Risk Management in Engineering
Topic: Engineering Failure Due to Human Error
Introduction
In all engineering operations and practices, risk has become an integral part of the day to day operations thus needs critical attention right from the design stage all the way to the project implementation phase. As Paulos (2012) defines it, risk refers to the probability distribution of loss, or the likeliness of loss occurrence while handling or undertaking engineering operations. On the other hand, Smith and Merritt express risk management as an organized set of techniques and procedures for controlling the occurrence of uncertainties in engineering projects. It worth noting that the whole process of risk management in engineering is not an exact science thus management procedures might differ depending on other underlying conditions of the project. This to imply that similar projects in different locations might have different and distinct risk management procedures depending on the condition and nature of the engineering practice undertaken. According to Dixon and Kwak (2018), complex engineering operations bear the highest possibility of risks than simple operations. In the context of construction engineering, mega projects have numerous risk possibilities as compared to small construction projects. There are numerous possible factors that might trigger or influence the occurrence of risks during or after the completion of the project. Of interest to this report is the engineering failures caused because of human beings due to simple errors made during design or during construction or due to simple omissions and negligence.
References
The main intent of this report is to analyse the causes of failure on two different engineering projects, which are Bhopal gas disaster and Kolkata flyover collapse. Through civilization, there has been high value on human rationality; the profound civilization is dominated if not sustained by clusters of companies and firms both small and large, which profess the intent of displaying the perfect score of value in pursuing rational course of actions in construction activities. The incident that occurred in Bhopal in the year 1984 was a disaster that claimed over 2500 lives through accident caused by leakage of methyl isocyanate. This report presents and describes human error analysis as emerged from the two case accidents, Bhopal gas leak accident and the collapse Kolkata Bridge; these two cases were so detrimental in the development of studies on the importance of human factor in engineering operations. The contribution of human error on the occurrence of the uncert6inities at work places, the human factor and human connection with safety management in this report will focus on the two highlighted case examples. The case examples brought about tremendous changes in how human performance was handled especially in the engineering practices and nuclear field.
Case 1: Bhopal Gas disaster 1984
Its more than 35 years since the Bhopal gas leak accident that claimed thousands of lives of workers and residents of the Bhopal town. The tragedy is still fresh in the minds of survivors as it left them with life time scar of disability and trauma. In the history of industrial disaster, Bhopal still stands to be the most feared and biggest accident that ever occurred in the gas and nuclear industry in the whole world. On the fateful night of 2nd-3rd of December 1984, an Indian based gas company, Union Carbide India Limited (UCIL) and partly owned by American gas company Union Carbide Corporation experienced a the greatest loss of the 20th century. Since 1984, the town of Bhopal has never been the same again as the streets still brings nostalgic and tragic memory of what happened in the town over 35 years ago. Out of the gas leak, over 2500 people lost their lives with over half a million people, residents of the Bhopal town got exposed to the toxic methyl isocyanate alongside other toxic and hazardous chemicals that emanated from the gas plant. The aftermath of the Bhopal gas leak was immense as over 2000 people died on the fateful night with over 300000 people suffered other injuries of varying severity as a result of the leak. Not to mention, properties worth hundreds of millions US dollars were damaged by contamination from various gas residue from the plant leak. Bhopal region become an ideal business location for the American enterprise, Carbide corporation for establishment of a gas plant and pesticides manufacturing industry since it was centrally located, densely populated thus labor was not a problem and the region had well-established road network. Since its establishment in 1970, the production boomed and business was progressing well until 1984 when the demand of pesticide in the region drastically reduces, forcing the plant to produce only a quarter of its full capacity. As management strategy, the company decided to shift some of its plants and machines to other countries where the business was lucrative. By doing so, the numbers of employees were cut and the operations at the Bhopal site was not of priority to the management.
