"The fire and explosion at West Fertilizer was preventable. It should never have occurred."
That's what Chemical Safety Board Chairperson Rafael Moure-Eraso told the community of West Tuesday night.
The CSB has concluded the large quantities of ammonium nitrate (AN) fertilizer exploded after being heated by a fire at the storage and distribution facility.
The blast killed 14, the majority firefighters and EMTs, and left more than 200 injured. The presentation came just five days after the first anniversary of the explosion.
"...It (the blast) resulted from the failure of a company to take the necessary steps to avert a preventable fire and explosion and from the inability of federal, state and local regulatory agencies to identify a serious hazard and correct it," Moure-Eraso said in a prepared statement.
West volunteer firefighters were not aware of the explosion hazard from the AN stored at West Fertilizer, and were caught in harm’s way when the blast occurred, officials said.
“Local authorities and specifically—local fire departments—need fire codes so they can hold industrial operators accountable for safe storage and handling of chemicals,” he added.
“It is imperative that people learn from the tragedy at West,” Moure-Eraso said.
The CSB makes recommendations to agencies like EPA and OSHA but does not issue fines or citations.
Following their yearlong probe, officials pointed to a number of failures that resulted in the deadly blast.
Supervisory Investigator Johnnie Banks wrote: “The CSB found at all levels of government a failure to adopt codes to keep populated areas away from hazardous facilities, not just in West, Texas. We found 1,351 facilities across the country that store ammonium nitrate. Farm communities are just starting to collect data on how close homes or schools are to AN storage, but there can be little doubt that West is not alone and that other communities should act to determine what hazards might exist in proximity.”
The CSB investigators also noted that McLennan County’s local emergency planning committee did not have an emergency response plan for West Fertilizer as it might have done under the federal Emergency Planning and Community Right to Know Act.
"The community clearly was not aware of the potential hazard at West Fertilizer," they noted.
Investigators said that the NFPA recommends that firefighters evacuate from AN fires of “massive and uncontrollable proportions.” Federal DOT guidance contained in the Emergency Response Guidebook, which is widely used by firefighters, suggests fighting even large ammonium nitrate fertilizer fires by “flood[ing] the area with water from a distance.”
However, CSB officials were quick to point out that the terms such as “massive,” “uncontrollable,” “large,” and “distance” are not clearly defined.
“All of these provisions should be reviewed and harmonized in light of the West disaster to ensure that firefighters are adequately protected and are not put into danger protecting property alone," Banks wrote.
But, they found it upsetting that information about what went wrong or lessons learned aren't shared even when firefighters are killed.
“Regulations need to be updated and new ones put in place. The state of Texas, McLennan County, OSHA and the EPA have work to do, because this hazard exists in hundreds of locations across the U.S.," the chairman noted.