Category Archives: Pipeline

The New Pipeline Rule I Waited Half a Career to See

By Charles Koval

One night, a couple feet underground outside an American home, the gas flowing in a service line began to escape through a puncture adjacent to a newly installed mailbox. A man and woman inside the home were watching the news. Their children were playing. Then, suddenly, without warning . . . nothing happened.

A simple and inexpensive device called an excess flow valve (EFV) kicked in, stopping the gas flow. There was no explosion, no fire, no injury or loss of life.

As a petroleum engineer and pipeline specialist for the NTSB, I know that the most important pipeline safety advance in recent decades has been the establishment of the national one-call 811 number. But EFVs may be the next most important life-saver, especially for homeowners.

Diagram of how an excess flow valve functionsGas companies install an EFV in a service pipeline where it meets the main line. The EFV shuts off the gas flow in the service line when it exceeds the normal flow rate; excess flow often indicates that gas is escaping the service line through a puncture or sever, potentially leading to an explosion or fire.

I’ve been working a long time to encourage the progress that came to fruition late last year regarding EFVs. The Pipeline and Hazardous Materials Safety Administration (PHMSA) quietly completed an important achievement and, in the process, closed an NTSB recommendation. PHMSA issued a rule expanding the use of EFVs to new or renewed service lines leading to almost all small commercial businesses and multi-residence buildings.

It’s taken decades to achieve this result. In all, the NTSB has made 24 safety recommendations related to EFVs.

When I came to the NTSB in 1990, the agency had already been endorsing EFVs for 20 years, beginning with recommending a shutoff valve after research that came out of a 1970 safety study.

I worked on accident after accident that may have been prevented by EFVs. Most of my work between 1990 and 1994 involved single-family residences, but many multi-residence accidents were just as horrible, if not worse. The incidents occurred in large cities like Tulsa, Oklahoma, and St. Paul, Minnesota, and in smaller towns like St. Cloud, Minnesota; Montezuma, Indiana; and Cliffwood Beach, New Jersey. I can still remember my first NTSB supervisor expressing exasperation that this simple and elegant solution was not in wider use.

Then came June 9, 1994. At about 6:45 that evening, a 2-inch-diameter steel gas service line that had been exposed during excavation separated at a compression coupling about 5 feet from the north wall of John T. Gross Towers, an 8-story retirement home. The escaping gas flowed underground toward Gross Towers, passed through openings in the building foundation, entered the mechanical room through the floor vents, and migrated to other floors.

A resident smelled the gas, as did a workman onsite, who told his foreman. The foreman called the gas company and the housing authority, then had other employees locate and shut off the gas line valve inside the towers. But at 6:58 p.m., the built-up natural gas in the building ignited and exploded; a second explosion followed 5 minutes later. The accident killed one person and injured 66—and it could have been much worse. Many residents were not in the building on the early summer evening of the disaster.

A humble EFV could have shut off the gas flow into Gross Towers. After the explosion, the NTSB recommended that PHMSA’s predecessor agency require that all gas distribution operators inform all customers of the availability of EFVs. After many years, the agency did so. Meanwhile, fatal accidents continued—all potentially preventable with EFVs.

Then, in 1998, the NTSB was called to the site of an explosion and fire at a single-family home in South Riding, Virginia.

A man, woman, and their two children were spending their first night together in their new home. The family retired at about 10:30—the children to the upper level of the house, and, because not all of their furniture had arrived, the parents to the first-floor study. Shortly after midnight, the house exploded and was engulfed in flames. The children were thrown out of the house and onto the lawn, suffering minor injuries. The parents fell into the basement as the first floor collapsed. The father was able to crawl to safety, badly burned; the mother did not escape and died as a result of her injuries.

Again, an EFV could have prevented the tragedy.

Following this accident, the NTSB recommended that PHMSA require EFVs in all new and renewed gas service lines, regardless of customer classification, when operating conditions were compatible with readily available valves. PHMSA first required only that single-family homeowners be notified of the availability of the valve and be allowed to pay for it themselves. Then, in 2009, PHMSA changed the rule, requiring EFVs to be installed on almost all new and renewed service pipelines to single family homes.[1] Finally, on October 14, 2016, PHMSA expanded the safety requirement to include most new and renewed service pipelines for multi-residential and commercial applications, closing one chapter in EFV history—and with it, an outstanding NTSB recommendation.

My first NTSB supervisor is no longer with us, but even years ago, he could imagine the broad use of EFVs that he did not live to see. Sometimes it takes a long time to normalize safety. Too often, it takes a highly visible accident—or several of them—to draw attention to a problem. Solutions often come a little bit at a time, or a long time afterward, without any fanfare.

