SAP II – DPT 2201

FIRST AID, PHARMACY DESIGN AND SAFETY: First aid/injuries and their treatment:
First aid box/kit - Importance, contents and their uses; Injuries and their treatment-shock,
asphyxia, wounds, burns, eye injuries, bleeding; Poisoning- Types, corrosive, irritant, nerve,
treatment of each type;
Pharmacy Design: Pharmacy layout; pharmacy counter; Sinks and drainage systems; floor
surfaces; types of ventilation; lighting in a pharmacy; source of pharmacy services-cold water,
hot water, electricity, equipment; Requirements for the conversion of an existing building to a
pharmacy;
Safety in the Pharmacy: Sources of danger-chemicals, explosions, gas cylinders; Prevention of
danger in the pharmacy; safety design features in a pharmacy
ENVIRONMENTAL ISSUES AND PREVENTIVE HEALTH CARE Pharmaceutical
Waste and waste disposal: Types of pharmaceutical wastes; methods of pharmaceutical waste
disposal-incineration, diluting and flushing out, sterilization, burying, detoxification, fume
cupboards; National guidelines on pharmaceutical waste disposal
Good laboratory Practice (GLP): Classification-Glassware ,plastic ware, platinum ware,
ceramic ware, steel ware; Cleaning laboratory ware-Glassware, plastic ware, water detergents,
chromic acid, platinum ware, hydrochloric acid, ceramic ware, strong acids, hot water,
detergents, steel ware; Storage- labeling, position of storage, method of storage; Effects of
reagents-acids, alkalis, air; Cleaning of floors, windows, walls and ceilings-detergents, dusters,
mops, protective cleaning devices-rubber gloves, overcoats, gumboots.

First aid
It is help given to a sick or injured person until full medical treatment is available.

Your basic first aid kit

A basic first aid kit may contain:

 plasters in a variety of different sizes and shapes – Use plasters for small cuts and grazes
 small, medium and large sterile gauze dressings – A sterile wound dressing is a sterile
pad attached to a bandage. These are for larger wounds to apply pressure to help stop
bleeding and are quick and easy to put on in an emergency
 at least two sterile eye dressings
 triangular bandages – Triangular bandages are large triangular shaped pieces of cloth.
You can fold a triangular bandage to use as either a bandage or sling, or, if sterile, as a
dressing for large wounds and burns.
 crêpe rolled bandages – Roller bandages are long thin bandages rolled up. Use a roller
bandage to support joint injuries, hold dressings in place, put pressure on wounds to stop
bleeding, and to reduce swelling
  safety pins – To fasten the loose end of bandages
 disposable sterile gloves – Using disposable gloves reduces the risk of infection between
you and someone you’re helping. If they’re available, always wear gloves whenever you
dress wounds or deal with any body fluids or waste
 tweezers
 scissors – To cut sterile pads, bandages or sticky tape to the right length. You can also
use them if you need to cut someone’s clothing, so that you can get to a wound
 alcohol-free cleansing wipes – To clean the skin around the wound
 sticky tape – To hold dressings in place or to hold the loose end of bandages
 thermometer (preferably digital)
 skin rash cream, such as hydrocortisone
 cream or spray to relieve insect bites and stings
 antiseptic cream
 painkillers such as paracetamol (or infant paracetamol for children), aspirin (not to be
given to children under 16), or ibuprofen
 antihistamine tablets
 distilled water for cleaning wounds
 eye wash and eye bath
 hand sanitizer gel – To clean your hands if you can’t find any water to use

Universal Precautions:
First aiders should equip themselves with and use, personal protection equipment. This
equipment is used to minimize infection from disease.
Exposure sources:
The following are common sources of exposure:
 All human body fluids and secretions, especially any fluid with visible blood
 Any other human material.

Exposure routes:
The following are typical means of exposure:
 Punctures or cuts from sharp objects contaminated with blood / fluid
 A spill of blood / fluid onto mucous membranes of the eyes, mouth and/or nose
 A spill of blood / fluid onto skin that may or may not be intact
 A laceration and contamination with blood/fluid from a bite.

Universal Precautions and Personal Protective Equipment (PPE)

Universal Precautions also known as Standard Precautions is a way to limit the spread of
disease by preventing contact with blood borne pathogens. Blood borne pathogens include but
are not limited to: Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human
Immunodeficiency Virus (HIV).
To follow Universal Precautions correctly means whether or not you think a victim’s blood or
body fluid is infected, you act as if it is. All blood and body fluids are considered hazardous
material and should be treated as if infectious.
PPE includes disposable gloves, gowns, lab coats, face shields, eye protection and pocket masks
/ facial barriers.
Action at scene following exposure:
For an open wound
 Encourage the wound to bleed, thoroughly wash with water for 15 minutes and dress
 Do not attempt to use a caustic solution to clean the wound
 Seek medical advice as soon as possible.

