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WATER INCURSION INTO THIONYL CHLORIDE RESULTED IN A FATAL ACCIDENT

The Incident

Water, which was being used as a direct cooling medium in an overhead heat exchanger, leaked into a vessel containing thionyl chloride.  The resulting gases vented into the building itself.  It is not clear whether this was through the designed relief system or through breakage in the overheads.  Two operators were working close by, one of whom was relatively new.  Unfortunately he was trapped and died as a result of injuries from gas inhalation.  The key points would seem obvious - nevertheless failure resulted in a fatal accident.

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