CSB Publishes Final Report on Kuraray America 2018 Ethylene Release and Fire

Earlier this week the Chemical Safety Board published their second accident report this week, describing the results of their investigation of the 2018 Ethylene release and fire at the Kuraray America manufacturing facility in Pasadena, TX. That fire injured 23 personnel. The CSB also provides a video overview of the incident.

You ever watch one of those cheap, poorly written detective movies where everyone figures out whodunnit in the first 20 minutes of the film, except the intrepid detective. That is what I felt when I watched the video. So many things done wrong, it is amazing that the incident did not occur earlier, or more catastrophically. The final event was the emergency venting of ethylene into an area where welding was going on.

Investigation Back Log

In my post on the earlier report this week, I reported that there were two remaining reports that the CSB had promised to complete by the end of the year and I noted: “It does not look like they will make it, given the holidays.” Well, I need to revise that now. With two reports in one week, there does not seem to be any reason to expect that the CSB could not publish the final report (Husky Energy Refinery – Superior, WI, 4/26/2018) in the upcoming short week. And I am happy to add that they did not appear to take any short cuts in completing this last week’s two reports.

CSB Releases TPC Group Port Neches Operations Facility Investigation Report

Yesterday, the Chemical Safety Board published their final report on the 2019 explosions and fire at the TPC Port Neches Operations Facility. The report outlines the actions that lead to the incident, starting 114 days before the first explosion. The report identifies and discusses four major safety problems. It goes on to outline the safety recommendations made by the Board as a result of the investigation, three for TPC and two for the American Chemistry Council.

This Report

The four safety issues identified in the report were:

• Dead leg identification and control,

• Process Hazard Analysis action item implementation,

• Control and prevention of popcorn polymer, and

• Remotely operated emergency isolation valve.

The root cause of the accident was not having a process in place to identify and rectify process dead legs, liquid filled pieces of process equipment without mixing or drainage. When a pipe was taken out of service a dead leg was created that was filled with process fluids containing butadiene, a flammable monomer. When that monomer began to polymerize in the dead leg, it formed a solid polymer (popcorn polymer) that had took up more volume than the process liquid. On the day of the incident, the pressure in the dead leg exceeded the pressure containment capability of the pipe. The resulting non-flammable ‘explosion’ damaged an adjacent butadiene line, releasing butadiene gas into the facility. Those fumes quickly reached an unidentified ignition source, resulting is multiple explosions and fires.

Investigation Back Log

Back in October, the CSB published a plan to closeout the backlog of 14 uncompleted investigations. This TPC investigation is one of three that were forecast to be completed by the end of the year. The other two are:

• Kuraray EVAL - Pasadena, TX 5/19/2018, and

• Husky Energy Refinery – Superior, WI, 4/26/2018

It does not look like they will make it, given the holidays.