For a splash to a mucous membrane

 Flush splashes to nose, mouth or eyes thoroughly with water for 15 minutes
 If the splash is in the mouth, spit out and thoroughly rinse out with water for 15 minutes
 If the splash is in the eyes, irrigate with the eyes open for 15 minutes
 Seek medical advice as soon as possible.

For a splash to the skin

 At the scene, wash thoroughly with soap and water
 Seek medical advice as soon as possible if the exposure is medium / high risk.

PRIORITY OF CASUALTIES
• Save the conscious casualties before the unconscious ones as they have a higher chance
of recovery.
• Save the young before the old.
• Do not jeopardize your own life while rendering First Aid. In the event of immediate
danger, get out of site immediately.
• Remember: One of your aims is to preserve life, and not endanger your own in the
process of rendering First Aid.

Characteristic of a first aider

Must be
Observant: -

Resourceful; - she/he may use to the best advantage who ever and whatever is at hand to prevent
further damage

Tactful: - She/he may learn the symptoms and history of the case, and secure the confidence of
the causality, and the bystanders in the treatment of the causality.

Dexterous; - that she/he may handle a causality without causing unnecessary pain and use
appliances efficiently, quickly and neatly
Explicit; - that he/she may give clear instructions to the causality and for the by standers how
best to assist him

Persevering; - that she/or may continue his efforts, though not at first successful, until relieved
by a superior medical authority, or death of the causality is undoubted

Discriminating: - that she/he may decide which of several causalities and injuries should be
treated first and where modification of the correct treatment as the result of common sense, may
be necessary.

Sympathetic: - that she/he may give real comfort and encouragement to the suffering, always
remembering the first principles of humanity.

The scope of first aid treatment:

•Assessing the situation
•Diagnosing the problems
•Giving immediate treatment
•Referring of the causality to higher health institutions

The primary assessment

The primary assessment is a systematic checklist designed to maximise safety and identify / treat
immediate life-threatening problems.

Before approaching any situation, you must assess the scene for any threat to:
 Yourself and anyone else assisting with the situation
 The casualty or casualties
 Bystanders near the scene.

By rushing into the situation without properly assessing what has occurred, you are
compromising your safety. If you are injured while attempting to assist the casualty, you will be
unable to help them. If the scene is not safe, remove the threat from the casualty (or the casualty
from the threat)

Moving a casualty?
A rescuer should only move a collapsed or injured victim.........
 To ensure the safety of both rescuer and the victim
 Where extreme weather conditions or difficult terrain indicate that movement of the victim is
essential
 To make possible the care of airway, breathing, and circulation (e.g. turning the unconscious
breathing victim onto the side or turning a collapsed victim onto the back to perform
cardiopulmonary resuscitation effectively)
 To make possible the control of severe bleeding.
All unconscious persons who are breathing normally must remain on their side (injuries
permitting). It is reasonable to roll a face-down unresponsive victim into the supine (back)
position to assess airway and breathing and initiate resuscitation. Concern for protecting the neck
should not hinder the evaluation process or life saving procedures
When ready to move the victim:
 Avoid bending or twisting the victim's neck and back: remember, spinal injury can be
aggravated by rough handling
 Try to have three or more people to assist in the support of the head and neck, the chest, the
pelvis and limbs
 A single rescuer may need to drag the victim (either an ankle drag or arm-shoulder drag is
acceptable)
 Make prompt arrangements for transport by ambulance to hospital.

Unconsciousness is a state of unresponsiveness, where the victim cannot be roused, is unaware

of their surroundings and no purposeful response can be obtained.
When checking a person’s response, you are assessing how well their brain is functioning. The
brain requires a constant supply of oxygenated blood and glucose to function. Interruption of this
supply will cause loss of consciousness within a few seconds and permanent brain damage in
minutes. When the casualty’s brain is not functioning normally, they may not be able to look
after their own airway. Their protective reflexes of coughing, swallowing, or gagging may not be
working very well.

Causes of unconsciousness:
The causes of unconsciousness can be classified into four broad groups:
 Blood oxygenation problems (heart attack)
 Blood circulation problems (trauma, blood loss)
 Metabolic problems (e.g. diabetes, overdose, alcohol)
 Central nervous system problems (e.g. head injury, stroke, tumour, epilepsy, spinal injury)

How to check for responsiveness:

Assess the collapsed victim's response to verbal and tactile stimuli (‘talk and touch’), ensuring
that this does not cause or aggravate any injury. Give a simple command such as, “open your
eyes, squeeze my hand, let it go”. Then grasp and squeeze the shoulders firmly to elicit a
response.

Cardiopulmonary Resuscitation (CPR)

Effective CPR - 30 compressions followed by 2 Breathes

CPR is a repetitive cycle of:

1. Airway opening.
2. Chest compressions
3. Rescue breathing

External chest compression is the most effective way of artificially circulating blood. Chest
compressions are accompanied by rescue breathing which provides oxygen that the blood
delivers around the body to its vital organs. This is the only way to keep the heart and brain
oxygenated until a defibrillator arrives.
Recognition of the need for chest compressions:
First aiders should use unresponsiveness and absence of normal breathing to identify the need for
resuscitation. Feeling for a pulse is unreliable and should not be performed to confirm the need
for resuscitation.
When should CPR be performed?

