Lessons learnt from the "Piper Alpha" disaster

Introduction
On the evening of the 6th July 1988 there was a gas leak, which ignited, causing an explosion and fire. 167 people were killed.
The subsequent report from the Lord Cullen public enquiry produced a broad range of recommendations for changes in the offshore safety regime. But for lessons learnt we must look to a wider area rather than just the official report.

Pre Piper Attitudes
Consider the situation prevailing in the North Sea five minutes prior to the disaster. The standard operating climate in the United Kingdom offshore oil and gas industry could be characterised as a lethal mixture of greed, ignorance, complacency, and a cavalier lack of concern for the danger that individuals faced.

This long recognised, but conveniently ignored fact was given tacit approval by the government through the legal framework. It excluded the offshore industry from the provisions of the Health and Safety at Work Act, and allowed the government safety watchdog, the offshore inspectorate to exist as a small and understaffed, under funded, unimportant sub division of the revenue watchdogs, the Department of Energy.

History of a young industry
This was a new industry introduced at high speed into the UK approximately thirty years ago, at the time of a naive government, seduced by the arrival of a high tech, high risk, high reward sunrise industry. The employment and the revenue that Oil brought meant that it accepted and indeed fostered a benign and lucrative partnership between big business and government.

The majority of the next twenty-five years was under the leadership of a government that was proud to demonstrate that it was inclined to favour business and profit over excessive "red tape" regulation and workers rights.

And that was the accepted status quo in the North Sea. There was legislation, but exceptions had been made. There were regulations but enforcement was lax. There were rules but these were mostly paid lip service, or, adhered to for the duration of occasional inspector's visits.

Generally a few missing fingers was seen as a mark of experience in the drilling industry. Strict adherence to the few safety rules was seen as wimpish and a disregard for the regulations was just part of the buccaneering can-do attitude that brought black gold to the surface.

Corporate Pride and Craftsmanship
There was a pervasive attitude in the North Sea. A cowboy pride in the frontier spirit, imported from the USA, coupled with a British pride in its engineering prowess, previously demonstrated during the industrial revolution.
There was the "British Bulldog" spirit that would put up with any conditions because they could take it - Men of Steel. There was the "Where there is muck there is brass" attitude. There was arrogance that enough money was being earned so obviously enough money had been spent. "If this major international oil company has spent £500 million on this platform there is no way they would risk losing all that money."

There was also the grim acceptance among the workforce that if a £500 million platform was to go up in smoke it would be unlikely that a £50,000 life boat or a £5,000 rubber dingy would save your life. High tech platforms crammed full of computers and high priced kit, pumping millions of dollars to shore every day with knotted ropes dangling down to the North Sea as means of escape. Board of trade regulations. Standby boats were viewed as hosed down trawlers with burned out alcoholic fishermen as crew. Nobody took that "safety" thing seriously. Not the owners, not the workers, not the government. So therefore the possibility of it all going up with a bang must be remote.

Everybody was doing all right and the money was good. Apart from the occasional casualty- an unlucky chap who lost a finger, an arm or a leg or once in a while a fatality where someone in the wrong place at the wrong time got flattened by a sheet of steel or got washed overboard.
Really serious accidents only happen overseas to under engineered and over loaded foreign ferryboats and clapped out dodgy chemical factories manned by the ill trained and the work-shy. At 5 minutes to ten on the evening of the 6 July 1988, that was the prevailing attitude. The single most important major change was a complete rethink in the attitude towards safety.

Complacency rather than competency
All major disasters lead to a tightening of regulations, and after the event major companies then comply with the newly imposed legal requirements. Until that point they do not generally spend any more time, money or management effort on making their operations safer or less polluting. Until the law says they have to, there is no perceived need.
When Piper Alpha happened, the whole of the North Sea woke up to reality. It was time to grow up.

A change to the rules
The Health and Safety at Work Act in 1971 brought a major change from prescriptive to goal setting.
The Cullen report was to belatedly introduce this principal to the offshore industry. This put the onus on the operator to consider what was necessary, rather than to just read and comply.
This also required some tangible proof - a demonstration that what was required by the law had all been considered and the outcome of this consideration has been put in place and is deemed sufficient - Hence the Safety Case. It was time to Show and |Tell.

Reaction and Acceptance
This was an onerous requirement since it is no longer sufficient to have compliance with the legal minimum specifications throughout. There follows much casting about for alternative standards to adhere to, and gain approval from.

Eventually the message sunk in and a realisation that there was no prescriptive code to follow - It would be necessary to start from first principals and to think about hazards, risk minimisation, safety, and to engineer safety into the operation. First, in the hardware, then the software, then the warm wear- the people. The mind set had to change.

It becames imperative and cheaper to do it safely rather than faster. The consideration of all the Hazards, the quantification of all the risks, the planning of all the scenarios involved a lot of thought and consultation. Thinking. Instead of just acting in compliance with the law.

Wise after the event
Oscar Wilde said that if you wanted to end wars that you should stop glorifying soldiers and make society considered it vulgar to fight. The continuous UK government campaign over drinking and driving has largely changed the attitude of society over a generation. Gradually a more reflective, mature and serious attitude developed in the oil industry.
Killing people had become a shameful thing to do. Injury likewise. The spectre of Corporate Manslaughter charges still stalks the boardrooms of the corporations. Reputations that have cost millions to establish are at risk.

And as a consequence we now have the time and the inclination and the resources to do the job safely, after we have planned it, trained for it, analysed the risks and considered the options.

Protect and Survive
The report also identified that since offshore platforms are surrounded by water, in the event of a disaster there is no easy means of escape. Consequently two major recommendations were introduced.
• Provide a reliable organised means of escape.
• Provide a temporary refuge until escape is organised.

The major fire that engulfed the platform was never controlled. In fact, it was continuously re-fuelled by operations on another production platform, even though the people there could see that there was a fire. The report recommended
  • that there should be investigation and studies performed to try to prevent this from re-occurring.
  • The control room should be manned at all times, by a person trained and qualified to control

  • The enquiry discovered that Permit to work systems and Audits were operated in a manner to comply with procedures, to meet the requirements, rather than in the spirit of the purpose of these systems to identify and eliminate risks.
    He recommended that all such systems should be independently monitored to evaluate their effectiveness and that any remedial actions required be carried out in a timely manner.

    It is depressing to consider that it took a catastrophe of such proportions to introduce such glaring obvious requirements.

    How safe should an industry be?

    Here is the Government Definition. ALARP - As Low As Reasonably Practical
    That's how safe the industry should be. Our attitude to Safety must be deadly serious. Any compromise we make with safety will come back to haunt us. The cost of safety is always less than the cost of an incident.

    Until a couple of years ago a little old lady lived just up the street from me. She walked past my house occasionally. She looked a bit strange, a bit haunted. She talked to herself. Her son was on Piper Alpha the night of the disaster. His body was never recovered. She never recovered. A Life Ruined. A Real Person.
    ALARP Indeed.


    Michael Heaney
    Benchwhistler Associates Ltd
    Planned People Maintenance - Enhancing the Performance of your most important asset
    Visit our website www.benchwhistler.com

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