A framework for human error risk analysis of coal mine emergency evacuation in China

Evacuation from underground coal mine in emergency as soon as possible makes the difference between life and death. Human factors have an important impact on a successful evacuation, but literature review shows that there is a lack of consideration of human error risk during coal mine emergency evacuation in China. To address the above problems, in this paper, we established a framework for human error risk analysis of coal mine emergency evacuation, consisting of scenario and task analysis, risk assessment and risk reduction. A general evacuation procedure which is applicable for different causes is detailed through the scenario and task analysis. A new method based on expert judgment, named OGI-Model, is proposed to evaluate the reliability of human safety barrier. In this new approach, human safety barrier is divided into three sub-barriers, i.e., organization safety sub-barrier (OSSB), group safety sub-barrier (GSSB), and individual safety sub-barrier (ISSB). Each sub-barrier consists of a series of concrete measures against specific evacuation actions. An example is provided in this paper to demonstrate the use of this framework and its effectiveness.     

安全阀失效模糊综合评价方法的研究

针对安全阀在实际使用过程中的失效涉及诸多因素影响的特点,运用模糊综合评价的数学模型,将安全阀失效的相关影响因素作为因素集,把可能产生故障的元件作为评价集,按照权重的大小对安全阀的故障进行综合评价,以提高维修人员对安全阀故障的判断能力和综合检修能力,达到设备稳定运行的目的。     

城市管道系统风险分析及闭环管理研究

为了探索构建城市管道系统安全及可靠性风险管理体系,基于FMECA,FTA&ETA及FRACAS等技术,建立涵盖故障模式辨识、影响及危害度分析、纠正措施执行等内容,且遵循闭环管理原则的科学、完整的风险闭环管理模式。针对城市管道安全及可靠性研究存在的局限性,引入FCE改进的FMECA和模糊灰关联FTA等定量计算方法,克服统计信息匮乏、数据模糊等瓶颈。研究结果表明:基于改进“3F”一体化技术的系统风险闭环管理体系契合城市管道风险管控需求,为多态、多要素耦合、不确定性复杂系统整体风险分析研究提供新思路。     

行为安全研究进展追溯与述评

为推动行为安全研究的发展和应用,通过文献综述方法,确定广义行为安全研究对象,从理论和管理2个维度来解析行为安全研究进展。在理论层面,通过分析行为机理来阐述行为安全理论基础,提炼行为影响因素并探究因素间作用关系;在管理层面,追溯行为安全管理在不同阶段、不同行业的应用现状,提出改进方案。结果表明:行为安全理论基础和影响因素分析2方面的研究较为深入,但是仍需夯实相关模型并引入先进的研究方法,而行为安全管理应用的时效性和针对性较差,需要在组织因素和个体因素结合、干预的效果、信息技术应用等方面进行改进。     

Comprehensive alarm information processing technology with application in petrochemical plant

During the abnormal plant conditions, too much information is produced due to momentary plant excursions above alarm limits. This flood of information impedes correct interpretation and correction of plant conditions by the operator. Existing techniques for the design of alarm systems mostly have weak ability to handle complex hazard scenarios and increase the probability of larger safety issues. In this paper, a comprehensive alarm information processing (AIP) technology is introduced, called multi-round alarm management system (MRAMS), including several processing strategies: AIP based on single sensor, AIP based on sensor group, root cause diagnosis based on Bayesian network, sensor fault judgment method and false alarm inhibition method. In case studies, both simulation experiment and pilot application on a real petrochemical plant are presented. Results indicate the MRAMS is helpful in improving the accuracy of correctly diagnosing the root causes and hence avoiding false and redundant alarms. By adopting this new technology, the safe and reliable operation of the plant can be achieved, and the economic loss brought by improper alarms can be reduced.     

An integrated approach to the analysis of incident causes

Root cause analysis (RCA) is a well-established method for the determination of incident causes. However, the application of the method, especially for accidents in complex socio-technical systems, encounters limitations. It cannot identify some types of causes. This article finds ways to deal with the limitations, and integrates them into the RCA procedure. It results in the proposal of the Integrated Procedure of Incident Cause Analysis (IPICA). The integrated approach is based on the integration of assumptions about the structure of safety management in the investigated process into a comprehensive picture. It offers an integrated view of various types of causes. To a necessary extent, it integrates a non-linear incident model into the RCA procedure. The example – an analysis of the Walkerton tragedy from 2000 – illustrates the application of the integrated approach. IPICA is shown to be more universal than RCA, just as effective, and not excessively complicated.     

