EVENT TREE
ANALYSIS
2nd Edition
P. L. Clemens
June 1990
Sverdrup
provided as a free service by [Link] -- Pat L. Clemens and Jacobs Sverdrup 1
EVENT TREE ANALYSIS IS…
• A bottom-up, deductive, system safety analytical technique
• Applicable to:
• Physical systems, with or without human operators
• Decision-making / management systems
• Complementary to other techniques, e.g.…
• Fault Tree Analysis
• Failure Modes and Effects Analysis
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EVENT TREE ANALYSIS…
Explores system RESPONSES
to
Initiating “CHALLENGES”
and
Enables PROBABILITY ASSESSMENT
of
SUCCESS / FAILURE
EXAMPLE “CHALLENGES”…
• Pipe or Vessel Burst • Utility System Failure
• Ignition of Stored Combustibles • Outbreak of Epidemic
• Technology Need • Heightened Business Competition
• Normal System Operating Command
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EVENT TREE ANALYSIS (General Case)…
Portray all credible system operating permutations.
Trace each path to eventual success or failure.
N
SUCCESS
D/A
O/O
n FAILURE
DECISION/
DECISION/
DECISION/
C
A
B
ACTION
ACTION
ACTION
SUCCESS
FAILURE
OPERATION/
OUTCOME SUCCESS
OPERATION/
3
OUTCOME FAILURE
1
SUCCESS
INITIATION FAILURE
OPERATION/
OUTCOME
2
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EVENT TREE ANALYSIS (Bernoulli Model)…
Reduce tree to simplified representation of SUCCESS
system behavior. Use binary branching.
FAILURE
Lead unrecoverable failures and
undefeatable successes directly to final FAILURE
outcomes. SUCCESS
FAILURE
SUCCESS
INITIATION FAILURE
SUCCESS
A fault tree or other analysis
SUCCESS
may be necessary to determine
probability of the initiating event FAILURE
or condition. (Unity probability SUCCESS
may be assumed.)
FAILURE
FAILURE
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AN EXAMPLE PROBLEM…
PUMP KLAXON
P B
K
BACKGROUND/PROBLEM — A subgrade compartment containing
S important control equipment is protected against flooding by the system
shown. Rising flood waters close float switch S, powering pump P from
an uninterruptible power supply. A klaxon K is also sounded, alerting
operators to perform manual bailing, B, should the pump fail. Either
pumping or bailing will dewater the compartment effectively. Assume
flooding has commenced, and analyze responses available to the
dewatering system…
• Develop an event tree representing system responses.
• Develop a reliability block diagram for the system.
• Develop a fault tree for the TOP event Failure to Dewater.
SIMPLIFYING ASSUMPTIONS:
• Power is available full time.
• Treat only the 4 system components S, P, K, and B.
• Consider operator error as included within the bailing function, B.
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Pump Succeeds
(1 – PP)
Float [1 – PS – PP + PPPS]
Switch
SUCCESS
Succeeds Bailing Succeeds
(1 – PS) (1 – PB)
EVENT TREE… [PP – PPPS – PKPP+ PKPPPS –
PBPP + PBPPPS + PBPKPP –
Klaxon Succeeds PBPKPPPS]
(1 – PK)
Water Rises [PP – PPPS –
(1.0) PKPP +
Pump Fails PKPPPS] Bailing Fails
(PP) (PB)
FAILURE
[PP – PPPS] [PBPP – PBPPPS –
PBPKPP +
Klaxon Fails PBPKPPPS]
(PK)
Float [PKPP – PKPPPS]
Switch
Fails
(PS)
[PS]
PSUCCESS = 1 – PS – PKPP + PKPPPS – PBPP + PBPPPS + PBPKPP – PBPKPPPS
PFAILURE = PS + PKPP – PKPPPS + PBPP – PBPPPS – PBPKPP + PBPKPPPS
PSUCCESS + PFAILURE = 1
7
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RELIABILITY
BLOCK PUMP
DIAGRAM… P
FLOAT
SWITCH
S
KLAXON BAILING
K B
CUT
SETS
PATH S
SETS
S/P P/K
S/K/B P/B
8
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FAULT TREE… FAILURE
TO
COMMAND DEWATER RESPONSE
FAILURE FAILURE
EXACT SOLUTION :
PTOP = PS + PPPK – PPPKPS + PBPP –
PBPPPS – PBPKPP + PBPKPPPS S FLOAT WATER
SWITCH REMOVAL
FAILS FAILS
OPEN
RARE EVENT APPROXIMATION:
PTOP = PS + PPPK + PPPB
CUT P MANUAL
PUMP
SETS FAILS
REMOVAL
FAILS
PATH S
SETS
S/P P/K
K B
KLAXON BAILING
FAILS FAILS
S/K/B P/B
9
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15 SUCCESS
7
16 FAILURE A1
^
3
17 SUCCESS
8
1
18 FAILURE B1 EVENT TREE FAULT TREE
19 SUCCESS
9
20 FAILURE B2 TRANSFORMATION…
4
21 SUCCESS
10
22 FAILURE C
i
23 SUCCESS
11
24 FAILURE B3
5
25 SUCCESS
12 FAILURE
26 FAILURE A2 A1-2
2
27 SUCCESS
13
28 FAILURE D
6 FAILURE FAILURE
29 SUCCESS A1 A2
14
30 FAILURE
16 7* 3* 1* i 26 12 5* 2 i
*Note that not all events represented here are failures.
10
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ASSESS RISK AND JUDGE TOLERABILITY…
Failure statements express SEVERITY
Event Tree Analysis explores OUTCOMES / assesses PROBABILITY
PROBABILITY and SEVERITY establish RISK
IS THE RISK ACCEPTABLE?
If not, develop intervenors!
Select intervenor(s) on the basis of:
EFFECTIVENESS
COST
FEASIBILITY (incl. schedule)
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11
EVENT TREE SHORTCOMINGS & ADVANTAGES…
• SHORTCOMINGS:
• Operating pathways must be anticipated.
• Partial successes/failures are not distinguishable.
• Initiating events are treated singly. (Multiple trees are required for multiple
events; co-existing initiating events are not considered.)
• Sequence-dependent scenarios are not modeled well.
• ADVANTAGES:
• End events need not be foreseen.
• Multiple failures can be analyzed.
• Potential Single-Point Failures can be identified.
• System weaknesses can be identified.
• Zero-payoff system elements/options can be discarded.
provided as a free service by [Link] -- Pat L. Clemens and Jacobs Sverdrup
12
BIBLIOGRAPHY —
Selected references for further study…
• Center for Process Safety; “Guidelines for Hazard Evaluation
Procedures; 2nd Edition with Worked Examples” 1992 (461 pp);
American Institute of Chemical Engineers
• Lees, Frank P.; “Loss Prevention in the Process Industries”;
1980 (1316 pp — two volumes)
• Henley, Ernest J. & Hiromitsu Kumamoto; “Reliability
Engineering and Risk Assessment”; 1981 (568 pp)
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