A deliver driver was moving a fully charged Oxygen cylinder for transport. The oxygen storage cylinder was 4.5 feet tall and pressurized to approximately 2000 psi. The driver was rolling the cylinder at a slant, using the base of the cylinder as a pivot point/rolling base. The valve was facing his abdomen. It is unknown for certain but likely was not capped. At some point during the moving process, the valve dislodged from the cylinder.
The immediate release of pressure threw the driver 20 feet from the point of rupture. The driver was killed instantly. A resulting autopsy showed broken ribs, fractured spinal column, and lacerations through his abdominal region. The final autopsy conclusion stated that the death was caused by blunt force, the force of gas escaping the cylinder. They did not find evidence of the valve penetrating the victim.
The cylinder itself remained intact. They also found the valve within the area. Specific locations were not documented. The actual information on the cylinder, such as age or extent of use, was not mentioned. It also did not mention if it was within a hydrostatic re-qualification period. The only thing mentioned in the autopsy report was that corrosion was found around the valve area. The speculation was that the valve came loose due to corrosion.
Since this incident caused loss of life, it would have been helpful if more of the investigation focused on the condition of the cylinder. It appeared that they located the cylinder and the valve, but no photographic evidence. The report focused on how the person died, and that it was caused by gas in a pressurized cylinder. It was reported as if they had no knowledge of how a cylinder works, or the unlikely event of a valve dislodging. Since the autopsy report was authored by a medical professional, I would not expect them to understand issues involving a high-pressure cylinder. However, since the cylinder was the cause of death, I would have hoped that focusing on the cause of the valve dislodging might help prevent future accidents.
With minimal knowledge of the cause of the valve dislodging all that can be done to keep others safe is to speculate and follow common safety principals:
- Use a dolly when moving a high-pressure cylinder – keeping the valve away from the employee
- air embolisms, dangerous noise levels and dislodging of valves
- Have caps in place when moving a cylinder
Helps protect the valve from damage
- Inspect the threads of all cylinders for damage and corrosion
- Regularly inspect the valves of a cylinder for thread integrity and proper function
Training all employees in the safe handling, filling, and inspection of cylinders should be a goal of all facilities dealing with high-pressure gases. Make all employees aware of proper safety procedures so they can ensure a safe work environment. A knowledgeable employee may be able to detect a hazard and pull the cylinder from service before it becomes harmful to others.
