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Wake Up Call: Refinery Disaster in Philadelphia

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Summary

Core Theme

A catastrophic fire and explosion at the Philadelphia Energy Solutions (PES) Refinery, caused by a corroded pipe elbow rupture and subsequent hydrofluoric acid (HF) release, highlighted critical failures in mechanical integrity, safety verification, safeguard reliability, and the need for inherently safer design in the industry.

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Voiceover: June 21, 2019,

the Philadelphia Energy Solutions,

or PES Refinery in Philadelphia, Pennsylvania.

A dangerously corroded pipe elbow ruptured,

releasing process fluid into the refinery's

hydrofluoric acid or HF alkylation unit.

The process fluid then ignited

causing a fire and series of explosions.

The fire and explosions caused the release of

over 5,000 pounds of highly toxic HF,

launched a 38,000-pound vessel fragment offsite

and resulted in an estimated property damage loss

of 750 million dollars.

Owens: Thankfully despite the urban location

of the PES Refinery,

the local community was not seriously harmed.

But it could've been worse.

Our investigation found that a critical safeguard

intended to protect the local community

from a release of hydrofluoric acid

did not function as designed.

If a large amount of hydrofluoric acid

had escaped from the refinery,

the consequences could've been disastrous.

This incident should be a wakeup call

to industry and regulators

to take every step possible

to prevent a similar event from occurring.

Voiceover: The Philadelphia Energy Solutions Refinery

was the largest oil refining complex on the east coast

and could process up to

335,000 barrels of crude oil per day.

Within its hydrofluoric acid alkylation unit,

the refinery produced alkylate,

a high octane blending component of gasoline.

That was done by using hydrofluoric acid as a catalyst.

HF is a highly toxic chemical

that is particularly hazardous

if a release occurs

because it vaporizes, becoming airborne.

Breathing HF can cause lung damage, and skin contact

with HF can cause severe burns and death.

On the day of the incident,

the HF alkylation unit was operating normally.

Shortly before 4:00 a.m. a board operator

in the refinery's main control room

performed a routine change

in the configuration of the process within the unit.

The operator increased the flow of process fluid

in an area of the unit

by a total of seven barrels per hour.

Stable operation continued with no abnormal pressure

or temperature changes in the unit

as a result of these actions.

But nevertheless at 4:00 a.m.

a severely corroded pipe elbow within the unit ruptured.

Flammable process fluid containing mostly propane

along with a small concentration of HF

escaped through the failed pipe elbow.

The leaking process fluid formed

a large ground-hugging vapor cloud about 10 feet high

that engulfed a portion of the unit.

Moments later the vapor cloud ignited,

causing a massive fire.

Approximately 30 seconds later,

the board operator took steps

to prevent the release of additional HF.

This was done by rapidly draining the unit's

339,000 pounds of hydrofluoric acid to a special vessel

called the Rapid Acid De-inventory or RAD drum.

The RAD drum was designed to safely

hold HF in the event of an incident.

At 4:15 due to the ongoing fire,

an explosion erupted in the alkylation unit.

Four minutes later a second explosion.

At 4:22 a process vessel in the unit

containing flammable hydrocarbons violently ruptured,

causing the third largest explosion.

A giant 38,000-pound fragment of the vessel

flew across the Schuylkill River

and landed on the river's opposite bank.

Two other fragments, one weighing about

23,000 pounds and the other about 15,500 pounds,

landed inside the refinery.

The fire knocked out the control system communication

to the refinery's HF water mitigation system,

and the backup power supply to the system also failed.

As a result,

the refinery's elevated HF mitigation water cannons

which were designed to spray high volumes of water

to help contain an HF release

could not be turned on remotely from the control room.

The water mitigation system is a critical safeguard

at the refinery designed to prevent

released HF from going offsite.

About 40 minutes after the release began,

the refinery shift supervisor wearing bunker gear

entered the unit and manually turned on a pump

that allowed the HF mitigation water cannons to operate.

Other refinery workers closed valves

to stop the flow of hydrocarbons and steam into the unit.

The fire burned for over 24 hours

until it was finally extinguished

the following day at about 8:30 a.m.

Five workers sustained minor injuries

during the incident and response.

The CSB is unaware of anyone offsite experiencing

health impacts from the hydrofluoric acid release.

