Industrial accidents have a long history of leaving behind devastating consequences, both human and economic, more than just damaged infrastructure. Despite advancements in technology, automation, and regulatory oversight, process safety failures still occur, often with catastrophic results. These incidents don’t just cause equipment damage or production delays, they cost lives, disrupt communities, and erode trust.

In early 2025 alone, multiple fatal accidents, including explosions at the Valero Three Rivers Refinery in Texas, a chemical recycling plant in Malaysia, and a deadly dust blast at a factory in Japan, claimed over a dozen lives and left many more injured. These tragedies are a stark reminder that industrial safety can never be an afterthought.

From 2007 to 2023, 162 people lost their lives in 81 major process safety events reported by the International Association of Oil & Gas Producers (IOGP). In the United States, more than 1,000 refinery incidents occurred in just five years, leading to over 50 deaths and 1,200 injuries. And in 2023, the U.S. alone saw over 270 chemical-related accidents, many of which were preventable.

In this article, we’ll revisit some of the most impactful process safety failures in recent years, understand their root causes, and explore how modern technologies like digital twins and AI can transform risk management. We’ll also emphasize the critical role of safety culture and behavioral science in preventing such disasters.

High-Profile Process Safety Failures: Lessons from the Frontlines

Valero Three Rivers Refinery Fires (Texas, USA, Jan 2025)

In January 2025, two separate incidents within a month at the Valero Three Rivers Refinery, a fire on January 1st and an explosion on January 26^th, resulted in multiple injuries and legal consequences. The explosion, triggered by improper opening of a bleeder valve during maintenance, released flammable chemicals near ignition sources, igniting a massive fire that injured five workers.

Root Cause: 
Improper valve operation during maintenance, due to a lack of lockout/tagout procedures. 

Key Learnings: 

• Always follow lockout/tagout (LOTO) procedures during maintenance. 
• Ensure all staff are trained and audited on hazardous energy control protocols. 
• Maintenance activities must be treated as high-risk operations, requiring supervision and validation. 

Chemical Recycling Plant Explosion (Malaysia, Jan 2025)

In January 2025, an explosion at a chemical recycling plant in Malaysia injured 32 people, with yellow smoke causing widespread irritation. Though the incident resulted in no fatalities, it raised significant questions about chemical handling and emergency preparedness.

Root Cause:
Poor chemical handling practices and insufficient emergency response planning contributed to the explosion. 

Key Learnings: 

• Establish and regularly test emergency response plans for chemical incidents. 
• Train employees on proper chemical handling and storage procedures. 
• Conduct routine safety audits to identify process gaps before incidents occur. 

OFBA Ordnance Factory Blast (India, Jan 2025)

A deadly explosion at the Ordnance Factory in Bhandara, Maharashtra, killed eight workers and caused widespread damage. The explosion was so severe that debris was found up to 500 meters away, and the detonation was heard from 5 kilometers.

Root Cause

The explosion was caused by a failure to implement proper zoning and safety buffers in the handling of explosives. Additionally, the absence of real-time monitoring systems for explosive manufacturing processes contributed to the incident. 

Key Learnings:

• Implement strict zoning and buffer zones for explosive materials. 
• Invest in real-time monitoring systems for high-risk manufacturing environments. 
• Enforce process segregation and limit personnel exposure in explosive zones. 

PBF Energy Refinery Fire (California, USA, Feb 2025)

A fire during planned maintenance injured six, triggered local evacuations, and is expected to cost $30 million in repairs. The incident began when workers opened a flange on a hydrotreater unit, causing a hydrocarbon leak that ignited seconds later. Over 7,000 gallons of hydrocarbons burned, and firefighting runoff overflowed containment systems.

Root Cause:
The failure was due to inadequate isolation procedures during maintenance. The workers did not properly isolate the system before opening the flange, resulting in a hydrocarbon leak and fire. 

Key Learnings:

• Follow standard isolation procedures to prevent leaks during maintenance. 
• Use pre-maintenance checklists and permitting systems rigorously. 
• Plan for containment of firefighting runoff to prevent environmental damage. 

Chuo Spring Dust Explosion (Japan, Mar 2025)

In March 2025, a dust explosion at an automotive parts factory in Japan killed one worker and injured two others. The explosion was the second incident of its kind at the same site within two years, signaling persistent risks in dust management.

Root Cause:
The explosion was triggered by a buildup of flammable dust particles, which ignited under certain conditions. This was the second such explosion at the same site, indicating that dust management protocols were inadequate. 