CPR should be performed on casualties who are not breathing or unresponsive and breathing
inadequately. Sometimes a casualty suffering a cardiac arrest may occasionally gasp, but this
does not constitute breathing.

After every two minutes of CPR, reassess for signs of life (coughing, breathing, or movement).
This should take no longer than 10 seconds. If the casualty begins to show signs of life during
CPR, reassess the breathing immediately. If the casualty is breathing, place them into the
recovery position and monitor continuously.

When to stop CPR:

You must perform CPR uninterruptedly until one or more of the following happens:
 The casualty recovers responsiveness and is able to breathe on their own
 You are placed at significant risk
 You cannot continue due to exhaustion
 Advanced help arrives and takes over the care of the casualty.

If Rescuers are unwilling or unable to do rescue breathing they should do chest compressions
only. If chest compressions only are given, they should be continuous at a rate of approximately
100 per minute

For a victim receiving chest compressions, place your hands on the lower half of the sternum.
Rescuers should place the heel of their hand in the centre of the chest with the other hand on top.
Avoid compression beyond the lower limit of the sternum. Compression applied too high is
ineffective and, if applied too low may cause regurgitation and/or damage to internal organs.

Method of compression:

Two hand technique is used for performing chest compressions in adults

One hand technique is used to perform chest compressions on children under 8 years old

In infants the two finger technique should be used. Infants requiring chest compressions should
be placed on their back on a firm surface (e.g. table or floor) to optimize the effectiveness of
compressions. Compressions should be rhythmic with equal time for compression and relaxation.
The rescuer must avoid either rocking backwards and forwards, or using thumps or quick jabs.
Rescuers should allow complete recoil of the chest after each compression.
Stable position
A stable side position is the single most effective method of providing and maintaining a
clear airway in the unresponsive, breathing casualty.
The stable side position:
 Allows the tongue to fall away from the back of the throat, enabling the casualty to maintain a
clear airway
 Facilitates drainage and reduces the risk of inhaling foreign material
 Is suitable for any unresponsive, breathing casualty, who has to be left alone for any reason.

Many versions of the stable side position exist. When considering the specific position to be
used, the following principles should be observed:
 The victim should be placed on their side with the head tilted, to allow free drainage of fluid
 The position should be stable
 Any pressure on the chest that impairs breathing should be avoided
 It should be possible to turn the victim onto the side and return to the back easily and safely,
having particular regard to the possibility of cervical spine injury
 Good observation of and access to the airway should be possible
 The position itself should not give rise to any injury to the victim

Procedure:
1. Kneel beside the casualty and check the casualty’s pocket s for anything that could injure them
during the procedure.
2. Roll the casualty toward you, pulling from the casualty’s hip and shoulder.
3. Once the casualty is on their side, tilt their head back to ensure an open airway.
4. Move the casualty’s uppermost knee to a position approximately 90° from their torso.
5. Move the casualty’s uppermost arm to a position approximately 90° from their torso.
Foreign Body Airway Obstruction (Choking)

There are two types of airway obstruction:

Partial:
 Breathing is laboured;
 Breathing may be noisy;
 Some escape of air can be felt from the mouth..

Complete:
 There may be efforts at breathing;
 There is no sound of breathing;
 There is no escape of air from nose and/or mouth.

Some typical causes of airway obstruction may include, but are not limited to:
 Relaxation of the airway muscles due to unconsciousness;
 Inhaled foreign body;
 Trauma to the airway;
 Anaphylactic reaction leading to swelling of the airway.

The symptoms and signs of obstruction will depend on the cause and severity of the condition.
Airway obstruction may be gradual or sudden in onset and may lead to complete obstruction
within a few seconds. Consequently the victim should be observed continually.
In the conscious victim who has inhaled a foreign body, there may be extreme anxiety, agitation,
gasping sounds, coughing or loss of voice. This may progress to the universal choking sign
(clutching the neck with the thumb and fingers).
Signs and symptoms:
The indications that someone may be struggling with an obstruction are:
 Panic
 Grasping the throat
 Inability to speak
 Inability to breathe
 Colour of face (pallor)
 Inability to cough.

Treatment for choking adults and children

Effective Cough (Partial Airway Obstruction)
 A casualty with an effective cough should be given reassurance and encouragement to keep
coughing to expel the foreign material.
 If the obstruction is not relieved the rescuer should call an ambulance.
Conscious Victim
 If the casualty is conscious, call an ambulance
 Perform up to five sharp, back blows with the heel of one hand in the middle of the back
between the shoulder blades. Check to see if each back blow has relieved the airway obstruction.
The aim is to relieve the obstruction with each blow rather than to give all five blows.

 If back blows are unsuccessful the rescuer should perform up to five chest thrusts. Check to
see if each chest thrust has relieved the airway obstruction. The aim is to relieve the obstruction
with each chest thrust rather than to give all five chest thrusts.