Up to around mid-1984, the company was still in operation though at low margins, safety precautions and standards became the least of management concerns. Surprisingly, the local authorities were aware of the low safety measures at UICL and were reluctant to enforce the standard measures required in control of struggling industry. Thought up to date there is still no official report to officially explain the root cause of the leak but it is clear to the people of Bhopal that the incident would have been avoided only if the company and safety engineers would have been honest in their duties. The error was that safety engineers ware aware of the sleek operations and kept quiet about it. The gas leak must have occurred at the supply pipes, if there were regular inspection on the pipe by operation engineers, these weary pipes would have been replaced thus preventing the leak. The damage was great, not only humans and animals were affected but also surrounding environment completely changed.
Stakeholder analysis
After the accident, the American based company UCC started to bolt out, distancing itself with the tragedy and shifting all the blame to the Indian based corporation UCIL. The main intent of UCC was to evade the responsibility of being liabe le to the damage as well. Eventually all the operations at the plan were halted with immediate effect as investigation was launched. In the case of Bhopal, there are three main stakeholders, the government authorities (both local and national), the firms (both UCC and UCIL) and the victims (plants employees and the residents of Bhopal region).
All these stakeholders had hand in the incident as all failed at some point thus lead to the accident. Starting with the authorities, they were aware of the relaxation of safety standards at the UCIL plant yet they deliberately took no action against the company to enforce safety measures. Both local and national movement officials in charge of safety inspection failed and err in their mandate thus contributed to the accident. To the UCC and UCIL, as a company that deals in handling of toxic gases such as MIC, they need to be more concerned with the safety of operations than the profit they get from the production. The employees who were the causalities also fault on their mandate as attributed in the Occupational, Safety and Health regulations. Personal safety is paramount to every employee operating in hazardous environment as UCIL pesticide plant. Indigenous community of the Bhopal were the causalities of the accident, they were just living their normal lives when the incident occurred. And they are the group that had the greatest effect from the accident as their lives never remained the same, trauma, depression and grief of losing loved ones, disabilities and other side effects that the leaked gases imposed on them are lifetime and its 35 years later but survivors are still traumatized.
Inherent risk analysis
Though there is still no report showing the cause of the accident at Bhopal pesticide manufacturing plant but it is clear that the cause was due to inherent human omissions and negligence on their key mandates and responsibilities. Engineering professionalism code of operation in hazardous plants such as Bhopal required that that safety of operations be of highest priority. As engineers, our role is to solve real life problems through our designs with high cognizance to the surrounding community and environment.
Going by the accident description its evident that if the operation engineers had initiated the emergency cooling system of the plant during the initial stages of the accident, they would controlled the melt down of the gas cores. By doing this the accident would have been controlled thus the whole accident was labeled to be as result of human negligence or operator error. from analysis of the activities and operations before the incident, human factor had a lot to contribute to the occurrence of the accident. First it is right to deduce that the operators lacked proper safety management trainings as it seams like the operators had insufficient knowledge on plant phenomenon that could enable them control the accident before it could spread to the entire community. Another cause was attributed to the error in operating the emergency freed water system at the start of chain event, as it failed to automatically function immediately the leak started. In rightful operation conditions, the emergency feed water system would have automatically opened the safety valves to release water to cool the melting cores containing MIC gas. Plant management failure to equip the operation units with standard and necessary equipment such as ergonomic human-machine interface contributed to the accident. Generally, all these inherent omissions can be attributed to the fact that employees were subjected to long hours of operation affected workers in terms of concentration and other mental related issues that could have led to various errors, causing the melt down of the plant core releasing MIC gas into air.
Casual chain
Case II: Kolkata Bridge Collapse 2016
The collapse of Kolkata Bridge was a big blow to the Indian infrastructure developments as it happened at the time when the country was in the verge of obtaining equivalent recognition as those of developed countries in terms of infrastructural developments. By 2016 India was following Unite4d states of America as the country with the second largest road network system in the world. With good road network system translate to the economic developments and advancement within the country as roads network penetrates up to the remote regions of India thus opening them up for both local and international trade hence boosting the country’s economy. In indian construction, industry, there have been a number of construction failures and collapse of structures that might have not reached the public attention. And close analysis to the root cause of these failures, it is established that sixty percent are attributed to failure due to human errors and omission either during design phase or during actual implementation of the designs. For this report will categorically focuses on the case of Kolkata Bridge collapse that occurred in April 2016.
