Safex Newsletter No.84 July 2026


It is remarkable that we are already approaching the midpoint of 2026. This has been a particularly busy and productive period for Safex International, highlighted by our Congress in Lisbon. We once again extend our sincere thanks to our hosts, Orica, for their support and hospitality. In particular, we acknowledge Amanda Santos from the Lisbon office for her dedication, attention to detail, and significant contribution to making the Congress such a success.

The Congress brought together 184 participants representing 26 companies from across the globe. Delegates returned with a shared message: the event provided valuable learning and reinforced awareness of the safety challenges and objectives facing our industry worldwide. These insights will be shared with our membership as part of our continued commitment to achieving zero harm.

I extend my sincere gratitude to all attendees for their participation, engagement, and support. This was one of the most successful Congresses I have had the privilege of attending.

This Newsletter opens with a message from our Chairman, John Rathbun, who reflects on the Congress and the highly successful CEO meeting.

Andy Begg has brought together contributions from the Expert Panel and individual Associates, resulting in the following insightful articles on incidents and safety management:

Also included are Vignettes of Lisbon and Surroundings, photographed and compiled by Noel Hsu, which provide a visual reflection of the Congress venue and its surroundings.

I trust that you will find this Newsletter both interesting and informative. As this is my final edition as Secretary General of this outstanding organisation, I would like to express my sincere appreciation to every contributor who has supported the Newsletter over the past 12 years.

Piet Halliday , Secretary General

ACCIDENTS IN EXPLOSIVE MANUFACTURING

Dr. N.V. SRINIVASA RAO,
Individual Associate Member, Safex international

INTRODUCTION

Accidents are unwanted and undesired. To avoid accidents, all possible precautions should be taken. No stone must be left unmoved for avoiding accidents. Even after taking all possible precautions; some times accidents may happen unfortunately.

Once an accident happens; better understand the situation well. Analyze the situation. Observe the debris. Try to list out probable causes. Take all precautions required to avoid such kind of accidents again. If we are not learning from our failures; we can not have success in our life

In the pursuit of safety and accident-free manufacturing; There should be a system of sharing knowledge among the manufacturers. If there is a common forum for having discussion and debating, a lot of scope will be there for improvement and preventing accidents.

Accident in Detonating Cord Plant

  • Company: A multi national explosive manufacturing Company
  • Facility: Detonating Cord plant
  • Incident: On 31st December, 1999; two mechanics were removing a metal plate which was mounted on to the wall of a spinning room. A detonation occurred.

Why this incident is chosen:

An incident which is a near miss will give very valuable lessons. Severity of the consequences in this incident might have been quite high. There was a clear potential for more serious injury and even death. Luck only saved the mechanic and left with minor injuries.

Description of the incident:

Two mechanics were disassembling a metal plate bolted onto a wall. The detonation occurred as the plate was being removed from the wall. The plate was projected and hit one of the mechanics. As per the practices of the company the following is the routine observed before they for maintenance.

Routine before maintenance:

Ensure there is no visible sign of any explosive or explosive waste in the compartment. Wash the room and wall carefully with high pressure water. Clean the equipment carefully using a brush. In addition to brush cleaning; use chemical for destruction of explosive. It is very essential to destroy any residual explosives in cracks or crevices. Maintain water flow all the time on the work area while undoing nuts and bolts.

The following findings were recorded by the investigation team:

The maintenance supervisor was present when the accident occurred. The supervisor and safety personnel know the standard procedure for cleaning the equipment and chemical destruction. Work permit was given and complied with requirements. The room was cleared from all explosives as per the prescribed procedure. Initially cleaning has been carried out by the production operator and then cleaning has been carried out by contract persons. The mechanics had previous training and experience with explosives. Water flow was being maintained during the removal of the plate. Even after taking all required precautions the detonation occurred.

The most probable causes for the accident:

Presence of PETN dust in the bolt / hole.
Improper tools used for removing the device.
Excessive use of force to remove the device.
Some dry PETN might not have been removed during the cleaning process. It remained inside the hole and was detonated by friction.