 To perform chest thrusts, identify the same compression point as for CPR and give up to five
chest thrusts. These are similar to chest compressions but sharper and delivered at a slower rate.
Children and adults may be treated in the sitting or standing position. If the obstruction is still not
relieved, continue alternating five back blows with five chest thrusts.
Unconscious Victim
The finger sweep can be used in the unconscious victim with an obstructed airway if solid
material is visible in the airway. Commence CPR immediately!
Treatment for choking infants (less than 1 year):
The following procedure is for a choking infant:
 Check to see if the obstruction can be cleared using the finger sweep.
 Lay the infant in a lying face down position over your forearm, supporting the baby’s face and
body with your arm. The infant’s body should be inclined downwards to utilise the effects of
gravity.
 Deliver up to five blows between the infant’s shoulder blades.
 If the obstruction is still present, turn the infant onto their back, again with the body inclined.
 Deliver up to five chest thrusts between the infant’s nipples (breast bone) using two fingers.
 Repeat this process until the obstruction is cleared or the infant becomes unresponsive.
 Commence CPR if the infant becomes unresponsive.

FAINTING
Fainting is a brief loss of consciousness that is caused by a temporary reduction of blood flow to
the brain.
SYMPTOMS:
• A brief loss of consciousness causing the casualty to fall to the floor

• A slow pulse

• Pale, cold skin and sweating

CAUSES:
• Taking in too little food and fluids (dehydration)

• Low blood pressure

• Lack of sleep
 • Over exhaustion

TREATMENT:
• Lay casualty down, and slightly elevate legs

• Make sure she has plenty of fresh air

• As she recovers, reassure her and help her sit up gradually

• Look for and treat any injury that has been sustained through falling

SHOCK
Shock occurs when the circulatory system fails, and insufficient oxygen reaches the tissues. If
the condition is not treated quickly, vital organs can fail, ultimately causing death. Shock is
made worse by fear and pain.
SYMPTOMS:
• Clammy skin (cool, pale and damp)

• Restlessness and nervousness

• Thirst

• Loss of blood

• Confusion

• Fast breathing

• Nausea or vomiting

• Blotched or bluish skin (especially around the mouth and lips)

• Often perspires freely

• May pass out.

CAUSES:
Shock can be divided into 4 types:
• Hypovolemic shock
 – caused by the loss of blood volume (such as through bleeding) or profound
dehydration

• Cardiogenic shock

– a result of a weakened heart that is unable to pump blood as efficiently as it once

did. Commonly occurs after a massive heart attack

• Distributive shock

– a result of the lack of distribution of blood to the organs

• Obstructive shock

– results from an obstruction to blood flow at a site other than the heart

TREATMENT:
• “P.E.L.C.R.N.” (Pronounced Pell-Crin)

• Position the casualty on their back

• Elevate the Legs

• Loosen clothing at neck waist or wherever it is binding

• Climatize (prevent too hot or too cold)

• Reassure (keep the casualty calm)

• Notify medical personnel (Help, Get a medic!!)

BEE/HORNET STING
SYMPTOMS:
• Redness and swelling in injured area

TREATMENT:
• Remove stinger as fast as possible

• Reduce pain and swelling with cold compress

CRAMPS
Cramps are painful sensations caused by contraction or over shortening, usually of muscles.
CAUSES:
 • Cold or overexertion

TREATMENT:
• Stretch the muscle and apply heat or cold (preferably heat)

• Cramps from lack of salt and water: Stretch the muscle, drink water and increase salt
intake

BURNS
Types of burns
Dry burn
• Caused by flame, contact with hot objects, friction etc.

Scalds
• Contact with steam and hot fluids

Electrical burn
• Low-voltage current, lightning strike

Cold injury
• Contact with freezing metals, dry ice, freezing vapours e.g. liquid oxygen and liquid
nitrogen

Chemical burn
• Industrial chemicals, including inhaled fumes and corrosive gases.

• Household chemicals, including paint remover, strong acid and alkali, bleach, weed
killers etc.

Radiation burn
• Sunburn over-exposure to ultra-violet (UV) lamp and exposure to radioactive source.

Degree of burns
First degree burn:
 • This involves only the outermost layer of skin and is characterized by redness, swelling
and tenderness.

Second degree burn:

• Any 1% burn affecting layers of the epidermis, giving rise to rawness, blisters and the
presence of a clear fluid. Can be fatal if it affects over 60% of the body.

Third degree burn:

• All the layers of the skin are burned and there maybe be some damage to the nerves,
fat tissue and muscles. Skin may look waxy, pale or charred. Purple fluid is observed and
no pain is felt by casualty. Urgent medical attention is required.

MINOR BURNS
(FIRST DEGREE BURNS)
TREATMENT:
• Rinse the injured part with cold water for at least 10 minutes to stop burning and relieve
pain

• Gently remove any jewelry, watches, belts or constricting clothing from injured area
before it begins to swell

• Cover area with sterile dressing, or any clean, non-fluffy material and bandage loosely in
place.

