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23 Mar 2019

NBlog March 23 - lessons from Fukushima

As far as incidents go, a core meltdown at a nuclear power plant is about as big as they come. This afternoon, I've been reading an official US report into the Fukushima incident following the Sendai tsunami eight years ago this month. "Lessons Learned from the Fukushima Nuclear Accident for Improving Safety of U.S. Nuclear Plants" is an excellent treatise on the incident, published just over three years afterwards.

As you would expect from a formal report, the style is matter-of-fact, describing the sequence of events that unfolded as the tsunami struck, the plant was terminally damaged, the electrical supplies and hence the monitoring, control and communications systems all failed, and the operators went to heroic lengths to shutdown all the units. The scenario was so extreme that the well-practiced emergency operating procedures and fail-safe controls proved inadequate, leaving the operators firstly struggling to determine what was going on inside the reactor buildings and the cores, and secondly almost powerless to keep things under control.

This paragraph from chapter 4 in particular stands out for me:
"Accidents frequently involve a confluence of interacting faults resulting in situations that have not been previously anticipated, placing a premium on the ingenuity and adaptability of plant personnel. In the committee's judgment, the personnel at the Fukushima Daiichi nuclear plant showed courage and resilience in responding to the March 11, 2011, accident under extraordinarily difficult conditions. Their actions potentially prevented even more severe outcomes at the plant."
In other words, yes it was a nightmare scenario that would have been even worse still, if it were not for the heroes working in the plant at the time. Their resilience and resolve made a real difference when the chips were down.

This was a true contingency situation, worse than their worst-case planning and preparations. They had to make-do with limited available resources including information, under extreme pressure. True grit.

If you work in nuclear power, I guess you are well aware of the incident, the reports and the changes arising as the lessons were learnt. There are lessons for the rest of us, too, in respect of incident preparation and management, regardless of the specific nature of the incident or the context. It is obviously and directly relevant to power stations, chemical factories and oil refineries, for example, but also in different ways to literally any organization, even individuals. For instance, severe power and communications problems literally and figuratively left people in the dark: what are your communications and emergency power arrangements in the event of a disaster? 

[Hinson tip: if you need to login to the cloud to search your online disaster management manual for 'comms' and 'power', you've already made a huge leap of faith!]

The incident might feature in April's awareness module on 'Spotting incidents', in particular concerning those comms issues that prevented the operators, managers and authorities (both on and off-site, and not just in Japan) from finding out exactly what had happened during the incident and coordinating the response. The situation is too complex to explain though, so we'd need to pick out a few key points that have general appeal and value. Tasters, as it were, of the full report.

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