But for now, and well into the future, for many businesses and homes nationwide, if a service line fails, nothing will happen. These homes and businesses are a little safer today because PHMSA and the gas industry acted on NTSB’s EFV recommendations.


Charles Koval is a Petroleum Engineer and Pipeline Specialist in the NTSB Office of Railroad, Pipeline and Hazardous Materials.


[1] The service line does not need an EFV if it: 1. does not operate at or above 10 psig all year, 2. has previously had contaminates, 3. could interfere with necessary operation or maintenance activities, or 4. is not commercially available to the operator.

Reflecting back on 10 years as a Board Member

By Robert Sumwalt

On August 21, 2006, I was sworn in as the 37th member of the National Transportation Safety Board. At the same time, I was appointed by President George W. Bush to serve as NTSB Vice Chairman. In 2011, President Barack Obama reappointed me for an additional five-year term as a board member.

Robert Sumwalt, taking the oath of office, administered by then-NTSB Chairman Mark V. Rosenker on August 21, 2006.
Robert Sumwalt, taking the oath of office, administered by then-NTSB Chairman Mark V. Rosenker on August 21, 2006.

As I reflect on 10 years as an NTSB board member, there are several things that stand out. First, is the mission. Our role in transportation safety quickly became apparent when, on my seventh day on the job, I launched to an airline crash in Lexington, Kentucky. Tragically, that crash claimed 49 lives.

But, the NTSB’s primary mission involves more than just investigating accidents. It also involves determining the cause of accidents, and then, most importantly, issuing safety recommendations to prevent future accidents. At the entrance to our training center, we have an etched glass window that says, “From tragedy we draw knowledge to protect the safety of us all.” And that’s exactly what we do – we learn from tragedy so we can keep it from happening again.

Recently, one of our investigators wrote to me about a rail accident he investigated where fire and explosion claimed multiple lives. He told of meeting a man who was glaring at the carnage as he pushed a baby in a carriage. As it turned out, the man’s wife – the baby’s mother – had been killed in the disaster. Our investigator promised the man that the NTSB would get to the bottom of why this event occurred so other accidents could be prevented. “I also watched a man standing outside of the exclusion zone peering over the barrier in tears as a backhoe demolished his home,” the investigator explained in his note to me. “My thoughts were of those victims, and it was clear that we were being called upon to do this for them.”

Yes, we are here to give a voice to those who don’t have a voice—the victims and their families of transportation accidents. I take great solace knowing our work really does make a difference and keeps others from enduring similar tragedies.

The NTSB is an independent federal agency – meaning, we are not attached to a larger federal organization such as the U.S. Department of Transportation. In my opinion, independence is one of our greatest virtues because it allows the agency to conduct investigations and explore safety issues without being encumbered by actual or perceived political pressures. As I’ve often said, our independence allows us to “call it the way we see it.”

What also stands out to me is the dedication of the men and women of the NTSB. Their passion and determination to find the truth is uplifting. In the most recent employee viewpoint survey, 96 percent of respondents replied positively to the statement, “When needed I am willing to put in the extra effort to get a job done.” That demonstrates the commitment and dedication NTSB employees share for fulfilling our mission.

In addition to investigative activities, there is a proactive side to the NTSB. Our staff conducts safety studies, tracks and follows up on our safety recommendations, and advocates for safety improvements by providing testimony on safety issues, promoting our Most Wanted List, bringing important safety issues into the public discussion via social media efforts, and organizing safety events such as roundtable discussions.

One of the NTSB’s values is transparency; we are open and honest with the public about our work. We post on our website all accident reports and publications, as well as the docket for each accident. The docket provides reams of background information for accidents, such as interviews, photos, and technical information that may not be in the actual accident report. Our board meetings are webcast and open to the public. And, our Office of Safety Recommendations and Communications ensures the media are informed of the status of investigations by answering questions, arranging interviews, issuing press releases, and releasing updates through social media.

Many are surprised to learn that the NTSB also serves as a court of appeals for pilots, aircraft mechanics, and mariners who receive violation notices from the Federal Aviation Administration and U.S Coast Guard. The NTSB’s Office of Administrative Law Judges (ALJ) processes those cases, and our three ALJs hold hearings to adjudicate those matters.

The NTSB’s Office of Transportation Disaster Assistance – a highly trained group with expertise in social services, emergency management, and forensics – works closely with various organizations to meet the needs of disaster victims and their families. This group also serves as the primary point of contact for family members and disaster victims, providing updates regarding the status of NTSB investigations and addressing their questions. It takes a special person to do the work they do, and I’m always appreciative of how well they do it.