• NOTE: Cold burns should not be rinsed with cold water and cold water should never be
applied to anyone with extensive burns.

SEVERE BURNS
(SECOND AND THIRD DEGREE BURNS)
• Remove any rings, watches, belts, shoes or burning clothing from injured area before it
begins to swell

• Remove burnt clothing, unless it is sticking to the burn

• Cover dressing with sterile dressing or some other suitable material to prevent infection
and germs (this is not necessary if burn is on face)

• Do NOT burst any blisters, touch infected area or apply any lotions to the injury as this
will retain heat within the burn.
TREATMENT:
• Lay the casualty down and protect the burnt area from contact with the ground if possible

• Rinse burn with plenty of cold water for at least 10 minutes or use burn-cooling gel

• Arrange for casualty to be sent to the hospital

• While cooling the burn, watch for signs of difficulty in breathing and be ready to
resuscitate if necessary

ELECTRIC SHOCKS (LOW-VOLTAGE CURRENTS)

• Break contact of electric source with casualty by switching off mains or meter point
(Only if it is safe for you to do so)

• If unable to reach cable, stand on insulating material e.g. plastic mat, wooden box and
push casualty’s limbs away from source with a broom or stick

• Do not touch the person until the power supply is turned off

• Be careful in areas that are wet

• Summon an ambulance

FRACTURES
A fracture is a break or crack in the continuity of the bone.
SYMPTOMS:
• Pain at or near fractured site

• Tenderness on gentle pressure

• Swelling over the fracture site

• Deformity e.g. irregularity of bone, angulation or rotation of limb, depression of bone etc.

• Loss of power

• Signs and symptoms of shock

DISLOCATIONS
A dislocation is the displacement of one or more bones at a joint. It usually occurs in the
shoulders, elbow, thumb, fingers and the lower jaw.
SYMPTOMS:
• Pain at the site of injury

• Limited movement at joint

• Deformity

• Swelling

• Tenderness

TREATMENT OF FRACTURES AND DISLOCATIONS

• Support and immobilize the injured limb

• Use a splint (if possible) in order to prevent movement of the injured part

• Arrange for casualty to be removed to hospital

• In doubtful cases, always treat as for a fracture

MINOR WOUNDS
Signs and symptoms
Break, cut or opening in the skin
Bleeding –may be minor, moderate or severe
Bruising and pain
Infection
Progressing shock

Treatment:
If bleeding, apply direct pressure with a clean cloth or absorbent pad
Wash area with antibacterial soap and clean until there appears to be no foreign matter in the
wound
Cover area with an adhesive bandage or gauze wrap
Bruising: Caused by broken blood vessels leaking blood under the skin. Bruising can be minimal
or large and severe

Signs and Symptoms:

Pain and swelling
Discoloration: new bruising will be dark purple / older bruising will fade to greenish yellow
Treatment:
Apply ice to injury to reduce pain, bleeding and swelling
To prevent frost bite to the injured area, place a thin towel or cloth between the skin and ice.
Limit ice application to 20 minutes on, 20 off

Crush Injury: Occurs when a body part is subjected to a high degree of force or pressure.
Example: smashed fingers in door.

Signs and Symptoms:

Pain and swelling
Discoloration and sometimes deformity
First Aid:
Apply ice just as you would with a bruising injury
If pain is severe and does not lessen with ice or there is decreased sensation, weakness, or
paleness of the skin in the affected area, seek emergency care

Severe Bleeding
Emergency Action Steps:

Assess the scene –if the scene is unsafe or becomes unsafe, get out! Only move the patient if
absolutely necessary.
Assess the victim -Tap shoulder, shout name. No response??
Alert–Have someone call 911 for help and get an AED. If you are alone –make the call yourself.
Attend to any life threatening problems.
Rip or cut away clothing so wound can be seen.
Place an absorbent pad directly over the wound.
Apply firm, direct pressure over the wound.
The victim can assist if they are able.

Wrap a conforming bandage securely over the pad to maintain pressure and hold the gauze in
place.
Bandage should be loose enough so a finger can slip under the bandage.

If Bleeding Continues:
As the first dressings become soaked with blood, apply more pads, dressings and maintain firm,
direct pressure.
Do not remove the first dressings, just continue to add more if soaking through continues.

Managing Shock:
Ensure an open airway for the victim and adequate breathing.
Keep the bleeding under control.
Prevent chilling or overheating.
Keep victim lying flat with feet slightly elevated if possible.

Eye Injuries

Eye injuries can range from minor irritations to severe and sight threatening. Injuries are
frequently caused by objects in the eye, burns, and blunt force injuries. Any of these conditions
or situations can lead to permanent loss of vision.

