemical spill. The study seeks to comprehend the events that led up to the occurrence as well as its immediate impact on workers and property.

3.3 Stakeholder Analysis

We can identify many important groups with diverse interests and concerns by analyzing the stakeholders involved in the LyondellBasell La Porte Fatal Chemical Release disaster.

Table 3 List of Stakeholders, their Interests and Concerns, Priority and Classification

Given their high priority ranking as an internal business stakeholder, LyondellBasell is particularly concerned with defending the company's brand and controlling legal responsibility. Specialty Turn2 Companies are worried about employee safety and contract compliance. Contract employees want workplace safety, employment stability, and fair pay, whereas wounded workers and their families want medical treatment, compensation, and justice for their injuries. Government agencies like the Chemical Safety Board (CSB) priorities maintaining compliance with safety standards and conducting a neutral party investigation. The local community has concerns about citizens' safety as well as the environmental effect. Other stakeholders include insurance firms, legal counsel, the media, investors, shareholders, and environmental activists, all of which have different interests and concerns in this context. Influence Impact Stakeholder Matrix is shown below (Figure 5):

Figure 5 Influence Impact Stakeholder Matrix

3.4 Inherent Risks of the LyondellBasell La Porte Fatal Chemical Release

We have defined following Inherent Risk for case study 2:

Table 4 Inherent Risks of the LyondellBasell La Porte Fatal Chemical Release

3.5 Causal Chain Analysis

The cause chain analysis for Case Study 2 demonstrates that the event began with the execution of a maintenance task, which resulted in insufficient work practises, such as a lack of training and the absence of safety instructions. As a consequence, an unintentional plug valve was activated, resulting in a chemical leak that exposed personnel to dangerous compounds. Two contract employees were killed, while several more were injured. The event produced significant property damage and drew the attention of regulatory authorities, who evaluated safety compliance and potential fines.

It also sparked worry in the local population as well as among environmental campaigners. The Chemical Safety Board investigated the incident, concentrating on fundamental causes and safety recommendations. In addition, insurance claims and legal processes were filed, and the episode got widespread media coverage, affecting investor trust. This research emphasises the complicated web of actions and effects that result from a faulty maintenance effort, influencing a wide variety of parties and aspects of the occurrence.

4 Summary of Key Findings and Lesson Learned

Key findings from Case Studies 1 and 2 highlight the crucial necessity of safety and risk management in the chemical sector. Extreme weather vulnerability, reactive chemical dangers, and poor emergency response all contributed to a chemical fire in Case Study 1, demonstrating the importance of robust infrastructure and emergency preparation. In Case Study 2, poor labor practices during maintenance resulted in a deadly chemical spill, highlighting the importance of good training and safety standards. Lessons learnt include the importance of proactive safety measures, strong regulatory control, and good stakeholder engagement. Both occurrences underscore the potentially catastrophic implications of chemical mishaps and the need for the chemical sector to priorities safety, environmental protection, and public well-being.

5 Conclusion

In conclusion, both case studies give important insights into the intricacies and hazards connected with the chemical sector. These accidents highlight the crucial relevance of safety, regulatory compliance, and risk management. Case Study 1 demonstrated the importance of resilient infrastructure and complete emergency response procedures by resulting in a deadly fire caused by extreme weather vulnerability and reactive chemical dangers. Case Study 2 indicated, on the other hand, that insufficient work procedures during maintenance operations might result in fatalities, emphasizing the need of effective training and safety measures.

Both case studies highlight the need of proactive efforts to prevent such events, such as rigorous risk assessment, tight safety standards, and clear communication among stakeholders. In order to ensure compliance and conduct unbiased investigations, regulatory agencies and organizations such as the Chemical Safety Board must be involved. Furthermore, these occurrences serve as a sharp reminder of the possible environmental and public health consequences of chemical leaks, emphasizing the importance of awareness and responsible chemical industry practices. Finally, the lessons obtained from these case studies should be used to guide future efforts to improve safety, protect communities, and reduce the hazards associated with chemical manufacture and handling.

6 Bibliography

[1] Royal Academy of Engineering, “Engineering in Society,” 2016. Available: https://raeng.org.uk/media/0gqhxmyy/engineering-in-society.pdf

[2] D. Kong, “Uncertainty in domino effects analysis,” Methods in Chemical Process Safety, pp. 365–394, 2021, doi: https://doi.org/10.1016/bs.mcps.2021.05.011.

[3] Chemical Safety Board, “Bio-Lab Lake Charles Chemical Fire and Release | CSB,” www.csb.gov, 2023. https://www.csb.gov/bio-lab-lake-charles-chemical-fire-and-release-/ (accessed Sep. 03, 2023).

[4] J. Johnson, “Safety board releases report on Bio-Lab accident,” C&EN global enterprise, vol. 101, no. 14, pp. 10–10, May 2023, doi: https://doi.org/10.1021/cen-10114-polcon2.

[5] Chemical Society Board, “LyondellBasell La Porte Fatal Chemical Release | CSB,” www.csb.gov, 2023. https://www.csb.gov/lyondellbasell-la-porte-fatal-chemical-release-/ (accessed Sep. 03, 2023).