Skills Based
1. The lack of expertise, skills and training
-can be seen in the misinterpretation of the negative pressure tests. The negative pressure test is a
standard procedure conducted during drilling operations to assess the integrity of the well's casing
and cementing. It involves temporarily reducing the pressure in the well to check for any anomalies
or leaks. The crew on the Deepwater Horizon misinterpreted the results of the negative pressure
test. Instead of recognizing signs of potential issues with the well's integrity, the crew mistakenly
interpreted the test as successful, giving a false indication of the well's stability. This
misinterpretation contributed to the decision to proceed with drilling. The misinterpretation of the
negative pressure test results created a false sense of security among the crew and decision-makers.
Believing that the well was secure, drilling operations continued without addressing the underlying
issues that the negative pressure test should have revealed. Due to the misinterpretation, the crew
failed to recognize the potential risks and did not take the necessary actions to halt drilling
operations or conduct further investigations into the well's stability. The decision to continue drilling,
based on the incorrect assessment of the negative pressure test, allowed for the escalation of a
blowout.
2. High Working pressure:
Most workers on Deepwater Horizon, from BP’s top men to the rig crew were put in a 12-hour night
or day shift, working three straight weeks on and then having three weeks off. This exhaustion could
have played a small role in the overall turnover of the event .
Knowledge Based:
1. Inadequate communication:
There were failures in communication between onshore and offshore personnel regarding crucial
well conditions and anomalies. Incomplete and inaccurate information exchange hindered timely
decision-making and response efforts during critical phases of the drilling operation. there was a
failure of communication between BP, Transocean and Halliburton, and employees within the
organizations, which made them not share some important reports and information. Halliburton
never reported to BP the results of another foam stability test earlier in February. More importantly,
it appears that well-site leaders and staff never coordinated the two different pressure readings that
occurred on this drill stem. The change in direction of drill pipe pressure and its subsequent steady
increases should have been a cause for concern but apparently went unnoticed. The data available to
rig personnel showed clear indications of a kick. Even after the drill crew noticed an anomaly, they do
not appear to have seriously considered the possibility that a kick was occurring. If the rig crew had
at all considered that a kick might be occurring, they had plenty of time to activate the blowout
preventer. Even after the drill crew noticed an anomaly, they do not appear to have seriously
considered the possibility that a kick was occurring. If the rig crew had at all considered that a kick
might be occurring, they had plenty of time to activate the blowout preventer.
2. Design Flaws
Inadequate well design, particularly in the casing and cementing process, contributed to a lack of
zonal isolation. Issues with the cementing process, including the failure to create a proper cement
barrier, compromised the integrity of the well. Known issues with the cement slurry, including
concerns about its quality, may not have been effectively addressed. Neglecting known problems
with the cement slurry can result in a compromised wellbore, allowing for the migration of
hydrocarbons. All these design Flaws lead to the uncontrolled release of oil and gas, leading to the
blowout.
Knowledge based:
1. Insufficient risk assessment and fail safes:
The absence of sufficient redundancy in critical safety systems left the operation vulnerable.
Effective planning should have ensured that even if one safety system failed, there would be
backup mechanisms to prevent or mitigate the impact of a blowout. The absence of backup
mechanisms in key safety systems, such as the BOP, reduced the ability to respond effectively to
technical failures. The overall risk assessment of the drilling operation did not adequately
account for potential well control issues. The lack of a well-coordinated and effective emergency
response contributed to the severity of the incident and delayed containment efforts.
2. Lack of maintenance:
The BOP, a critical safety device designed to seal the well in emergencies, failed to activate and
control the blowout. Inadequate testing, maintenance, and human errors in the installation and
activation of the BOP contributed to its failure during the crisis. The BOP is a massive, specialized
piece of equipment installed at the wellhead to control and seal the well in the event of a
blowout. The primary function of the BOP is to provide a failsafe mechanism to shut off the flow
of oil and gas in case of an unexpected pressure surge. Despite its critical role, the BOP on the
Deepwater Horizon failed to activate and seal the well during the blowout. There were warning
signs of equipment malfunctions and anomalies that were either ignored or not given sufficient
attention. Neglecting warning signs prevented proactive maintenance interventions, allowing
issues to escalate and contribute to the breakdown of critical systems.