26工人和救援人员进入密闭空间的窒息危险.docxVIP

CASE STUDY Confined Space Entry - Worker and Would-be Rescuer Asphyxiated No. 2006-02-I-DE November 2, 2006 案例研究 工人和救援人员进入密闭空间的窒息危险 编号：2006-02-I-DE 2006年11月2日 1.0 Incident Description This Case Study examines the November 5, 2005, nitrogen asphyxiation death of two Matrix Service Industrial Contractors, Inc. (Matrix) employees at the Valero Energy Corporation (Valero) refinery in Delaware City, Delaware. Matrix was contracted by Premcor, Inc.,1 the previous owner of the refinery, to serve as the primary maintenance contractor during the fall 2005 maintenance turnaround (unit shutdown). Nitrogen, which makes up 78 percent of the air we breathe, is non-toxic. The normal oxygen concentration in air is about 21 percent. Nitrogen is frequently added to process equipment to significantly reduce the oxygen concentration inside. This oxygen-depleted atmosphere inside the equipment is hazardous because there is not enough oxygen to support life (Table 1). Furthermore, an oxygen-depleted, hazardous atmosphere might be present outside the equipment near unsealed equipment openings. 1、突发事件 该案例研究回顾了2005年11月5日在特拉华州特拉华州市瓦莱罗能源公司（瓦莱罗）炼油厂发生的两名承包商工人氮气窒息死亡事故。承包商是由炼油厂的前所有人签约的，主要负责2005年秋季的维修周转工作。作为我们呼吸的空气78%的氮气是无毒气体。空气中的正常氧气含量是21%。氮气被广泛应用于工艺设备填充，以减少设备内部的氧气含量。设备内部的贫氧环境是非常危险的，因为这样的环境无法提供支持生命所需的氧气（表1）。此外，设备外部也可能有窒息的危险，比如无密封件设备的开口处附近。 Table 1. Effects of oxygen deficiency on the human body. Percent Oxygen Physiological Symptoms 23.5 Maximum “safe level’ 21 Typical oxygen concentration in air 19.5 Minimum safe level 15 - 19 First sign of hypoxia. Decreased ability to work strenuously. May induce symptoms in persons with heart, lung, or circulatory problems 12 - 15 Respiration increases with exertion, pulse up, impaired muscular coordination, perception, and judgment 10 - 12 Respiration further increases in rate and depth, poor judgment, blue lips 8 - 10 Mental failure, fainting, unconsciousness, ashen face, blue lips, nausea, vomiting, inability to move freely 6 - 8 Six minutes–50% pro