Key
Lessons for Preventing Incidents from Flammable Chemicals in Educational
Demonstrations.
October
30, 2014, Denver, CO – Today the U.S. Chemical Safety Board (CSB) released a
safety bulletin called “Key Lessons for Preventing Incidents from Flammable
Chemicals in Educational Demonstrations” based on three recent
serious incidents in Nevada, Colorado, and Illinois where children were burned
while observing laboratory demonstrations involving flammable liquid methanol.
The
first incident described in the CSB safety bulletin is the September 3, 2014,
accident at the Terry Lee Wells Discovery Museum, known as “The Discovery,” in
Reno, Nevada, where thirteen people, most of them children, were injured. Two
CSB investigators were deployed to the site and interviewed personnel who were
directly involved.
Just
12 days after the fire in Nevada, a second similar accident occurred on
September 15th at the SMART Academy in Denver, Colorado, severely burning a
16-year-old high school student. Most recently, on October 20, 2014, less than
five weeks after the incident at SMART, three Cub Scouts and one adult were
injured during a demonstration using methanol at a Cub Scout event in Raymond,
Illinois.
All
the incidents involved demonstrations of flames – usually with a color additive
– using methanol as the flammable liquid. In all three cases there was a flash
back to the methanol bulk containers, and fire engulfed members of the viewing
audience who were not protected by any physical barriers.
The safety bulletin notes that these incidents
are similar to others the CSB has identified in which laboratory demonstrations
involving flammable materials have resulted in fires and injuries. These
include a 2006 accident at an Ohio high school that severely burned
then-15-year-old student Calais Weber. The accident took place during a
demonstration of a chemical “rainbow” that involved combusting salts with
methanol. Calais’ story was described in a CSB safety video released in
December 2013, called “After the Rainbow.”
The
CSB found that the accident at The Discovery took place during a “fire tornado”
demonstration, where salts of different elements are burned in a dish along with
methanol-soaked cotton balls, while spinning on a rotating tray. This produces
a colored flame that looks like a tornado.
However,
on the day of the accident the cotton failed to catch fire as expected.
Additional methanol was added from a four-liter (about a gallon) bottle. CSB
investigators determined that unbeknownst to museum personnel, the cotton ball
was likely already smoldering, which ignited the freshly added methanol. A
flash fire raced back into the large bottle - and burning methanol from the
bottle sprayed toward the nearby audience of adults and children.
CSB
Chairperson Rafael Moure-Eraso said, “ When performed safely these kinds of
demonstrations can engage students and visitors and stimulate their interest in
science. But methanol, the hazardous chemical involved in The Discovery and two
other recent incidents the CSB has investigated, is classified as a highly
flammable liquid, and users should adopt strict safety controls.”
Methanol
can ignite at room temperature and has the potential for dangerous flash fires,
especially when large quantities are present. The threat is quite similar to
gasoline. However, CSB investigators learned that methanol is readily sold to
schools and museums in four-liter containers.
The
CSB also found that The Discovery developed the fire tornado demonstration
based on YouTube video and additional online resources, where descriptions of
accident risks or comprehensive safety instructions were not provided. And
museum personnel who wrote procedures for the demonstration did not have an
adequate background in chemistry or safety. The demonstration was performed
approximately 15 feet away from museum visitors, with no barrier between the
audience and the flames.
Similarly
the CSB found that in the incident at SMART in Denver, the school lacked
adequate safety procedures and a lab safety training program. The accident
occurred during a demonstration activity of flammable properties which involved
igniting a small pool of methanol to create a flame. When the flame did not
rise as high as anticipated, additional methanol was added from a four-liter
bulk container resulting in a 12 foot flash fire.
The
CSB found that the teacher was not aware of the potential for a methanol flash
fire and had received no training about the hazards related to demonstrations
involving large quantities of methanol or other flammable materials. This
incident resulted in four students being burned in the flash fire, one
seriously.
Likewise
the October 20, 2014, accident demonstration at a Cub Scout event in Raymond,
Illinois, occurred when methanol was poured from a container onto boric acid
near an open flame. Similar to other incidents, the flame propagated back into
the bottle and resulted in a flash fire that burned members of the group and
seriously injured one Cub Scout. Like The Discovery incident, this
demonstration involved burning methanol with boric acid to produce a green
colored flame.