Key Learnings:

• Establish regular dust cleanup protocols and enforce them consistently. 
• Use explosion-proof ventilation and dust collection systems. 
• Conduct hazard assessments for combustible dust risks in production lines. 

SpaceX Starship Explosion (USA, Mar 2025)

A SpaceX Starship explosion in March 2025, while unmanned and without casualties, raised serious concerns about safety protocols in emerging industries like commercial spaceflight. The explosion caused significant disruption, grounding 240 flights and raising doubts about the company’s safety management.

Root Cause:
The explosion was attributed to a failure in the management of high-risk systems during launch preparation.

Key Learning:

• Treat emerging technologies with the same rigor as established industries when it comes to safety. 
• Develop comprehensive risk assessments for experimental operations. 
• Recognize that public trust in high-tech industries is heavily tied to visible safety performance. 

Common Root Causes of Major Process Safety Disasters

Upon analyzing these incidents, several recurring root causes emerge: 

1. Failure to Maintain Safe Isolation: Improper isolation procedures during maintenance allow hazardous energy to reach workers, creating unsafe conditions. 

2. Failure to Recognize Change: Unmanaged changes in process conditions, equipment, or procedures often lead to unexpected hazards. 

3. Failure to Apply Procedures: Deviation from established safety protocols, driven by time pressure or lack of training, results in accidents. 

4. Failure to Control Ignition Sources: Inadequate management of ignition risks around flammable materials contributes to devastating fires and explosions. 

These root causes underscore the importance of implementing strict adherence to safety protocols, maintaining equipment integrity, and properly managing hazards.

Preventing Future Process Safety Failures

To mitigate the risk of future accidents, industries must focus on certain practices:

1. Comprehensive Hazard Identification 

Regular and thorough hazard analyses, such as HAZOP (Hazard and Operability Study) and What-If analysis, are critical in identifying potential risks before they escalate. 

2. Robust Safety Information Systems 

Maintaining up-to-date safety documentation, including process flow diagrams, equipment specifications, and operating procedures, is essential for managing risks effectively. 

3. Strict Adherence to Procedures 

Enforcing compliance with established safety protocols, particularly during maintenance and non-routine operations, prevents lapses that can lead to accidents. 

4. Continuous Training 

Regular, ongoing training ensures workers are equipped with the knowledge to recognize hazards and respond appropriately during emergencies. 

5. Emergency Preparedness 

Well-rehearsed emergency response plans can save lives and limit damage during incidents. Industries must ensure that their emergency plans are up to date and that staff are trained to act quickly and effectively. 

6. Incident Investigation and Learning 

Thorough investigations into near-misses and incidents provide valuable insights into process safety weaknesses, allowing for continuous improvement. 

The Role of Digital Twins and AI in Improving Safety 

Digital twins are virtual replicas of physical assets or processes that integrate real-time data with advanced analytics and simulation. By continuously monitoring equipment, processes, and workers, digital twins provide a real-time picture of operational conditions, enabling proactive risk management. 

How Digital Twins and AI Enhance Safety 

1. Real-Time Monitoring: Digital twins allow for continuous visibility into equipment health, process conditions, and worker safety, enabling early detection of potential hazards. 

2. Predictive Maintenance: AI-driven digital twins predict equipment failures before they occur, reducing downtime and the risk of unplanned shutdowns. 

3. Proactive Risk Management: By simulating process conditions and hazards, digital twins enable operators to address unsafe conditions before they escalate into incidents. 

4. Human-Centric Safety: Integration with wearable sensors and augmented reality (AR) allows digital twins to monitor worker fatigue, posture, and exposure, dynamically adjusting tasks to minimize risk. 

5. Enhanced Training: Digital twins can be used in immersive training simulations, helping workers practice emergency response techniques in a safe and controlled environment. 

Case Studies of Digital Twins in Action

1. Automotive Manufacturing 

In Japan, automotive manufacturers are leveraging digital twins to enhance safety in their production facilities. By using digital twins to monitor safety risks in shared workspaces, manufacturers are able to detect potential hazards like machine malfunctions or unsafe worker behavior before accidents occur. For example, if a robot arm malfunctions, a digital twin can alert operators to the issue in real time, preventing injuries and costly downtime. 

