Discussion on the Causes of Organic Synthesis R&D Accidents-Accident Chain (1)

1.

There is a causal relationship in any accident

For example, starting with hidden danger a (factor a) → hidden danger b (factor b) forming the culprit of the accident → factor 1 leads to event 1 (attempt accident or sign or minor accident) → factor 2 leads to event 2 (attempt accident or Signs or minor accidents)→…→factor n leads to event n→causes accidents (large accidents such as injury, death, property damage, environmental degradation, or social impact), which constitutes an accident chain

In most accidents, in addition to the cause of the accident chain (which can be called the "fuse" of the accident) and the "primal culprit" of the accident, the middle section of the accident chain usually contains multiple "events"

Figure 3-14 Compound plough accident chain

2.

In 2007, a serious liability accident occurred in a New York R&D company.

Figure 3-15 The entire floor of the laboratory was burned out

Figure 3-16 A corner of the fire scene

(1) The process and chain of accidents

A researcher performed atmospheric catalytic oxidation (factor a) in a fume hood in his laboratory, and the glass bottle was broken (fuse)

Throw the glass bottle fragments together with the activated palladium-carbon catalyst (Pd/C) into the trash can (factor b), and the palladium-carbon catalyst in the trash can catches fire (the prime culprit)

At noon, the R&D personnel left their jobs to eat.

Solvent barrels, reagent bottles and waste liquid barrels used for reaction and column passing are everywhere, and they are placed everywhere (factor 2).

The person who was found would not use a fire extinguisher (factor 3), and the fire was not controlled (event 3)

In order to disperse the smoke, the doors and windows were opened wide, and the air intake increased the firepower (factor 4), and accelerated the spread of the fire (event 4).

The entire accident chain is shown in Figure 3-17

Figure 3-17 Schematic diagram of the accident chain

Related Links: Discussion on the Causes of Organic Synthesis R&D Accidents—Multi-dimensional Dynamic Trajectory Intersection Theory (5)