There are other parts of the agency that aren’t often acknowledged, but nevertheless are important to allowing the agency to function. As in any organization, job openings need to be posted and filled, bills paid, contracts written and executed, and our computers maintained. The employees who perform these functions are as dedicated as those performing the agency’s core mission.

To put it simply, I’m so proud to be part of this agency. Our mission, independence, transparency, and people are all so important. I’m honored to have served with them for the past 10 years.

Robert Sumwalt is an NTSB board member.

What does transportation have to do with your health? . . . Everything!

By Natalie Draisin

Transportation is Public Healt graphic

Often, I get some confused looks when I tell people I’m doing an internship at the National Transportation Safety Board (NTSB) as part of my joint public health and business degrees at Johns Hopkins University. “What does transportation have to do with public health?” they ask.

Actually, transportation has a whole lot to do with public health. How did you get to work or school today? If you walked, drove, cycled, or took a bus, you were in danger of a life-changing incident. You could’ve been struck by another vehicle. Imagine the hospital bills, the lost productivity, and the debilitating consequences. Flown on a plane recently? Did your palms sweat a little when the turbulence started? You probably arrived at your destination safely, nonetheless. That’s because your pilot was well trained, following safety protocols and mitigating the inclement weather that in another situation, could have brought the plane down.

If you believe that you have the right to cross the street without worrying about being hit, injured, or killed by a drunk driver, or you believe that you have the right to board a plane, take off, and land safely – then you believe in transportation safety, and you believe in public health.

The two are integrally linked – think about the effects of a transportation incident on our public’s health. When a bus carrying an entire high school band crashes, it has a ripple effect, impacting the rest of the transportation system, the health system, and of course, the victims’ families. Miles of bumper-to-bumper traffic will follow, which could lead to further crashes, along with lost productivity when you, and everyone else caught in traffic, are late to work. Hospitals nearby will receive an influx of patients. In major incidents, it’s often more than one hospital can handle. Victims may not be able to function at the same level thereafter, and their families might be permanently scarred, in desperate need of mental health services.

When a pipeline bursts (pipelines are a mode of transportation, as they bring something from one place to another), it has economic, environmental and health repercussions. Remember the 2010 pipeline rupture and fire in San Bruno, California? More than 4 years later, that community is still rebuilding homes and infrastructure; families are still trying to pick up the pieces. Transportation incidents don’t occur in a bubble, they affect society at large, which inherently includes, of course, the public’s health.

What is it about public health that uniquely positions the field to address transportation, and particularly traffic, safety? Public health is about protecting and improving the health and safety of the population. Public health figures out what’s hurting and killing people, and then uses evidence-based initiatives to fix it. We call that preventing morbidity and mortality. And, according to the Centers for Disease Control and Prevention (CDC) and the National Highway Traffic Safety Administration, motor vehicle crashes are a leading cause of injury in our country – 2,362,000 injured and 33,561 killed in 2012. The CDC estimates that Americans spend over one million days in the hospital each year from crash related injuries. In 2012, that translated into $18 billion in lifetime medical costs, and $33 billion lost in lifetime work, such as lost wages or benefits. That’s a lot of lives changed, expenses incurred, and productivity lost.

Though it may not seem like it, transportation incidents have a lot of characteristics similar to a disease, which public health analyzes through the lens of a host, agent, and the environment. In a car crash, the host could be the young driver; the agent, the impact of the car hitting another car; and the environment, the slippery roads at night. Like a disease, public health can intervene in a number of ways to reduce the occurrence of crashes – for example, implementing graduated driver’s licenses so youth can gain more experience before having full driving privileges, incorporating airbags and seat belts into cars to reduce the impact of a crash, or equipping roads with reflectors and guard rails to make it easier to see at night and in the rain, and harder to veer into oncoming traffic. Also like a disease, the incidence of these crashes can be tracked, so we can see if our interventions are working and revise them when they’re not.

The government recognizes that it has a responsibility to keep the public safe from incidents while using our transportation system, and that’s why they’ve created organizations like the NTSB. It’s not a public health agency, but that doesn’t mean it doesn’t address public health issues. And the good news is that through the help of agencies like the NTSB, we can work towards decreasing crash rates. The NTSB investigates accidents, determines probable cause, assists families, and then issues recommendations to federal agencies to prevent future accidents. This leads to life-saving changes.