Lessons to be learnt

  • Third party inspection: No third-party inspection is carried out before starting the work.
  • Risk assessment: Risk assessment is not done; what can happen; what effect will it have; what can be done to prevent or reduce the consequences.
  • Careful adherence to standard procedure; Adequacy of the procedure:
  • One can understand that how easily this explosive penetrates into crevices; joints; threads etc. It is better to prevent this from occurring than treating the consequences subsequently.
  • Avoid use of excessive force to remove equipment which offers resistance. If force is required; provide it from behind a barricade or remotely if possible.
  • The working personnel should have sufficient knowledge on how to do the maintenance work.
  • They should stand not directly in front of the workpiece but they should position themselves to the side and out of the direct line of fire should the piece be ejected by explosion

Accident in Booster Plant

  • Company : An explosive manufacturing plant (Defense undertaking) in USA.
  • Facility : Booster manufacturing plant and PETN drying plant
  • Incident : On January 7th, 1998 in Booster plant during a ‘Melt Pour’ operation involving TNT; PETN and composition B an explosion occurred, followed by a 2nd explosion 3 seconds later in PETN Plant
  • Causalities : 4 persons died; 6 persons had serious injuries; Total
    explosive involved is 47,000 lbs

Observation by investigation team:

A metal hammer was being used to break up lumps of explosive. The company was getting some of its raw materials from military explosives such as torpedoes; rockets; motor shells and bombs. Sometimes; nuts, bolts and other objects from the above materials would be discovered in explosive mixing pot. After completion of each shift; the melting pot was being cleared and it was being completely freed from all explosives. Next shift operator perhaps did not look into mixing pots before starting. Management believed that unless a detonator is used; it was nearly impossible to detonate the chemicals used. Many essential elements of process safety management were missing. The use of contaminated explosive material will pose some risk. This was not adequately studied.

Reasons for Incident:

Different theories were made to identify the reasons 4 scenarios were developed; using a steel hammer to break solid explosive, which may cause a friction and/or impact. Operators used brooms and plastic buckets to clean up spills; which will have a static risk. Process of drying PETN made faster by increasing the temperature increasing risk of PETN explosion. Training / safety rules not displayed in other than local language. Inadequacy of training and awareness among the persons. But the investigation team basing on seismic data; interviews with workers; the physical evidence observed during the investigation believed that the day before the incident one melt / pour operator working in booster 2 plant left the work early. About 50 to 100 pounds of explosive was there in mixing pot at that time. The mixing pots blade extended about 2 inches into the mix. The next shift; no operation in the building. The following day morning the same operator switched on the motor of mixing pot. By that time it was considered that the mix in the pot solidified with the bottom of the mixer blade embedded in the solidified explosives. Because of impact; shearing or friction of explosive material when the mixer was switched on with the pot wall, explosion took place. Another possibility is that lumps of explosive material were crushed between the mixer blade and the pot walls; causing the detonation. A heavy piece of equipment or burning debris from the 1st blast fell through the reinforced concrete or the skylight of the PETN building and initiated the 2nd explosion.

Lesson to be learnt

  • Process hazard analysis is to be conducted for all processes.
  • Proper training programmes for managers and operating persons are very much essential.
  • Operating procedures must be updated. They should be in the language understood by the work force.
  • No deviation should be allowed without proper analysis.
  • Systematic safety inspection / auditing programmes should be followed.
  • Employees should be involved in developing or conducting process safety activities.
  • There should be a proper check list to check before starting the plant and a check list before stopping the plant also.

Accidents can be avoided or effects can be minimized;

Whether it is in primary explosives; secondary explosives; pyrotechnics or Bulk explosives if the following few points are followed without fail accidents can be minimized.

  • Maintain explosive & man limits in the buildings.
  • Don’t allow untrained operators to conduct manufacturing operations.
  • For every worker; supervisor and line manager; not only general safety training but also on the job training is required.
  • Standard operating instructions; MSDS for materials involved should be available in local language.

All involved must aware of these things.

  • No-one should change the operating procedures without thorough understanding & proper analysis & approval.
  • Third party safety audits to all plants at regular intervals should be planned. Adequacy of safety systems procedures and equipments should be thoroughly studied.
  • Hazard analysis and Risk assessment for all the process should be conducted before implementing the process.
  • Suitability of equipment for the process is to be thoroughly studied before introducing.