High Pressure Injection 06/10/29 256-162

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High Pressure Injection 06/10/29 256-162
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Prelude To Incident

• A Miner was assisting his partner was the
  operator of the Mclean Bolter.
• The Miner was new to the bolter, he was currently
  working as a miner in a non mechanized heading of
  the mine bolting with Stoper and Jackleg.
• The Miner did not have work in his particular
  area that day and was sent with the operator to
  act as helper for the day
• The Miner did not have training in mechanized
  bolting through out his career.

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How It Happened

• The Miner was attempting to locate a hydraulic
  leak in a hose cluster with the power off.
• The Miner pulled three hoses to the side and was
  holding on to a fourth and instructed his partner
  to energize the unit.
• The hose that the Miner was holding was the hose
  that was leaking.

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What Happened Next

• The pressurized oil penetrated the Miners glove
  and was injected into his right index finger.
• The estimated pressure exiting the hose from the
  leak was 3000 p.s.i.

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The Ruptured Hose
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What Happened Next

• The Miner was not aware that the hydraulic oil
  had penetrated his finger and suspected that he
  may have received a splinter from the frayed
  metal in the hydraulic hose.
• His finger then began to swell quite rapidly.
• He and his partner then contacted his Supervisor
  and was transported to surface.

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What Happened Next

• The Miner was taken to the Medic Facility at site
  where the injury to his finger was examined, he
  was transported to Yellowknife NWT and then
  Edmonton Alberta for Medical treatment.
• All during this time the Miner insisted it was
  not serious.

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What Happened Next

• The Miner arrived in Edmonton and underwent
  Surgery to remove any oil that had been injected
  into his finger.
• The initial surgery was very extensive.
• A initial incision was made from the tip of his
  right index finger through his palm extending to
  his right wrist.

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What Happened Next

• The Miner was kept in the hospital for one week
  after the incident.
• His condition was monitored, and the prognosis of
  the finger was still unknown.
• It was determined after the one week that the
  finger would have to be amputated to the second
  knuckle.

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Extent of Surgery after the Amputation
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Extent of Surgery after the Amputation

• The Miner was fortunate that the extent of his
  amputation only included the finger to the second
  knuckle.
• If the injection had occurred into his palm he
  would have lost his hand.

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Factors Contributing to the Incident

• Failure to warn The Miner and his partner did
  not identify the potential of such actions.
• Failure to make safe The McLean Bolter was not
  in a zero energy state as per site requirements.
• Improper placement The Miner was manually
  searching the cluster of pressurized hydraulic
  hoses with his hands
• Improper placement for the task The Manufactures
  recommendation is for visual inspection only.
• Servicing of equipment while in operation The
  request for hydraulic activation to locate
  damaged hose when the Miner was not certified to
  service or inspect equipment.
• Failure to use appropriate PPE The operators
  manual states use a piece of tin or cardboard
  for inspection of hydraulic leaks.

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Root Causes

• Lack of knowledge The Miner had not received any
  documented training or been made aware the
  potential hazards associated with the McLean
  Bolter.
• Lack of skill The Miner was not adequately
  trained in the use, operation and hazards of the
  McLean Bolter.
• Inadequate Work Standards The company had at the
  time, no written procedures for the inspection of
  high pressure lines. There was at the time no
  mention in the company orientation of the risk
  factors when dealing with high pressure hoses and
  maintenance of them.

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Hose Separator Tool

• This tool was developed specifically for use on
  our mobile Electric/Hydraulic drills.
• The tool is to be available for inspection and
  finding the location of leaking high pressure
  lines.
• The operator is not to try to repair or remove
  any high pressure lines, this must be done by
  trained maintenance personnel.

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Hose Separator Tool
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Manual Update

• Training manuals for all company equipment at the
  mine site have been updated with information
  outlining the hazards of High Pressure Injections.

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Snap Lake SWP 87

• A review and sign off of a Safe Work Plan on
  Checking for Hydraulic Leaks, is required by
  current employees and all new personnel arriving
  on site.

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Out Come

• The Miner will be off work for an undetermined
  amount of time. He has been subjected to
  extensive damage and surgery to his hand and
  finger.
• He is currently attending Physiotherapy near his
  home in New Brunswick.
• The pain and physiological problems that the
  Miner has endured will continue for some time.
• In his own words, he could not believe that it
  would have become this serious