At the NTSB, though, I didn’t sit at a desk and analyze crash data. I helped the NTSB address all elements of the public health triad – the host, the agent, and the environment. In the Safety Advocacy Division of the Office of Communications, I helped craft messages to internal and external stakeholders, to obtain support for our recommendations. Working with staff from the Office of Aviation Safety, I’ve drafted some of the web content for the NTSB’s Most Wanted List. I also wrote advocacy blogs about traffic safety, and tweets for forums. Building on my prior drunk driving prevention work, I’ve researched state laws addressing ignition interlocks (breathalyzers on cars to prevent drunk driving), and Automatic License Revocation. Some of these projects I’ve dreamed of working on for years, since I first became involved in traffic safety after the tragic death of a friend in college who was hit and killed by a drunk driver.

Throughout my internship, I’ve picked up invaluable skills. I’m fortunate to work for an outstanding group who were equally committed to developing my skills, providing constructive feedback, while at the same time, finding the synergy between their important safety work and mine. They are equally as talented and dedicated, and they’ve given me the opportunity to work with them on a variety of topics and projects. This team is representative of many of NTSB’s employees, some of the smartest, most driven people I’ve encountered. So, what does traffic safety have to do with public health? Everything.

Natalie Draisin was a graduate student intern in the Safety Advocacy Division.

Four Views on Safety, The Never-Ending Journey

By Christopher Hart

Acting Chairman Hart in Atlanta, GAIt is said that safety is not a destination but a never-ending journey.

At the NTSB, we investigate accidents, make recommendations to prevent recurrences, and work for the adoption of our recommendations. The vast majority of flights take off and land safely, the vast majority of passenger and freight trains make it to their destinations without incident, and the vast majority of pipeline operations successfully move energy and other products into American homes and businesses. When anything goes wrong in any of those transportation processes, we at the NTSB are called upon to investigate and find out what went wrong and why.

All of these transportation operations are part of an enormous and complex web of systems integrated within themselves, and with each other. Together they make up America’s transportation network. And behind the scenes, there are dedicated professionals working each day to take countermeasures against even the possibility of an accident.

I recently had the opportunity to visit four transportation organizations in Atlanta: the Metropolitan Atlanta Rapid Transit Authority (MARTA), CSX, Colonial Pipeline, and Delta Air Lines. It was enormously gratifying to see in some of their safety measures the echoes of past NTSB recommendations – but it was even more gratifying to see proactive safety principles at work, so that the NTSB will hopefully have fewer accidents to investigate in the future. Although different in what and who they transport, MARTA, CSX, Colonial Pipeline and Delta Airlines are similar in their commitment to continuously improving safety.

MARTA provides transportation for approximately 500,000 passengers each weekday using more than 338 rail cars in 38 stations on 48.1 miles of rail. This requires proper rail inspections, rigorous training and detailed-oriented work with a safety-first objective.

It also requires policies that keep up with the times. For example, MARTA’s answer to today’s temptation of operator distraction by personal electronic devices is a zero-tolerance rule among its operators. And Marta means business: a leading cause for termination of MARTA’s operators is operator distraction.

CSX travels different rails and moves more products than people, resulting in different, but equally important, safety concerns. CSX serves 23 states, the District of Columbia and two Canadian provinces. Its network connects major metropolitan centers in the eastern United States, and connects approximately 240 short line and regional railroads and more than 70 ocean, river, and lake ports to population centers of various sizes.

According to CSX officials, last year was CSX’s safest year ever. I visited the CSX REDI Center, where the railroad teaches workers to incorporate the highest level of safety in their daily routines. I was able to witness first-hand the medical screenings available to CSX employees through its wellness program, and I was fascinated to hear how CSX is looking to commercial aviation to make operations even safer.

The company’s new operations rulebook, for example, is based on the aviation rulebook, adapted to rail operations. Kudos to CSX for reaching out to aviation to learn about ways that have worked for others to mitigate safety risk.

Colonial Pipeline Company provides services in an often-overlooked area of transportation – the use of pipelines to transport refined petroleum products to homes and businesses. Colonial moves an average of 100 million gallons of fuel daily through its pipelines. The visit showed me some of they ways that they put safety first.

Colonial knows that its own employees are not the only ones who must be ready to respond if a mishap occurs, and they showed me the emergency preparedness training that they provide for communities through which their pipelines travel, as well as their process safety approach, and their industry learning program; each has an aspect touching on pipeline safety external to Colonial itself.

But I also saw a control room where Colonial’s workers monitor its pipelines’ functions all around the country. Because human fatigue is a constant concern for Colonial, employees have ready access to exercise equipment located near the control room and on-site sleep rooms. They even encourages employees’ families to engage in its fatigue training programs, so that spouses understand the importance of proper rest during the employees’ off-duty hours.