Signs and Symptoms:

Pain, redness, stinging
Burning, itching
Bleeding/bruising in or around eyes
Sensitivity to light
Decreased or double vision
Loss of vision
Something actually visibly stuck in eye

First Aid Interventions:

Rinse eye with saline solution or tap water if saline is not available.
Do not try to remove object
Do not allow the victim to rub or apply pressure to the injured eye
Cover the eye lightly with a gauze pad or clean cloth
Seek medical attention

Nosebleeds
Signs and symptoms to monitor:
Bleeding from one or both nostrils
Bleeding in the back of the throat, causing the victim to vomit blood

First Aid:
Sit upright and lean forward. By remaining upright, you reduce blood pressure in the veins of
your nose. This discourages further bleeding. Sitting forward will help you avoid swallowing
blood, which can irritate your stomach. Have the victim spit out blood that collects in the back of
the throat or mouth.
Pinch the nose [Link] your thumb and index finger to pinch your nostrils shut. Breathe
through your mouth. Continue to pinch for five to 10 minutes. Pinching sends pressure to the
bleeding point on the nasal septum and often stops the flow of blood.
To prevent re-bleeding, don't pick or blow your nose and don't bend down for several hours after
the bleeding episode. During this time remember to keep your head higher than the level of your
heart.

Poisoning
Poisoning may be accidental or deliberate. In many situations, it will be important to identify the
drugs or toxic substances used in the poisoning and determine the amount ingested. It will be
helpful to ascertain what pills have been ingested and any empty bottles given to the attending
ambulance officers.
Caution must be observed when any resuscitation attempt is required. If in doubt do not
commence resuscitation. as you can be poisoned from what casualty has ingested or inhaled.

Some common poisons include:

•  Household cleaners
•  Pesticides
•  Weed killer
•  Thinner based solvents
•  Motor vehicle fumes (carbon monoxide poisoning)
•  Pool chemicals
•  Prescribed medicines

Poisons can enter the body by:

•  Inhalation
•  Absorption
•  Ingestion
•  Instilled (into the eye)

Signs and symptoms

Depending on the poison, symptoms will vary, but include:

Abdominal pain
Bluish lips
Chest pain
Confusion
Cough
Diarrhea
Difficulty breathing
Blurred vision
Dizziness
Drowsiness
Fever
Headache
Heart palpitations
Muscle twitching
Nausea and vomiting
Tingling and Numbness
Seizures
Skin rash and burns
Stupor
Loss of consciousness
Unusual breath odor
Weakness
Treatment
Call emergency services
Begin CPR if necessary.
Try to identify the poison and do not make the person throw up unless you are advised to do so.
If the person vomits on their own, take measures to clear their airway, but wrap a cloth around
your fingers before sweeping out the mouth and throat.
If the person starts having a seizure, protect them from injury by laying them down gently on a
soft surface. Do not restrain the person; instead, turn the head to one side in order to keep the
airway open.
Roll unconscious persons onto their left side in the recovery position until help arrives.
Remove the person’s clothes if any poison has spilled on them and flush the skin with water.

For inhalation poisoning call emergency services, and only if it is safe, remove the person from
the danger of the gas, fumes, or smoke. Open all the windows and doors to remove the fumes
while holding your breath or holding a wet cloth over your nose and mouth.

Good Laboratory Practices

Definition: “a quality system concerned with the organizational process and the conditions under
which non-clinical health and environmental safety studies are planned, performed, monitored,
recorded, archived and reported.”
GLP is a Quality System concerned with the organizational process and the conditions under
which laboratory studies are –
• Planned, Performed and Monitored
• Recorded, Reported and Archived

OBJECTIVES OF GLP
– Ensure quality test data
– Ensure sound laboratory management
– Ensure robust conductance of laboratory testing
– Ensure accurate reporting of test findings
– Ensure safe archival of laboratory data

As far as pharmaceutical development is concerned, the GLP Principles, in their regulatory

sense, apply only to studies which:
• are non-clinical, i.e. mostly studies on animals or in vitro, including the analytical aspects of
such studies;
• are designed to obtain data on the properties and/or the safety of items with respect to human
health and/or the environment;
• are intended to be submitted to a national registration authority with the purpose of registering
or licensing the tested substance or any product derived from it.

Depending on national legal situations, the GLP requirements for non-clinical laboratory studies
conducted to evaluate drug safety cover the following classes of studies:
• Single dose toxicity
• Repeated dose toxicity (sub-acute and chronic)
• Reproductive toxicity (fertility, embryo-foetal toxicity and teratogenicity, peri-/post8natal
toxicity)
• Mutagenic potential
• Carcinogenic potential
• Toxicokinetics (pharmacokinetic studies which provide systemic exposure data for the above
studies)
• Pharmacodynamic studies designed to test the potential for adverse effects (Safety
pharmacology)
• Local tolerance studies, including phototoxicity, irritation and sensitization studies, or testing
for suspected addictive and/or withdrawal effects of drugs.

Pharmacy and Dose Mixing Areas

The Pharmacy and Dose Mixing area is a laboratory zone dealing with test item work flow:
receipt, storage, dispensing, weighing, mixing, dispatch to the animal house and waste disposal.