2. Nuclear Power Plants 

Nuclear power plants are utilizing digital twins to manage robotic fleets and enhance situational awareness in high-risk environments. With hazardous operations such as handling radioactive materials, having a virtual model that tracks real-time data from sensors embedded in both robots and the plant itself ensures that operators can identify abnormal conditions before they escalate. This enhances safety by allowing operators to intervene proactively rather than react to emergencies. 

3. Oil and Gas 

The oil and gas industry is making use of digital twins for real-time leak detection, flare monitoring, and process optimization. In offshore drilling operations, for example, digital twins are used to monitor pipelines for signs of leaks or corrosion, providing early warnings before hazardous material is released into the environment. This proactive approach helps prevent catastrophic environmental damage and improves worker safety by avoiding exposure to dangerous chemicals. 

Cultural Transformation and Behavioral Safety: The Key to Preventing Safety Failures 

While technological advancements such as digital twins and AI play a significant role in enhancing industrial safety, one of the most powerful tools in preventing safety failures is cultural transformation. Creating and maintaining a strong safety culture within an organization is paramount in ensuring that safety practices are consistently followed and deeply embedded at every level of the operation. 

A robust safety culture is not just about having the right systems or technology in place; it is about fostering a mindset where safety is everyone’s responsibility. From senior leadership to entry-level employees, safety must be prioritized, valued, and actively promoted as an integral part of the organizational ethos. This shift in mindset can lead to fewer accidents, more proactive safety measures, and a more resilient workforce.
 

a.) Empathy and Accountability 

One of the cornerstones of a strong safety culture is the principle of empathy and accountability. In order to foster a safety-conscious work environment, leaders and workers alike must prioritize mutual respect. Leaders need to not only enforce safety standards but also show empathy towards workers’ concerns, recognizing the human element behind every task. When workers feel that their safety is genuinely valued, they are more likely to follow safety protocols and voice concerns when something feels unsafe. 

Accountability goes hand-in-hand with empathy. It’s not just about checking boxes on safety procedures; it’s about ensuring that every individual, regardless of their position, takes responsibility for their own safety as well as the safety of their coworkers. This sense of ownership encourages everyone to stay vigilant and proactive, ultimately minimizing risks. 

b.) Behavioral Science and Its Role in Safety 

Behavioral science focuses on understanding human behavior- why people make certain choices and how they can be encouraged to make safer decisions. By using behavioral insights, safety programs can be tailored to identify the root causes of unsafe practices and address them effectively. 

Behavioral-based safety (BBS) programs are designed to encourage positive behavior change and reinforce safe habits. For example, instead of simply focusing on enforcing rules, BBS programs identify and reward safe behaviors, creating a positive feedback loop. Workers are more likely to adopt safe practices when they feel supported and recognized for doing so, rather than solely penalized for non-compliance. 

By understanding and influencing behavior, safety leaders can create an environment where adherence to safety protocols becomes second nature to all employees. This proactive approach helps mitigate risks before they escalate into incidents. 

c.) Embedding Safety into Organizational Culture 

To effectively prevent safety failures, safety must be ingrained into the very fabric of the organization. This goes beyond regular safety drills or compliance checks, it involves continuous reinforcement and constant dialogue about the importance of safety in daily operations. 

The key to embedding safety into organizational culture is consistency. It’s not just about one-off training sessions or safety campaigns; safety practices must be continuously reinforced and modeled by leaders. Regular discussions, real-time safety audits, and open channels of communication allow for a constant focus on safety, keeping it top of mind for all employees. 

When safety becomes an intrinsic part of an organization’s culture, it no longer feels like an obligation—it becomes a natural and seamless aspect of the work environment. Employees are empowered to make safer decisions on their own, to intervene when they spot risks, and to take pride in maintaining a safe work environment.  

Building a Safer Future with Chola MS Risk Services 

The tragic accidents of the past and present serve as stark reminders of the persistent risks in industrial operations. However, the lessons learned from these incidents, combined with advancements in digital twins, AI, and cultural transformation, offer a roadmap for reducing the likelihood of future catastrophes. By rigorously applying process safety fundamentals, embracing new technologies, and fostering a safety-first culture, industries can build a safer future for workers, communities, and the environment.

Chola MS Risk Services stands as a trusted partner in this journey. With deep expertise in risk assessment, process safety, and the integration of digital solutions, Chola MS helps organizations identify vulnerabilities, implement best practices, and foster a culture of continuous improvement. By working together, industries and Chola MS Risk Services can build a safer, more resilient future where safety is not just a priority, but a way of life.

Also read- Boost Workplace Safety Through Expert-Led Process Safety Management