Inspection Detail

Inspection: 18815605 - Westvaco Corporation Fine Papers Division

Inspection Information - Office: Department Of Labor, Licensing, And Regulation Division Of Labor And Industry Maryland Occupational Safety And Health

Investigation Summary

EMPLOYEES #3, #4, AND #5 WERE LOCATED ON TOP OF A NONCONDENSIBLE GAS STORAGE TANK, PREPARING TO COVER IT WITH PLASTIC SO THAT THEY COULD SANDBLAST AND PAINT THE RAILS THAT IT RIDES UP AND DOWN ON. THE TANK WAS 25 FEET HIGH AND LOCATED ON THE TOP OF A 5 STORY DIGESTER HOUSE. THEY HAD BEEN ON THE TANK FOR APPROXIMATELY 15 MINUTES WHEN EMPLOYEE #3 COLLAPSED. SHORTLY THEREAFTER, EMPLOYEE #4 COLLASPED. EMPLOYEE #5 CALLED DOWN TO EMPLOYEE #6 AND EMPLOYEE #8 WHO WHO WERE WORKING ON THE ROOF LEVEL BELOW. THEY CAME UP THE LADDER AND EMPLOYEE #6 HELPED TO GET EMPLOYEE #5 OFF THE TANK. EMPLOYEE #8 WENT TO GET HELP. EMPLOYEES #1,#2,#9 AND OTHERS ARRIVED AT THE SCENE TO RESCUE THE INJURED PERSONS. EMPLOYEES #3 AND #4 WERE IN FULL CARDIAC ARREST AND HAD STOPPED BREATHING. CPR WAS ADMINISTERED. EMPLOYEE #4 REVIVED QUICKLY, BUT IT TOOK LONGER TO GET EMPLOYEE #3'S HEART TO RESUME BEATING. OXYGEN HAD TO BE ADMINISTERED ALL THE WAY TO THE HOSPITAL. EMPLOYEE #1 REMOVED HIS SCBA MASK DURING THE RESCUE IN ORDER TO RENDER CPR. THE ALARMS ON SEVERAL SCBA'S WENT OFF BEFORE THE PROCEDURE WAS COMPLETE. EMPLOYEES #2,#6,#7,#8 AND #9 WERE GIVEN OXYGEN AT THE HOSPITAL AND RELEASED. EMPLOYEES #1,#5 AND #4 SUFFERED FROM RESPIRATORY DISTRESS AND NAUSEA. THEY WERE KEPT IN THE HOSPITAL UNDER OBSERVATION FOR 3 DAYS. EMPLOYEE #3 IS STILL IN THE HOSPITAL. HIS EEG IS A STRAIGHT LINE FOR BOTH BRAIN HEMISPHERES. HE IS IN A COMA AND THERE IS ONLY ENOUGH ACTIVITY IN THE BRAIN STEM TO OPERATE NECESSARY BODILY FUNCTIONS. THE PHYSICIAN'S PROGNOSIS IS GRIM. THE CASUAL FACTOR WAS FOUND TO BE A CRACK IN THE EMERGENCY VENT ASSEMBLY AT THE TOP OF THE TANK. THE PAINTERS WERE NOT WARNED ABOUT WHAT WAS IN THE TANK AND ONLY KNEW THAT IT WAS POTENTIALLY EXPLOSIVE. THEY DID NOT HAVE RESPIRATORY EQUIPMENT WITH THEM AT THE TIME OF THE ACCIDENT. THE RESCUERS DIDN'T KNOW WHAT GAS THEY WERE DEALING WITH, BUT THEY DID HAVE PROPER RESCUE EQUIPMENT. ALTHOUGH PROPERLY TRAINED, THE RESCUERS REMOVED THEIR SCBAS WHILE STILL IN THE DANGER ZONE (TO PERFORM CPR). THEY SHOULD HAVE KEPT THE SCBAS ON UNTIL THEY WERE OUT OF THE DANGER ZONE.

Keywords: RESPIRATORY, UNCONSCIOUSNESS, CPR, PPE, WORK RULES, INHALATION, SCBA, TOXIC FUMES, HYDROGEN SULFIDE, GAS LEAK