The CSB launched an investigation into the fire

and explosions

and found five key safety issues

contributed to the severity of the incident.

They are: mechanical integrity;

verifying safety of equipment

after changes to good practice guidance;

remotely operated emergency isolation valves;

safeguard reliability in HF alkylation units;

and inherently safer design.

The first safety issue is mechanical integrity.

The CSB determined that the pipe elbow

that failed had corroded faster than

other piping in the HF alkylation unit.

That is because the steel pipe elbow

contained a higher content of nickel and copper

than other piping in the unit.

Carbon steel is commonly used in HF alkylation units

but is known to be susceptible

to hydrofluoric acid corrosion.

In refinery processes using some amount of HF,

hydrogen fluoride reacts with iron

in steel piping to produce iron fluoride.

The iron fluoride then forms a film

that coats the inside surface of the piping

and protects the steel from corrosion.

However if the steel contains

high concentrations of copper,

nickel or chromium known as residual elements,

the rate of corrosion is often higher.

This is because the iron fluoride film

that forms on steel containing high amounts

of residual elements is less protective.

The pipe elbow that ruptured in the PES Refinery

was installed around 1973.

It had originally been constructed

of a particular steel alloy

that intentionally contained

a higher concentration of nickel and copper.

But by current industry practices,

the high concentrations of nickel and copper

in the pipe elbow

meant it was not fit for service

in a process using hydrofluoric acid.

Yet the pipe elbow remained in service for over 40 years,

corroding at a much faster rate

than adjacent piping components that did not have

high concentrations of residual elements.

The CSB also found that PES

and the previous owner of the refinery

never inspected all carbon steel piping

circuit components susceptible to HF corrosion.

Such a program was not required in the standard

set by the American Petroleum Institute or API

for the safe operation

of hydrofluoric acid alkylation units.

But had PES or the former owner inspected

all of the carbon steel piping circuit components

susceptible to HF corrosion in the unit,

they may have identified that the pipe elbow

was corroding at a faster rate

than adjacent piping components,

which could have prevented the incident.

After the incident, API revised its standard

to include a new requirement for companies

to develop a special emphasis inspection program

to identify areas of accelerated corrosion

in their refineries.

Grim: The new API special emphasis program

requires companies to inspect all individual

carbon steel piping components in HF corrosion zones.

This will prompt refineries to find

any components that are corroding at a faster rate.

This is an important safety requirement developed by API,

and it should help prevent future catastrophic failures

from this known safety hazard.

Voiceover: The second safety issue identified by the CSB

involves verifying the safety of equipment

after changes to good practice guidance.

When the pipe elbow was initially installed in 1973,

the standard set by ASTM International for carbon steel piping

did not specify limits on nickel or copper content.

Over the next decades, that standard changed,

and by 1995 the ASTM standard

had been revised enough that the pipe elbow

no longer met its requirements

due to the elbow's high levels of nickel and copper.

Yet neither PES nor the previous refinery owner

performed a comprehensive evaluation

of all installed HF alkylation unit piping components

manufactured to older versions of ASTM standards

to ensure that the piping components

were still safe to use.

Grim: To prevent catastrophic incidents,

companies and industry trade groups

must take swift action to ensure process safety

when new knowledge on hazards is published.

These actions must include ensuring

that facilities built before the new knowledge

was published are still safe to operate.

Ensuring safety can include

100% inspection of all equipment and piping,

equipment replacement and other changes

needed to prevent loss of containment events.

Voiceover: A third safety issue discovered by the CSB

concerns remotely operated emergency isolation valves.

The largest of the three explosions at PES

occurred when a vessel located above

the failed pipe elbow violently ruptured.

The CSB concluded that a jet flame shot

from the ruptured pipe elbow

and heated the bottom of the steel vessel

which contained a large amount of flammable hydrocarbons.

For over 20 minutes, the jet flame erupted

from the failed pipe elbow,

wakening the steel bottom of the vessel

and causing it to stretch and thin.

The vessel then ruptured,

launching three huge fragments into the air.

The CSB found that there were no emergency

isolation valves installed in the HF alkylation unit

to remotely isolate nearby hydrocarbon sources

that could then flow through the failed elbow.

And these valves are not explicitly required

by the current API standard

on safe operation of hydrofluoric acid alkylation units.