Size
The area should be big enough to accommodate the number of staff working in it, and allow
them to carry on their work without risk of getting in one another’s way or of mixing up different
materials. Each operator should have a workstation sufficiently large to enable him/her to carry
out the operation efficiently. To reduce the chance of mix-up of materials or of cross-
contamination, there should also be a degree of physical separation between the workstations
The pharmacy is a sensitive area, and access to such facilities should be restricted so as to limit
the possible contamination of one study or compound by another.

Construction
The zone must be built of materials that allow easy cleaning and that are not likely to allow test
materials to accumulate and contaminate one another. There should be a ventilation system that
provides air-flow away from the operator through filters which both protect personnel and
prevent cross-contamination.

Arrangement
There should be separate areas for:
• Storage of test items under different conditions.
• Storage of control items.
• Handling of volatile materials.
• Weighing.
• Mixing of different dose formulations, e.g. in the diet or as solutions or suspensions.
• Storage of prepared dose formulations.
• Cleaning equipment.
• Offices and refreshment rooms.
• Changing rooms.
Animal facility
The facility should be designed and operated in order to minimise the effects of environmental
variables on the animal. Consideration should also be given to measures which prevent the
animal from coming into contact with disease, or with a test item other than the one under
investigation.

The building and its rooms should provide enough space for animals and studies to be separated
and to allow the operators to work efficiently.
The environment and control system should maintain the temperature, humidity and airflow at
the defined levels depending on the species concerned.
The surfaces of walls, doors, floors and ceilings should be constructed to allow for easy and
complete cleaning, and there should be no gaps or ledges where dirt and dust can build up, or
where water will collect, for instance on uneven floors.

Equipment
For the proper conduct of the study, appropriate equipment of adequate capacity must be
available. All equipment should be suitable for its intended use, and it should be properly
calibrated and maintained to ensure reliable and accurate performance. Records of repairs and
routine maintenance and of any non-routine work should be retained.

Suitability can only be assessed by considering the tasks that the equipment is expected to
perform: there is no need to have a balance capable of weighing to decimals of a milligram to
obtain the weekly weight of a rat, but a balance of this precision may well be required in the
analytical laboratory

All equipment, whether it is used to generate data (e.g. analytical equipment or balances), or to
maintain standard conditions (e.g. refrigerators or air conditioning equipment), should work to
fixed specifications. Proof that specifications are being met will generally be furnished by
periodic checking.

The requirement that equipment be properly maintained is based on the assertion that this
ensures the constant performance of equipment to specifications and that it reduces the
likelihood of an unexpected breakdown and consequent loss of data.

Maintenance may be carried out in two quite distinct ways:

 Preventive maintenance; when parts are changed regularly based upon the expected life
of the part concerned.
 Curative maintenance; when repairs are made in the case of a fault being detected.

Routine maintenance should be documented in such a way that users of equipment can be
assured that it is reliable. Records of equipment calibration, checking and maintenance
demonstrate that the respective SOPs have been followed and that equipment used was adequate
for the task and operating within its specifications.

Classification of laboratory equipment

Classifications of Laboratory Apparatus

Glassware
Disposable Lab Ware – Test tubes, culture tubes and tissue culture flasks
Storage facilities – Most labs have a variety of cooling equipment, including a refrigerator, a
freezer at around -20 degrees Celsius, a second deep freezer set at around -80 degrees Celsius,
and a liquid nitrogen tank that keeps cells frozen at -196 degrees Celsius.
Experimental Apparatus – PCR Machine, which replicates and amplifies DNA so that scientists
can study it more easily. Chemistry labs are more likely to own equipment like chemical fume
hoods, which are large ventilated boxes that chemists use to protect themselves from explosive
and toxic chemicals.
Analytical Apparatus – Spectrophotometers to determine the concentrations of DNA that they
have in order to sequence it. Scales so that they can weigh out their products

Classification according to application

[Link] category

Mostly are glass chemical laboratory instruments which used for measuring quality, volume,
temperature and density, including burette, thermometer, transfer pipette, measuring cylinder,
measuring glass and so on.

[Link] category

Chemical laboratory instruments which is used for chemical reaction, mostly are glassware or
porcelain equipment, including test tube, flask, evaporating dish, crucible , etc.

[Link] category

Chemical reagent bottle used for holding or keeping solid, liquid, gas chemical reagent.

[Link] category
The chemical laboratory instruments which is used for filtration, skimming, extraction,
evaporation, firing, crystallization and fractional distilation, including funnel, evaporating dish,
flask, condenser, beaker and so on.

[Link] clamping category

Used for fixing and clamping various chemical laboratory instruments, including iron clamp,
iron ring, iron stand and funnel stand.

[Link] category

It mainly includes test tube, flask, beaker, evaporating dish and crucible.

[Link] category

For example, glass tube, glass valve, rubber tube and rubber plug which are used for assemble
and chemical laboratory instruments connection

Injuries and their treatment

Shock

Shock (not to be confused with emotional shock) is a life-threatening condition which happens
when the body isn’t getting enough flow of blood.

