A petroleum refinery experienced a catastrophic rupture at one bank of three heat exchangers in a catalytic reformer/naphtha hydrotreater unit because of high temperature hydrogen attack (HTHA). Hydrogen and naphtha at more than 500F were released from the ruptured heat exchanger and ignited, causing an explosion and an intense fire burned for more than three hours.

The rupture fatally injured seven employees working in the immediate vicinity of heat exchanger at the time of the incident. The workers were in the final stages of a start-up activity to put a parallel bank of three heat exchangers back in service following cleaning. Such start-up activities had resulted in frequent leaks and occasional fires in the past and should have been considered as hazardous and nonroutine. view more

Overview: A hydrogen leak and explosion occurred due to the installation of an incorrectly sized gasket at the suction line of a hydrogen compressor in a refinery hydrodesulfurization plant. The incorrectly sized gasket was mounted during the startup of the plant in 2001 and had never being inspected nor replaced.

Incident synopsis: The operating conditions were stable when the operator received an alarm indicating pressure loss in the circuit. He immediately instructed his field personnel to inspect the area. The hydrogen leak was confined inside the compressor room because the walls and roof were not provided with ventilation devices. An explosion occurred, causing two fatalities and the destruction of the compressor room and some of the surrounding area.

An explosion at a coal-fired power plant killed one person and injured 10 others. The blast killed the delivery truck driver who was unloading compressed hydrogen gas, which is used to cool the plant's steam generators. Hydrogen deliveries are routine at the plant, occurring about once a week. Evidence pointed to the premature failure of a pressure-relief device (PRD) rupture disk, which had been repaired by the vendor six months prior to the explosion.

A laboratory technician died and three others were injured when hydrogen gas being used in experiments leaked and ignited a flash fire.

The incident occurred in a 5,700-square-foot, single-story building of unprotected non-combustible construction. The building was not equipped with automatic gas detection or fire suppression systems.

Employees in the laboratory were conducting high-pressure, high-temperature experiments with animal and vegetable oils in a catalytic cracker under a gas blanket. They were using a liquefied petroleum gas burner to supply heat in the process.

Investigators believe that a large volume of hydrogen leaked into the room through a pump seal or a pipe union, spread throughout the laboratory, and ignited after coming into contact with the view more

Incident Synopsis
One man was killed and another severely injured while working with a portable battery power supply.

At a test facility, a water-submersible portable battery power supply was used to power lighting. The battery power supply contained two 12-volt lead-acid automotive batteries, a wiring harness, and switching relays mounted in an air-tight case suitable for submersion in water. The case possessed ½-inch aluminum walls and a 13.8-pound lid. The box had been used periodically over two years.

After charging all night, the battery power supply was moved into place and connected to the lighting. Two technicians started to test the unit. One technician rested his hand on the case lid while the second leaned over the lid and threw the switch to activate view more