Grim: Prolonged releases and fires in HF alkylation units

can cause equipment ruptures,

compromise safeguards

or lead to releases of toxic hydrofluoric acid.

Companies need to install

remotely operated emergency isolation valves

to quickly stop releases

before they become catastrophic events.

Voiceover: As a result,

the CSB made a recommendation to API

to update its standard on

safe operation of hydrofluoric acid alkylation units

to require installation of remotely operated

emergency isolation valves on the inlets and outlets

of all hydrofluoric acid containing vessels,

and any hydrocarbon containing vessels

meeting defined threshold quantities.

The CSB found a fourth safety issue

that contributed to the incident at the PES Refinery

which is safeguard reliability in HF alkylation units.

At PES the HF alkylation unit

was equipped with a water spray mitigation system

that was a critical safeguard

in the event of an HF release.

The water mitigation system was designed to use

cannons to spray large volumes of water at any HF release

in order to suppress the amount of vaporized HF

so that it could not travel

offsite to neighboring communities.

But when the control room operator tried to remotely

turn on the water pumps that fed the water cannons,

it was not possible because the

control system communication to the water pumps

as well as a backup power system in the unit

had both failed during the initial fire.

Although API recommends fireproofing these elements,

it does not specifically require companies to do so.

Instead 40 minutes elapsed from the time of the release

before a worker was able to manually turn on the pump.

In the meantime, highly toxic HF was able

to freely escape from equipment and vaporize into the air.

Grim: Hydrofluoric acid alkylation units

present unique hazards due to the presence of

highly toxic HF alongside large quantities

of flammable materials within one unit.

The damage to the water spray mitigation system at PES

demonstrates that active safeguards

or safeguards that require a person

or technology to trigger their activation

have the potential to fail

in major incidents involving fires and explosions.

Critical safeguards and their

associated control system components

must be protected from fire and explosion hazards.

Voiceover: As a result,

the CSB made an additional recommendation to API

to update its standard to require protection of critical

safeguards and associated control system components

from fire and explosion hazards,

including radiant heat and flying projectiles.

And to help ensure that new API

safety requirements and recommendations

are implemented effectively nationwide,

the CSB recommended that the EPA should develop a program

that emphasizes inspecting refinery HF alkylation units

to verify that companies

are complying with API's standard.

The fifth and final safety issue highlighted by the CSB

in its report on the incident at PES

is inherently safer design.

Of the 155 U.S. petroleum refineries

currently in operation in the United States,

46 operate HF alkylation units.

But hydrofluoric acid is highly toxic

and is one of the eight most hazardous chemicals

regulated by EPA's RMP program.

The other acid catalyst

used in refinery alkylation units is sulfuric acid.

Although sulfuric acid is highly corrosive and can cause

skin burns upon contact, it remains a liquid upon release.

Therefore it does not present the same risk

to surrounding communities

as HF which vaporizes

upon release and has the potential to travel offsite.

In addition,

alternative alkylation technologies have been developed.

These include a solid acid catalyst

as well as the new ionic liquid acid catalyst

which was developed by Chevron.

Using a sulfuric acid catalyst

or other new alkylation technologies

would prevent offsite human exposure

to HF in the event of future incidents.

Replacing highly toxic chemicals with less hazardous

chemicals is an inherently safer design approach.

Grim: Currently there is no federal regulatory requirement

for refineries to analyze

inherently safer design strategies

to reduce the risk of serious accidental releases.

Technologies are being developed

that could be safer alternatives to HF alkylation,

and refiners should periodically

evaluate these available technologies.

Voiceover: In its report, the CSB recommended that the EPA

require petroleum refineries

to conduct a safer technology and alternatives analysis

as part of their Process Hazard Analysis

as evaluate the practicability of any inherently

safer technology,

and initiate prioritization to evaluate whether

HF is a high priority substance for risk evaluation.

If it is,conduct a risk evaluation of HF

and implement any identified corrective actions

as required by the Toxic Substances Control Act.

Owens: The destructive event

at the Philadelphia Energy Solutions Refinery

exposed weaknesses not only in PES policies

but also industry standards and federal regulations.

We call on the American Petroleum Institute,

the refining industry

and the United States Environmental Protection Agency

to implement our recommendations and help make sure

that another catastrophic incident

in a hydrofluoric acid alkylation unit never occurs.

Thank you for watching this CSB safety video.

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