Development of a risk-based maintenance strategy using FMEA for a continuous catalytic reforming plant

Petrochemical facilities and plants require essential ongoing maintenance to ensure high levels of reliability and safety. A risk-based maintenance (RBM) strategy is a useful tool to design a cost-effective maintenance schedule; its objective is to reduce overall risk in the operating facility. In risk assessment of a failure scenario, consequences often have three key features: personnel safety effect, environmental threat and economic loss. In this paper, to quantify the severity of personnel injury and environmental pollution, a failure modes and effects analysis (FMEA) method is developed using subjective information derived from domain experts. On the basis of failure probability and consequence analysis, the risk is calculated and compared against the known acceptable risk criteria. To facilitate the comparison, a risk index is introduced, and weight factors are determined by an analytic hierarchy process. Finally, the appropriate maintenance tasks are scheduled under the risk constraints. A case study of a continuous catalytic reforming plant is used to illustrate the proposed approach. The results indicate that FMEA is helpful to identify critical facilities; the RBM strategy can increase the reliability of high-risk facilities, and corrective maintenance is the preferred approach for low-risk facilities to reduce maintenance expenditure.     

危化品物流运输企业安全管理能力模型构建

为了明晰危化品物流运输企业安全管理能力要素的相互关系和结构属性,提出了 一种层次分析法和DEMATEL法耦合的安全管理能力分析方法。首先,在现有安全管理能 力研究的基础上建立考虑涌现性的危化品物流运输企业安全管理能力概念模型并确定危 化品物流运输企业安全管理能力的构成要素;然后针对传统DEMATEL方法的不足,构建 了基于层次分析法的改进DEMATEL方法;最后,通过问卷调研获取危化品物流运输企业 安全管理能力影响因素重要度判断矩阵,并通过中心度和原因度确定能力要素相互关系 。研究结果表明,所建立的方法可以用于分析危化品物流运输企业安全管理能力并构建 其结构模型。     

Managing safety in hydropower projects in emerging markets – Experiences in developing from a reactive to a proactive approach

International companies investing in emerging markets need to address the management of safety under varying conditions. The paper presents an evaluation of the approaches taken by an international hydropower company in two different construction projects, one in India and one in the Philippines. In the first project, the company had to intervene as a reaction to poor safety and overall performance. Based on previous experiences, the company selected a proactive approach in the second project, involving use of the contracting process to ensure adequate conditions from the start of construction and onwards. The paper accounts for the safety performance results in the two projects and interprets them in relationship to external and internal influencing factors in the respective project. It is concluded that a proactive approach has the potential of delivering satisfactory safety results at moderate costs for follow-up. A reactive approach risks exposing the company to ethical and reputation risks due to a poor safety performance before the corrective actions have taken full effect. It is also resource demanding. Results demonstrate the feasibility of turning around a project’s safety performance also when preconditions are challenging.     

Experts,Bayesian Belief Networks,rare events and aviation risk estimates

Bayesian Belief Networks (BBN) are conceptually sensible models for aviation risk assessment. The aim here is to examine the ability of BBN-based techniques to make accurate aviation risk predictions. BBNs consist of a framework of causal factors linked by conditional probabilities. BBN conditional probabilities are elicited from aviation experts. The issue is that experts are not being asked about their expertise but about others’ failure rates. A simple model of expertise, which incorporates the main features proposed by researchers, implies that a best-expert’s estimates of failure rates are based on accessible quantitative data on accidents, incidents, etc. Best-expert estimates will use the best available and accessible data. Depending on the frequency of occurrence, this will be data on similar events, on similar types of event, or general mental rules about event frequencies. These considerations, plus the need to be cautious about statistical fluctuations, limit the accuracy of conditional probability estimates. The BBN framework assumes what is known as the Causal Markov Condition. In the present context, this assumes that there are no hidden common causes for sequences of failure events. Examples are given from safety regulation comparisons and serious accident investigations to indicate that common causes may be frequent occurrences in aviation. This is because some States/airlines have safety cultures that do not meet ‘best practice’. BBN accuracy might be improved by using data from controlled experiments. Aviation risk assessment is now very difficult, so further work on resilience engineering could be a better way of achieving safety improvements.     

