After the Accident
Liu Biao, the team leader of the No. 1 Blast Furnace Feeding Team, noticed that the pressure had reached the level of the pressure distribution system. He immediately contacted the maintenance crew to address the issue. Once Qinmou, Sun Mou, and Deng Mou arrived on site, Liu informed them of the situation and allowed the operation to proceed. The main control room then deactivated the pressure equalization and venting system and switched to accident mode. At that time, the accident diverter was tested on-site, but no equipment failure occurred. While the maintenance team was working on the equalizing valve to release gas from the flange, Deng, a maintenance engineer, was exposed to a small amount of gas and suffered mild poisoning. Deng later reported feeling dizzy. Liu, Sun, and Qin quickly took Deng to the air outlet and called the dispatcher to arrange for oxygen administration.
Accident Analysis
1. The maintenance team did not implement any safety precautions before starting the work. They failed to use an air respirator and proceeded with the task without proper protection, which was the primary cause of the incident.
2. Deng, as a maintenance engineer, lacked a strong safety awareness and did not take necessary protective measures while working on gas facilities. This negligence contributed significantly to the accident.
Lessons Learned from the Accident
1. Any maintenance or emergency repair involving gas facilities must be coordinated with the gas technician or the safety department. Proper safety measures should be in place, and all personnel involved must wear air respirators during such operations.
2. Before beginning any work, it is essential to determine the wind direction. Maintenance staff should always position themselves upwind, facing the air outlet, to minimize exposure to hazardous gases.
3. All team members should receive regular safety training to reinforce the importance of following protocols, especially when dealing with high-risk systems like gas pipelines and pressure equalization units.
4. A clear communication protocol should be established between the control room and field workers to ensure that all actions are properly documented and monitored in real-time.
5. After the incident, a full review of the maintenance procedures and safety practices was conducted, leading to the implementation of stricter guidelines and more frequent safety inspections.
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