The
CSB safety bulletin outlines key lessons learned as a result of the CSB’s investigation
into these incidents:
-
Due to flash fire hazards and the potential for serious injuries, do not use
bulk containers of flammable chemicals in educational demonstrations when small
quantities are sufficient
-
Employers should implement strict safety controls when demonstrations
necessitate handling hazardous chemicals — including written procedures,
effective training, and the required use of appropriate personal protective
equipment for all participants
-
Conduct a comprehensive hazard review prior to performing any educational
demonstration
-
Provide a safety barrier between the demonstration and the audience
Chairperson
Rafael Moure-Erason said, “These key lessons, if followed, will prevent future
injuries. Educators should substitute or minimize the use of flammable
chemicals and perform an effective hazard review prior to conducting an
educational demonstration. Safety must be the absolute priority and educators
should demonstrate chemical safety concepts as well as the science topic.”
The
CSB is an independent federal agency charged with investigating industrial
chemical accidents. The agency's board members are appointed by the president
and confirmed by the Senate. CSB investigations look into all aspects of chemical
accidents, including physical causes such as equipment failure as well as
inadequacies in regulations, industry standards, and safety management systems.
The
Board does not issue citations or fines but does make safety recommendations to
plants, industry organizations, labor groups, and regulatory agencies such as
OSHA and EPA. Visit our website, www.csb.gov.
High
Percentage of Chemical Accidents in Schools are Preventable
An
analysis of chemical incidents in elementary and secondary schools conducted by
the Agency for Toxic Substances and Disease Registry (ATSDR), found that 62
percent of these incidents resulted from human error (i.e., mistakes in the use
or handling of a substance), and 30 percent of incidents resulted in at least
one acute injury.
Proper
handling of chemicals is critical for the protection of students and facility
in schools. Keeping an inventory of chemicals, correctly storing and labeling
these products, as well as proper disposal are all required for safety.
Education and training of the possible risks and hazards of chemicals needs to
be provided to those who will be handling these dangerous chemicals.
Damage
to a classroom in Fresno, CA after a chemical fire.
In
their analysis of these incidents, the ATSDR found that the majority were
caused by one of the following:
Improper
chemical storage
Unsafe
handling practices
Improper
application of standard workplace procedures
Equipment
failure (i.e., broken containers, hoses, or pipes)
The
U.S. Chemical Safety Board (CSB) recently released a video safety message, After
the Rainbow, that focuses on potential dangers in high school
chemistry laboratories. The message features Calais Weber, an accident
survivor, who on January 23, 2006, at age 15 was burned over 40 percent of her
body during a chemistry demonstration performed by her teacher at a prestigious
boarding school she attended in Ohio.
What
steps can schools take to prevent these accidents? The U.S. Environmental
Protection Agency offers these four strategies to help prevent chemical
accidents:
1.
Identify places where chemical health and safety incidents might occur on
your school’s campus such as:
Store
rooms
Custodial
closets
Kitchens
Nurses’
offices
Swimming
pools
Science
and art classrooms
Motor
pools (bus barns)
Vocational
and agricultural shops
2.
Develop and follow appropriate health and safety training and worksite
practices for staff/students who use chemicals:
Store
hazardous chemicals securely, in well-ventilated and lit areas; and, in tightly
closed, properly labeled containers.
Avoid
the combination of incompatible chemicals (For example, do not store
alphabetically).
Avoid
the use of flammable chemicals near open ignition sources (i.e. furnaces and
space heaters) or damaged electrical outlets and wiring.
Perform
periodic maintenance checks on vessels and equipment that contain hazardous
chemicals (Look for unexpected crystallization in bottles, or bulging
containers).
3.
Develop and distribute campus-specific contingency plans; then, train
staff and students on emergency practices and procedures for chemical events,
such as:
Practice
evacuation and “shelter-in-place” drills with faculty
Compile
chemical event notebooks with emergency checklists and phone contacts, chemical
inventories and material safety data sheets (MSDS).
Designate
lead staff to serve as monitors who would be responsible for making sure
everyone under their charge follows the appropriate evacuation procedures.
4.
Develop, communicate and implement preventative policies and
practices with chemicals on school grounds to:
Ensure
that proper ventilation practices are considered when chemicals like
pesticides, paints, and floor strippers are applied.
Identify
and properly dispose of waste or derelict chemicals that have been in storage
for an unknown period of time.
Enforce
policies on improper possession or use of chemicals when observed on school
grounds; common items may include liquid mercury, pepper spray, or cans of
spray paint.
Substitute
equipment that does not use mercury when replacement purchases are made; such
as thermometers, blood pressure cuffs, or electrical equipment.
Additional
resources for schools from the EPA can be found on their website, including the
Healthy
School Environments Assessment Tool and the Indoor
Air Quality Tools for Schools Kit.