Railway safety climate: a study on organizational development

The safety climate of an organization is considered a leading indicator of potential risk for railway organizations. This study adopts the perceptual measurement–individual attribute approach to investigate the safety climate of a railway organization. The railway safety climate attributes are evaluated from the perspective of railway system staff. We identify four safety climate dimensions from exploratory factor analysis, namely safety communication, safety training, safety management and subjectively evaluated safety performance. Analytical results indicate that the safety climate differs at vertical and horizontal organizational levels. This study contributes to the literature by providing empirical evidence of the multilevel safety climate in a railway organization, presents possible causes of the differences under various cultural contexts and differentiates between safety climate scales for diverse workgroups within the railway organization. This information can be used to improve the safety sustainability of railway organizations and to conduct safety supervisions for the government.     

Safety investment optimization in process industry: A risk-based approach

Process plant safety is a critical indicator of organizational performance. Adequate investment into safety practices to avoid future accident cost is therefore a beneficial strategy. The current approach to such investments in the process industry is driven largely by simple risk-based heuristics, insurance market premiums, organizational culture and management judgment. There is, however, an absence of an overarching methodology to assist such an effort. Therefore, there is a need for developing a robust decision-making framework for enabling systematic and optimal allocation of financial resources across all significant risk elements within a process plant.The present work proposes a safety investment optimization (SIO) framework for a typical process plant. Such an optimization approach targets maximal reduction of risk values across all potential hazards within the constraint of a given safety investment budget at the incipient stage of establishing a plant such that it saves future cost to company by reducing the risk from accidents. At the same time the framework takes into account the need to comply with the regulatory requirements imposed by the government. Additionally, access to insurance market as a strategy to transfer risk is also integrated. Finally, the residual risks are managed through investments in selective safeguards while ensuring that the benefits over-weigh the cost of such an exercise. For illustrating the application of the framework, a representative process plant with a select number of risk scenarios is chosen and all steps suggested by the framework are demonstrated quantitatively. It is anticipated that the proposed SIO framework will help optimal resource allocation for managing the risks implicit in a typical process plant.     

From a survey on accidents in the downstream oil industry to the development of a detailed near-miss reporting system

A historical analysis with statistical investigation on accidental events in the oil industry from the beginning of the XX century till now, was performed in order to identify historical trend and go deeper into accident causes. The classification methodology was developed referring to three headings, namely plant/process, environment and organization and trying to go deeper into the analysis of the causes of the accidents reported and understand more of what is probably behind the accidents. The accident types and severity were studied, plotting the accumulated frequency–fatality curve for each item. In the subsequent applicative phase, we applied a similar classification approach to near-misses directly collected over nine years observation in a large downstream oil firm. The historical analysis was extended on each section of the refinery, paying a careful attention to all causes and consequences of the event. Data were structured for analyzing trends and identifying possible precursors of unwanted events. According to the step-by-step approach we try to evidence how immediate causes of a near-miss could be linked in some kind of causal chain to underlying causes that should be controlled by middle or higher management, or are part of the corporate safety culture.     

Inherent safety in offshore oil and gas activities: a review of the present status and future directions

Inherent safety is a proactive approach for hazard/risk management during process plant design and operation. It has been proven that, considering the lifetime costs of a process and its operation, an inherently safer approach is a cost-optimal option. Inherent safety can be incorporated at any stage of design and operation; however, its application at the earliest possible stages of process design (such as process selection and conceptual design) yields the best results.Although it is an attractive and cost-effective approach to hazard/risk management, inherent safety has not been used as widely as other techniques such as HAZOP and quantitative risk assessment. There are many reasons responsible for this; key among them are a lack of awareness and the non-availability of a systematic methodology and tools.The inherent safety approach is the best option for hazard/risk management in offshore oil and gas activities. In the past, it has been applied to several aspects of offshore process design and operation. However, its use is still limited. This article attempts to present a complete picture of inherent safety application in offshore oil and gas activities. It discuses the use of available technology for implementation of inherent safety principles in various offshore activities, both current and planned for the future.     

Focus on mission success: Process safety for the Atychiphobist

Modern process plants are complex engineering systems. While thorough reviews of system safeguards are performed, catastrophic events continue to occur, often unfolding in unforeseen ways. Success in process safety demands safe processes, and understanding rare, high consequence events is central to the traditional process safety approach. This philosophy is common to all high-hazard industries, offering the potential for sharing approaches, experience, and lessons learned. The problem, however, is that people (and organizations and entire industries) who fear failure (atychiphobia) sometimes obsess about failure so much that they miss opportunities to succeed.This paper examines selected risk management practices in the power generation and aerospace industries and how those practices have led to improved performance. Risk informed decision making (RIDM) has had widespread application in the nuclear and aerospace industries, and is undergoing enhancements to become a key framework for risk management. Additionally, rather than focusing on avoidance of loss, there are emerging approaches supporting achievement of success. This approach provides a more direct link of risk to business and operational objectives, but does challenge conventional risk approaches founded in a loss prevention-centric view. The paper reflects upon risk informed decision making and success modeling, and suggests how these methods may be applied in the field of process safety. Specific examples are drawn from the defense in depth approach from the nuclear power industry and mission success concepts developed for NASA.     

