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CSB Investigation Report No. CSB-PEMEX-DEERPARK-2024 2024 Safety Safety Environmental Environmental
PEMEX Deer Park 胺回收单元硫化氢泄漏
PEMEX Deer Park, Deer Park, Texas
Related equipment → 吸收塔/洗涤塔/脱硫塔/胺吸收塔 (Absorber/Scrubber) (吸收塔/洗涤塔/脱硫塔/胺吸收塔 (Absorber/Scrubber))Related equipment → 切断阀/球阀/闸阀/蝶阀/止回阀 (Isolation Valve) (切断阀/球阀/闸阀/蝶阀/止回阀 (Isolation Valve))Related equipment → piping (piping)
0Fatalities
0Injuries
LeakageMechanism code OTH
⌗Failure Mode · ISO 14224 Mapping
Damage mechanism (recorded in KB)
LeakageOTH
ISO functional code (as recorded)
ISO 14224:2016 functional failure code
OTH · Other
ISO OTH — Other.
1What Happened

工人试图拆除隔离阀时，胺回收单元硫化氢泄漏；隔离与泄压程序缺陷致有毒气体释放

2Root Cause

隔离/泄压作业程序缺陷；高风险作业（打开含 H2S 系统）前气体检测与通风不足；PSM 执行薄弱

3Reliability Lessons (from investigation root cause)
  • The 'Root Cause' above is the core lesson of this accident; not split further.
4Associated Failure Mechanisms (Keywords)
硫化氢 胺液 酸性气 泄漏 阀门隔离 中毒 隔离维修 泄压
About the Failure-Mode Code (click to expand)

The recorded code OTH is an ISO 14224:2016 functional failure code (describes what the equipment failed to do). The damage mechanism (how it failed) is shown in the Mapping block above. The two are distinct dimensions in ISO 14224.

5Evidence Source (transparent)
Authority：U.S. Chemical Safety and Hazard Investigation Board (CSB)
Official Report：www.csb.gov ↗
Data Verification：url_verified_csb_investigations_list_2026-08-07（事故 2024-10-10 / 终报 2026-02-23）
↗Related Failure Modes · Traceability
拒动（超压不开启） failure_to_open回座失效（持续泄漏） failure_to_reseat阀门卡涩/内漏 MECH-VALVE-STICKING湿硫化氢损伤 MECH-WET-H2S安全仪表拒动 MECH-SIS-FAIL-TO-ACT酸性水腐蚀 MECH-SOUR-WATER高温硫化氢/氢腐蚀 MECH-HT-H2S结垢/堵塞 MECH-FOULING硫化腐蚀 MECH-SULFIDATION冲蚀/冲刷腐蚀 MECH-EROSION硫氢化铵腐蚀 MECH-ABS密封失效 MECH-SEAL-FAILURE均匀/局部减薄（通用减薄） MECH-THINNING大气腐蚀 MECH-ATMOS机械疲劳 MECH-MECH-FATIGUE电偶腐蚀 MECH-GALVANIC脆性断裂 MECH-BRITTLE-FRACTURE保温层下腐蚀 MECH-CUI湿硫化氢损伤 MECH-WET-H2S胺腐蚀 MECH-AMINE-CORR结垢/堵塞 MECH-FOULING酸性水腐蚀 MECH-SOUR-WATER高温硫化氢/氢腐蚀 MECH-HT-H2S胺应力腐蚀开裂 MECH-AMINE-SCC硫化腐蚀 MECH-SULFIDATION碱腐蚀 MECH-CAUSTIC-CORR碱脆（碱应力腐蚀开裂） MECH-CAUSTIC-SCC冲蚀/冲刷腐蚀 MECH-EROSION硫氢化铵腐蚀 MECH-ABS均匀/局部减薄（通用减薄） MECH-THINNING碳酸盐应力腐蚀开裂 MECH-CARBONATE-SCC大气腐蚀 MECH-ATMOS
Report No. CSB-PEMEX-DEERPARK-2024 · Data from CSB public investigation conclusions, compiled by Reliability AI, for reliability demonstration purposes only. This case is derived from public incident investigation reports for learning purposes only. AIM does not endorse or guarantee its accuracy.