Prevent Tragedies - Lessons learned from the Deepwater Horizon in the Gulf of Mexico and RISK MANAGEMENT modules, AND THE PROACTIVE SAFETY METHOD, RISKS AND EMERGENCIES

 

Figure - Deepwater Horizon in the Gulf of Mexico

Lessons learned from the Deepwater Horizon in the Gulf of Mexico and ProSREM

Reference: Organizational Accidents Revisited - James Reason

Deepwater Horizon was a semi-submersible, mobile, floating, dynamically positioned oil rig, operated mainly by BP and, at the time of the explosion, was situated in the Macondo Prospect roughly 41 miles off the Louisiana coast. The disaster was in two parts: the explosion on 20 April 2010, killing 11 people, and an oil spill discovered on 22 April – the spillage continued for 87 days without pause and covered an area of the Gulf equivalent to the size of Oklahoma. This was the largest accidental oil spill in the story of petroleum exploration. After several failed efforts, the well was finally sealed on 19 September. Among others, two companies were involved in the event: Transocean, which owned/operated the drilling rig, and Halliburton, which carried out (among other things) essential cementing work. BP (with a 65 percent share) was in overall charge. many problems arose because of conflicts between these three companies.

Deepwater oil exploration is highly complex – made more so by earlier attempts to abandon the well. It is best therefore that I confine myself to the salient points. These have been admirably summarized by Professor Patrick Hudson, who served as an expert witness on behalf of Halliburton. The main points of the accident sequence are listed below:

• At 9.45 am CDT on 20 April 2010, high-pressure methane gas from the well expanded into the drilling riser (it was underbalanced with seawater) and rose into the drilling rig, where it ignited and exploded, engulfing the platform.

• The Blow Out Preventer was activated late and failed to shut in the well.

• The riser was not disconnected and escaping gas ignited. As a result, 11 people died.

• The drilling rig sank after two days.

On 8 March, just over a month before the explosion, there was what Patrick Hudson termed a ‘dress rehearsal’. There was an influx of hydrocarbon, what the drillers term a ‘kick’. It was detected late – the mud-logger was not believed. Nonetheless, the well was shut in successfully. The costs including rig time exceeded $10 million. no report was made to the London office. Halliburton was subsequently engaged in cementing the well. Its purpose was to centralize the production casing to avoid channeling. Centralizers were necessary to ensure that the annulus was constant, otherwise the cement leave’s mud behind.

This allowed the possibility of hydrocarbon escaping through the mud. Halliburton’s software recommended 21 centralizers.

BP unilaterally decided to use only six. The well needed to be cleaned by circulating mud. BP rejected Halliburton’s recommendation to run a full bottom-up clean. It was also necessary to carry out both positive and negative pressure tests to ensure that the cement barrier was effective. This procedure also encountered a variety of BP cost-saving measures.

In 1990, John Browne was appointed as CEO of BP Exploration and Production upstream. Five years later, he was appointed CEO of BP. He established a rigorous discipline of cost-cutting. This was judged to be a major cause of the problems at Texas City which had 2.25 percent across-the-board cost reduction targets before the disaster. The financiers loved him. He created a community that is loss-averse, unlike its risk-averse competitors (Shell and Exxon-Mobil). His successor, Tony Hayward, continued the cost-cutting culture with the maxim ‘every dollar counts. Patrick Hudson’s conclusions about the explosion and oil spill:

• The accident was preventable. • If BP’s Oms had been applied rigorously, the temporary well abandonment could have been completed safely.

• The dominant failures were associated with no risk analyses or assessments despite major changes and problems with the well.

• These primary causes could be related back to BP’s organizational safety culture. In particular, the problem was – as noted at Texas City – that safety was seen as personal rather than personal plus process safety.

In November 2012, BP pleaded guilty to 11 counts of manslaughter, two misdemeanors, and a felony count of lying to Congress.

The Environmental Protection Agency announced that BP would be temporarily banned from new contracts with the Us government. BP and the Department of Justice agreed to a record-setting $4.525 billion in fines and other payments. As of February 2013, criminal and civil settlements had cost BP $42.2 billion. Further legal proceedings are not expected to conclude until 2014 and are currently ongoing to determine payouts and fines under the Clean Water Act and the Natural Resources Damage Assessment.

For more information, videos, and complementary materials, about Safety, access the links at the end of this post. Are we paying attention to the essential issues for the Safety of Organizations? How many lives, what social, environmental, patrimonial impact, in the image of the organization and others, would be spared? It is important to look into these issues, and to deepen academic studies, with application in companies, to develop proposals to avoid these tragedies. Below is the proposal for preventing and mitigating major and fatal negative events, which I developed based on studies and applications in organizations. It is important to present models, principles and structured forms, together with lessons learned from Major and Fatal Negative Events, which facilitate the analysis of these tragedies, That's why I created the Prevent Tragedy Course - Proactive Safety, Risks, and Emergencies Methodology (ProSREM). I developed ProSREM, in my Ph.D., in progress, in Production Engineering at UFRJ, and used as academic bases: Ergonomics, Resilience Engineering, Integrated Management Systems (Quality, Safety, and Environment), among other methods and tools, and my database to build this proposal, was the biggest and fatal negative events, prominent in the world and in Brazil, I apply this methodology at Fiocruz, where I am a public servant and in organizations, companies, sectors, and activities. If you are interested in the proposal, send me an email, and when there is the availability of e-learning training, of the Introductory Course of the Proactive Safety Method, Risks and Emergencies, I can contact you, the email is: washington.fiocruz@gmail.com I will send you a form, for your registration, for the e-learning training. If you are a professional with experience in the area of ​​safety, risk management, or similar areas, the initial training will consist of two 1-hour meetings, plus guided reading of the modules, complementary materials, and other guidelines, which I will send. I will assemble these training, in order of registration, so speed up yours, to start the course earlier. This course will be free of charge and will help me at this stage of my research, for the Doctorate in Production Engineering at UFRJ. Prevent Tragedy Course - Reports of professionals from the course's study cycle: - They liked the proposal, it lacks this approach with application in the industry (deficiency in the training), very didactic, motivating for the theme, bringing reality, bringing disasters, it could be avoided, ANDEST (National Association of Teachers in Engineering Safety at Work in Brazil) identified a deficiency in risk management in the training of the safety eng., posts of proactive safety are important, you raise the ball, it is up to people to absorb the lessons of the post, I encourage them to understand what happened, think about all the aspects, awaken this need for analysis.

RISK MANAGEMENT modules, AND THE PROACTIVE SAFETY METHOD, RISKS AND EMERGENCIES.

Module 1, UNDERSTANDING AND PREVENTING TRAGEDY:

https://gestaoproativawb.blogspot.com/2023/08/module-1-understanding-and-preventing.html

Module 2, THEORY OF THESE TRAGEDY - SHORT VERSION:

https://gestaoproativawb.blogspot.com/2023/08/module-2-theory-of-these-tragedy.html

Module 3, CASE STUDIES OF THESE TRAGEDY:

https://gestaoproativawb.blogspot.com/2023/08/module-3-case-studies-of-international.html

Module 4, EXERCISES AND ACTIVITIES, TO UNDERSTAND AND PREVENT TRAGEDY:

https://gestaoproativawb.blogspot.com/2023/08/module-4-exercises-and-activities-to.html

Article approved in JRACR journal - The Sociotechnical Construction of Risks, and Principles of the Proactive Approach to Safety

https://gestaoproativawb.blogspot.com/2023/03/article-sociotechnical-construction-of.html

Participate, specialize and support the dissemination of this initiative. Washington Barbosa