谈职业健康安全管理体系审核的有效性

笔者从审核人日、抽样的合理性、审核员能力、审核过程的有效性等4个方面讨论了职业健康安全管理体系(OHSMS)审核的有效性。从要素的角度,介绍国家标准GB/T28001—2001中“对危险源辨识,风险评价和风险控制的策划”,“法律法规及其他要求”,“职业健康安全管理方案”,“结构和职责”,“运行控制”,“绩效测量与监测”,“事故事件,不符合,纠正与预防措施”等7个要素审核过程的有效性。可为认可认证机构判断OHSMS审核的有效性提供一定的参考。     

基于DBT-DBN模型的气化炉超温动态风险分析

为加强煤气化装置核心设备气化炉的安全风险管理,利用动态领结(DBT)模型和动态贝叶斯网络(DBN)相结合的风险分析方法,构建气化炉超温事故风险分析模型。首先,分析设备故障的时序性,建立超温事故的DBT模型,结合模糊评价确定设备故障的发生概率;然后,将DBT映射到DBN中,将故障维修的动态特征定义为转移概率,双向推理气化炉超温的风险因素;最后,预测气化炉发生超温及其后果的动态趋势,并依据诊断推理辨识导致气化炉超温的主要因素。研究结果表明:在考虑维修因素下气化炉运行一年后发生超温的概率为64.4%;气化炉超温的风险因素中,操作失误在生产周期内的影响较大,设备故障集中在磨煤制浆工段。     

Applications of fuzzy faulty tree analysis and expert elicitation for evaluation of risks in LPG refuelling station

A method is presented for analysis of reliability of complex engineering systems using information from fault tree analysis and uncertainty/imprecision of data. Fuzzy logic is a mathematical tool to model inaccuracy and uncertainty of the real world and human thinking. The method can address subjective, qualitative, and quantitative uncertainties involving risk analysis. Risk analysis with all the inherent uncertainties is a prime candidate for Fuzzy Logic application. Fuzzy logic combined with expert elicitation is employed in order to deal with vagueness of the data, to effectively generate basic event failure probabilities without reliance on quantitative historical failure data through qualitative data processing.The proposed model is able to quantify the fault tree of LPG refuelling facility in the absence or existence of data. This paper also illustrates the use of importance measures in sensitivity analysis. The result demonstrates that the approach is an apposite for the probabilistic reliability approach when quantitative historical failure data are unavailable. The research results can help professionals to decide whether and where to take preventive or corrective actions and help informed decision-making in the risk management process.     

核电站重要敏感性设备分析

核电站重要敏感性设备管理是国内首次采用归纳法和演绎法对核电站重要敏感系统和设备进行识别和设备分级的一种新方法。目标是为了找到导致反应堆紧急停堆、强迫停机和非计划跳机跳堆风险的主要部件 ,并采用 80 - 2 0的原理进行有效的管理 ,建立有效的风险管理 (预防、探测、改正行动 PDC ,Prevention/Detec tion/Correction)大纲和PDC管理数据库 ,并对大部分的重要敏感设备的子部件进行的FMEA(FailureModeandEffectAnalysis)分析 ,识别其失效机理 ,从而确定重要敏感设备清单和预防跳机跳堆的改正行动 ,减少未来由于设备失效导致的跳堆次数 ,达到提高核电站的设备可靠性、安全性和经济性的目的。     

基于HAZOP分析的加氢装置工程设计方法

加氢装置属甲类火灾、爆炸危险生产装置。为了在设计阶段尽可能消除或控制潜在风险,本文总结了多套加氢装置HAZOP分析报告中的设备类别及其分析内容,提出了基于危险与可操作性(HAZOP)分析的加氢装置工程设计方法。在传统工程设计方法的基础上增加了参数敏感性工程设计方法,依据分析报告中的设计建议,利用ASPEN软件计算过程参数变化对目标参数的影响程度,确定参数稳定操作区域;建立了数据库管理界面实现了加氢装置工程安全设计经验知识的有序管理。应用基于HAZOP分析的加氢装置工程设计方法,有助于将安全隐患问题在设计阶段消除或加以控制,可为降低石化装置改造成本和提高装置的安全水平提供方法依据。