June 5, 2019
Catastrophic Consequences of Not Knowing What You Dont Know
Manny Ehrlich, Board member, US Chemical Safety Board
The CSB investigated an incident involving the inadvertent mixture of sulfuric acid from a cargo tank into a sodium hypochlorite tank at a facility in Atchison, Kansas on October 21, 2106. The mixture of the two materials resulted in a chemical reaction that produced a dense, green-yellow cloud containing chlorine gas. Thousands of community members were ordered to shelter-in-place – some areas were evacuated. Over 140 individuals, including members of the public and company employees, sought medical attention; some required hospitalization. This presentation will examine the many lessons learned from this investigation with an expectation that they will be employed in preventing similar incidents during chemical unloading.