During a trial of fire-fighting equipment, a hose expansion joint or bellows failed. The release of pressurized water hit a crewman who was standing nearby, slamming him backward and knocking him unconscious. The fire pump was shut down and help was sought. CPR was administered; subsequently the injured person was medevaced.
This incident was considered by our member to be a potential fatality. The injured person was in hospital for some weeks.
What went wrong? What were the causes?
Some identified issues were:
- There was inadequate management of significant risk;
- There was no understanding of the life time of the expansion joint or bellows;
- There was no installation procedure provided for this bellows by the manufacturer;
- There was no preventive maintenance or inspection/testing of the failed equipment.
What actions were taken? What lessons were learned?
Our member drew the following lessons:
- There had been a similar rupture of a bellows some years previously; this earlier incident was not investigated. Had it been investigated, it might have helped in preventing reoccurrence;
- Engineering and design of critical equipment during new building should take into consideration personnel safety as well as equipment protection;
- There needs to be a better design review of pressurised equipment, particularly where different components are in use.
Members may wish to review the following incidents:
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