Last but not least, I visited Delta Air Lines. In the early days of air travel, aviation was largely for the well-to-do. Today, air travel is mass transportation, carrying more than 730 million passengers annually in the U.S. alone. Nevertheless, airlines like Delta are in an unprecedented period of safety; a U.S. commercial air carrier has not had a fatal accident for more than five-and-a-half years.

As such, Delta was an excellent place to witness the vigilance and systemic thinking that keep this safety record strong. I learned about some of their safety information programs that enable line employees throughout the company to provide feedback regarding Delta’s safety mission. These voluntary reporting programs, along with similar programs in other airlines, have contributed to the industry’s excellent safety record.

A key aspect of these safety programs is that they are non-punitive. Non-punitive feedback is vital to catching small problems before they become big problems. Delta maintains a safety management system, and aggressively uses information from the voluntary reporting programs to inform the safety management process and help them find possible safety issues.

What have I learned from my visits to these transportation giants? I was pleased to see how important safety is to all of them, whether they carry people, products, or fuel, and whether their transportation is by rail, pipeline, or air. But more than that, I was able to see first-hand the daily hard work that helps ensure the high level of safety evident in the transportation of people and goods throughout America.

The NTSB often adds emphasis to the need for safety initiatives within both government and industry when we find lapses in the course of our accident investigations. The NTSB’s ability to find and report on any such safety lapses is part of what helps to keep America’s safety record moving steadily forward.

It was truly a pleasure to meet so many people who cared so much about safety and whose safety decisions and processes are behind the scenes each time we take a seat on an airplane or train, see a freight train rolling by, or use the energy transported by pipelines. One of America’s great achievements has been the creation of a transportation network in which safety is the rule, and accidents – such as those the NTSB investigates – are thankfully the exception.

Accident Response is Part of Prevention

By Christopher A. Hart

Installation of oil boomLast month, the NTSB launched a team to investigate a gas explosion and subsequent fire in New York City. It often surprises people that pipelines are one of the transportation modes covered in our statutory authority. What might surprise people even more is that 2.5 million miles of pipeline crisscrosses the nation – enough to travel around the earth 100 times – and they present a unique challenge because they are most often underground. But if something goes wrong, it can be very dramatic, such as with the December 2012 natural gas pipeline rupture near Sissonville, West Virginia; and they can be deadly, such as in the September 2010 natural gas pipeline rupture in San Bruno, California.

When it comes to enhancing pipeline safety, the ultimate goal for any pipeline operator should be to prevent a pipeline rupture. The next goal should be to make sure that lessons learned from such accidents are applied throughout the industry to keep them from happening again. Last month, the NTSB reviewed steps taken by the pipeline operator, Enbridge Energy (“Enbridge”), in response to its July 2010 crude oil pipeline rupture in Marshall, Michigan, and closed three of our safety recommendations addressing pipeline control center staff training, first responder training, and response plans.

As a result of the Marshall pipeline rupture, almost 850,000 gallons of crude oil spilled into the surrounding wetlands and flowed into local waterways, resulting in by far the most expensive environmental clean-up for an onshore oil spill in the U.S. The release entered Talmadge Creek and flowed into the Kalamazoo River; heavy rain caused the river to flow over existing dams and carried oil 35 miles downstream. County health agencies closed public access to 39 miles of the river system to protect public health and safety during the cleanup. The lives of local residents were disrupted or changed forever, and the impact on natural resources and wildlife was substantial. Our investigation of the Marshall rupture revealed gaps in Enbridge’s training and preparations for responding to spills in all environmental conditions. For example, we found that Enbridge’s response was hampered by inadequate resources on site, lack of spill response organizations under contract near Marshall, and the use of spill response equipment that was inappropriate for the environment and weather conditions.

Since we issued our report and recommendations in July 2012, Enbridge has taken steps to improve its steps for responding to emergencies. Enbridge developed and implemented semiannual training for its control center staff that includes the theory and practice of decisionmaking in the event of an emergency, tools for effective communication, leadership and team building, and situation awareness and workload management. Enbridge also updated its first responder training curricula with tabletop and practical exercises, completed the training of first responders, and will provide them refresher training. In addition, an independent expert completed a systemwide emergency response capability assessment for Enbridge, which subsequently developed an incident action plan, emergency response handbooks, and other guidance to support the regional emergency response teams.

These lessons, however, go beyond Enbridge. Most pipelines function properly most of the time. First responders need to prepare more effectively for those (fortunately rare) times when something goes wrong.

Christopher A. Hart was sworn in as a Member of the NTSB on August 12, 2009 and designated by the President for a two-year term as Vice Chairman of the Board on August 18. Member Hart joined the Board after a long career in transportation safety, including a previous term as a Member of the NTSB.