Construction of a 2.5Km Kolkata Flyover Bridge across Vivekananda Road in the central Kolkata was to serve the Burra Bazar wholesale market, one of the largest wholesale points in Asia and the objective of this construction was to ease traffic congestion that was becoming a nightmare along Vivekananda Road. By design, Kolkata Bridge was exemplary perfect since the results obtained from various simulation models proved that it was the ideal solution to the traffic along Vivekananda road, plus being a major milestone in the country’s infrastructure. The flyover was designed to have four lanes and steel was to be the main material to be used for construction, however due to tight construction schedule, it is believed that construction engineers must have had some human error or omission in following the design that lead to the bridge collapse.
The collapse description
Kolkata Bridge was contracted in the year 2008 to the IVRCL Hyderabad based construction company. By tendering the project had overshot the set deadline multiple times as the initial deadline was to be in 2010. It calls for the intervention of the Mamata Banerjee, Western Bengal chief minister to give an 18 month ultimatum for the bridge to be completed on or before the end of month of February 2016. It is believed that the collapse of the bridge was due to errors made by construction engineers in reinforcing the columns, piers and beams of the bridge as it collapsed a day after the concrete of the bridge was laid. The collapse occurred on 31st of March 2016 at around midday at the Rabindra Sarani road crossing, where a 150m steel span fell trapping a number of pedestrians and motorists underneath. Over 60 people lost their lives instantly with over 100 escaped with injuries of varying severity. Until 1st of April 2016, hundreds of people were still unaccountable and it was suspected that they were still underneath the collapsed bridge.
Stakeholder analysis
Considering the magnitude of the Kolkata Flyover, it was a concern to a number of parties. The government was concerned with its completion as it was one of the mega project launched by the government since 2008. And for this reason, chief minister of Bengal order for the immediate completion of the stalled project. Another key stakeholder in this project was the IVRCL construction company since it was the contracted firm to undertake construction process. With IVRCL Construction Company includes the engineers and construction worker who were responsible for the bridge construction. And lastly the general publics who were hopeful that after completion of the Kolkata Bridge, there would be ease of movement across the busy roads Burra Buzzer wholesale market.
Inherent risk analysis
According to report released by retired head of civil engineering department at IIT KGP, Gupta Anandapran, confirmed that the cause of the collapse was due to human errors made by engineers. The report showed that there were multiple defects in the bridge layout right from its design, construction material used, construction process and the overall supervision. Acharya Biranchi who was professional and construction expert with vast experience in bridge construction stated that the collapse of the Kolkata bridge was on the account of pier cup failure that brought down the two span the supported it due to buckling effect. Thus commented that the failure of pier was either due to entering error or use of substandard construction materials such as metals used or mortar for reinforcement. And generally the simple omission made by engineers as they were rushing the project to meet the thin set deadline by the chief ministers.
Casual chain analysis
From the above considered case analysis (Bhopal gas accident and Kolkata Bridge collapse), they shows the essential of having casual chain analysis in engineering production plants and construction processes. Most of the recently reported accidents in most of engineering practices are due to simple mistakes made by engineers, often referred to human error but the aftermath of these errors are detrimental as they result to loss of lives and disabilities to many innocent individuals. Therefore it is a call of engineering professionalism to ensure and maintain high standards of precision in all engineering undertakings as lives of innocent people are at stake.
Conclusion
It natural that to err is to human and no one is perfect in their dealings to attain 100% accuracy but as professional engineer, it call for an extra sense of responsibility to ensure that the dealings and practices involved in are safe and does not expose the public to any form of hazards. There are numerous lessons learnt from the two case analysis considered in this study. Most important is that, engineers are tasked with the responsibility of making the lives better and not making it miserable as with the Bhopal gas incident and Kolkata bridge collapse.