Learning Lessons from the Santika Nightclub Fire

For many years SafetyAtWorkBlog and its forerunner Safety At Work magazine reported on various tragic fires in crowded nightclubs around the world.  Several in recent memory include the 2003 Rhode Island fire that killed 100 patrons and for which, according to an Associated Press report from the time,

Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel
Biechele to 15 years, but suspended 11 years of that sentence, and
also ordered three years of probation.

“Superior Court Judge Francis Darigan Jr sentenced 29-year-old Daniel Biechele to 15 years, but suspended 11 years of that sentence, and also ordered three years of probation.”

A brief report on the Rhode Island fire is in the OSHA media archives.

In March 2006, Safety At Work included an AFP report saying

“The municipal council has impeached Buenos Aires Mayor Anibal Ibarra after finding him guilty of dereliction of duty following a December 30, 2004 nightclub fire that killed 194 people.”

An earlier report on the mayor’s response is include at the CrowdSafe website.

Engineering and design company ARUP have provided SafetyAtWorkBlog with an article that analyses recurring elements of nightclub fires using the Santika fire in Bangkok from 1 January 2009 as a most recent incident.  Below is the introduction to the article which can be found in full in the pages listed above.

Our thanks to ARUP for the terrific article.

Kevin Jones

LEARNING LESSONS FROM THE SANTIKA NIGHTCLUB FIRE

by Dr Marianne Foley and Travis Stirling, Arup Fire, Sydney

In the early hours of New Years Day 2009, fire engulfed Bangkok’s Santika nightclub, killing 64 people and injuring more than 200.  Our knowledge of the events of that night is based on media reports and publicly available information, and the precise cause of the fire is still unclear.  However, we do know that there are strong correlations between this and many similar tragedies at entertainment venues dating back as far as the first half of the twentieth century.  While we wait for the results of the official investigation and coronial enquiries, it’s timely to ask questions about these fires.  Why do they happen over and over again?  Why do so many people lose their lives?  What lessons can be learnt?  And what practical measures can be implemented to stop them happening?

RECURRING MISTAKES

Arup’s analysis of case studies has revealed six themes that commonly contribute to the severity of high-fatality nightclub fires: insufficient exits, the presence of highly flammable materials, a lack of good fire safety systems, confusing environments, pyrotechnics and open flames, and buildings used inappropriately and maintained poorly.  By addressing each of these themes, we aim to provide design solutions that could mitigate the risk of future nightclub disasters.

[The themes in the full article are

  • Insufficient exits
  • Highly flammable materials
  • Fire safety systems
  • Confusing environments
  • Pyrotechnics and open flames
  • Buildings used inappropriately or maintained poorly]

Firefighter trauma

A major element of risk management  is business continuity.  This requires considerable planning, disaster recovery resources, and a long-term focus.

In early 2009 parts of Victoria, some not far from the offices of SafetyAtWorkBlog, were incinerated and across the State over 170 people died. In a conservative western culture like Australia, the bush-fires were the biggest natural disaster in living memory.

The is a Royal Commission into the Victorian Bushfires that is illustrating many of the disaster planning and community continuity needs in risk management.

The Australian Broadcasting Corporation’s “7.30 Report” provided a report on 5 August 2009 which originates from the views of the community and the volunteer firefighters.  One of the issues relevant to safety professionals and risk managers is the psychological impact on volunteer workers.  Many in the report talk of trauma.  Many in the disaster areas have not returned and their are many who remain psychologically harmed.

When a workforce is so closely integrated with a community, rehabilitation is a daunting task and changes a community forever.

Overseas readers may have experienced their own natural disasters such as hurricane Katrina, earthquakes, floods and wildfires.  Many of these stories are reported around the world.  In the recovery phase of any disaster, businesses need to rebuild but are often rebuilding with damaged people.  It would be heartening to see the OHS regulators and OHS professions becoming more involved over the long recovery period.

Kevin Jones

Varanus Island is back to normal

According to various Australian media reports, the natural gas plant at Varanus Island in Western Australia is now back to full capacity following the major pipeline explosion in 2008.

The government has estimated that the explosion blasted $A2 billion from the state economy and will be pursuing the pipeline’s owner, Apache Energy, through the courts.

The government says the pipeline was inadequately maintained and corrosion led to the failure of the pipe.

Apache has already been in the courts seeking an injunction to stop the Western Australian Mines & Petroleum Minister, Norman Moore, from seeing a “a federal-state government report into alleged regulatory lapses that may have contributed to the Varanus Island blast”.

Apache’s move is peculiar but the WA government has become more involved in the investigation of this explosion than others and the company has not been happy with the investigation process for some time.

Kevin Jones

Panic in disaster planning

Three years ago I had the privilege of arranging for Dr Lee Clarke of Rutgers University to attend the Safety in Action Conference in Australia.  Lee had a book out at the time, Worst Cases, and spoke about the reality of panic.  Lee’s studies have continued and are, sadly, becoming more relevant.

Recently, Rutgers University posted a video interview with Lee on Youtube.

Shortly after the World Trade Center collapse in 2001, I asked Lee to write something about the event from his experience and perspective.  He wrote a piece for a special edition of Safety At Work magazine.  The article has been available through his website for some time and is now available through here by clicking on the image below.

I strongly recommend Lee’s books.  As he says in the video, they’re quite fun, in a sad sort of way.

Kevin Jones

Sept11

Worst Case Scenarios and Pandemics – 2005 interview

In 2005 I had the great opportunity to spend some time with Peter Sandman, a world renowned risk communicator.  We spoke about worst case scenarios and risk communication in those times of avian influenza and smallpox threats.  The interview has gained additional poignancy in this time of swine flu.  

Although the audio is “noisy” as Collins St in Melbourne had more traffic on a Sunday morning than I expected, I think some readers may find this excerpt very useful at the moment.

Click on the magazine’s cover image below to download the interview transcript.

[For Peter Sandman’s current commentary on swine flu, see http://www.psandman.com/index-infec.htm#swineflu1 and especially http://www.psandman.com/col/swinecomm.htm]

or Peter Sandman’s current commentary on swine flu, see
http://www.psandman.com/index-infec.htm#swineflu1 and especially
http://www.psandman.com/col/swinecomm.htm. 

 

Kevin Jones

6i11 cover

Insights into crisis decision-making and communications – Victorian Bushfire Royal Commission

There’s an opportunity to follow the hearings of the Victorian Royal Commission on last summer’s horrendous bushfires via a live web stream. Here is the link to the Commission’s home page: http://www.royalcommission.vic.gov.au/ The “live stream” link on that page takes you to a live broadcast of the hearings underway at the time.

Fortunately, the catastrophe of the summer’s bushfires don’t happen often (unfortunately, the enormity of some people lighting fires does happen too often). What is even more rare is for us to be able to listen to first-hand witness experiences of decision-making in extreme conditions and to gain insights from listening to those experiences.

I often have the Royal Commission’s live stream running in the background while doing other work. I do that because I’d prefer to hear the witnesses reports directly. Of course, there will be a final report, but hearing the tone and context of the questions and answers are the sort of things that can be very difficult to recreate in a written report.

Monitoring the live stream is highly recommended for all safety professionals; doubly so for those people who work in larger businesses or organizations. A rare chance to observe and compare decision-making processes and lines of communication in complex situations to see what did and didn’t work.

Col Finnie
col@finiohs.com
www.finiohs.com

Varanus Island investigations continue

International safety attention was focused on a tiny island of the northwest Australian cost in mid-June 2008 when a pipeline exploded.  Investigation reports have been presented to government and companies have regained operations after the major gas explosion that disrupted supplies across Western Australia.

In early May 2009, the WA Department of Mines & Petroleum announced a further investigation will be undertaken. WA Mines and Petroleum Minister Norman Moore has said that the department would carry out the final stage of investigations into the  explosion.

Kym Bills and David Agostini have been classified officially as inspectors and will undertake the investigation.

Moore said that the October 2008 report by NOPSA needed additional information which has recently become available.

 “…that investigation was limited by its reporting time frame and the absence of critical evidence, such as the results from destructive and non-destructive testing of the pipeline.”

A ministerial media release identifies the investigation’s scope:

  • the pertinent sequence of events on Varanus Island during the incident
  • the likely cause(s) of the incident
  • any actions and omissions by the operator of the Varanus Island facility, or its contractors, leading up to and during the incident that may have contributed to those events.

The final report will be presented to the department in June 2009.

Background on Varanus Island is available in SafetyAtWorkBlog by searching “Varanus” as a keyword.

Kevin Jones

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