This means that the cells don’t get enough oxygen to enable them to work properly, which can
lead to damage of the vital organs like the brain and the heart.

Shock can be caused by anything that reduces the flow of blood, including:

• heart problems, such as a heart attack, or heart failure

• severe internal or external bleeding

• loss of body fluids, from dehydration, diarrhoea, vomiting or burns

• severe allergic reactions and severe infection

If you think somebody could be suffering from shock, there are seven key things to look for:

1. Paleness of the face (pallor)

2. Cold, clammy skin
3. Fast, shallow breathing
4. Fast, weak pulse
5. Yawning or sighing
6. Confusion
7. Loss of response (in extreme cases)

If they are showing signs of shock:

• Lay them down with their head low and legs raised and supported, to increase the flow of blood
to their head. Do not raise an injured leg.

• Call for medical help and say you think they are in shock, and explain what you think caused it
(such as bleeding or a heart attack).

• Loosen any tight clothing around the neck, chest and waist to make sure it doesn’t constrict
their blood flow

• Fear and pain can make shock worse, by increasing the body’s demand for oxygen, so while
you wait for help to arrive, it’s important to keep them comfortable, warm and calm. Do this by
covering them with a coat or blanket and comforting and reassuring them

• Keep checking their breathing, pulse and level of response.

• If they become unresponsive at any point, open their airway, check their breathing, and prepare
to treat someone who has become unresponsive.

Burns and scalds

Burns and scalds are damage to the skin caused by heat. A burn is usually caused by dry heat,
like fire, a hot iron, or the sun. A scald is caused by wet heat, like steam or a hot cup of tea.

You need to be extra careful when treating burns. The longer the burning goes on, the more
severe the injury will be, and the longer it may take to heal. So you need to cool the burn as soon
as possible.

If someone has a severe burn or scald they are likely to suffer from shock, because of the fluid
loss, so they will need urgent hospital treatment.

If you think someone has a burn or scald, there are five key things to look for:

1. Red skin
2. Swelling
 3. Blisters may form on the skin later on
4. The skin may peel
5. The skin may be white or scorched

Stop the burning getting any worse, by moving the casualty away from the source of heat.

Start cooling the burn as quickly as possible. Run it under cool water for at least ten minutes or
until the pain feels better. (Don’t use ice, creams or gels – they can damage tissues and increase
risk of infection).

Assess how bad the burn is. It is serious if it is:

• larger than the size of the casualty's hand

• on the face, hands or feet, or

• a deep burn

If it is serious, call 999 or 112 for emergency medical help.

Remove any jewellery or clothing near the burn (unless it is stuck to it).

Cover the burned area with kitchen cling film or another clean, non-fluffy material, like a clean
plastic bag. This will protect from infection.

Bleeding

You can usually control bleeding from cuts and grazes by elevating the wound and applying
pressure.

A nose bleed can be serious if someone loses a lot of blood – and severe bleeding can cause
distress, lead to shock and loss of responsiveness

Cuts and grazes

Cuts and grazes are common injuries that can usually be treated at home. A cut is when the skin
is fully broken, and a graze is when only the top layers of skin are scraped off.

Clean the wound by rinsing it under running water or using alcohol-free wipes.

Pat it dry using a gauze swab and cover it with sterile gauze
Raise and support the part of the body that’s injured. If it’s a hand or arm, raise it above the head.
If it’s a lower limb, lay them down and raise the cut area above the level of the heart. This will
help stop the bleeding.

Remove the gauze covering the wound and apply a sterile dressing.

Nose bleeds
A nose bleed is when blood flows from one or both nostrils. It’s normally caused by the tiny
blood vessels inside the nostrils being ruptured.

If someone is having a nose bleed, your priority is to control the bleeding and keep their airway
open.

Get them to sit down (not lie down) as keeping the nose above the heart will reduce bleeding.

Get them to lean forward (not backwards), to make sure the blood drains out through their nose,
rather than down their throat which could block their airway.

Ask them to breathe through their mouth and pinch the soft part of the nose, taking a brief pause
every ten minutes, until the bleeding stops.

Encourage them not to speak, swallow, cough, spit or sniff because this may break blood clots
that may have started to form in the nose.

Severe Bleeding

When bleeding is severe, it can be dramatic and distressing. If someone’s bleeding isn’t
controlled quickly, they may lose a lot of blood, become unresponsive or develop shock.

Your priority is to stop the bleeding. Protect yourself by wearing gloves.

If the wound is covered by the casualty's clothing, remove or cut the clothes to uncover the
wound.

If there's an object in the wound

If there’s an object in there, don’t pull it out, because it may be acting as a plug to reduce the
bleeding. Instead, leave it in and apply pressure either side of it with a pad (such as a clean cloth)
or fingers, until a sterile dressing is available.

If there's no object in the wound

Follow the steps below for treating severe bleeding.

1. Press it: apply direct pressure to the wound

2. Call 999/112 for emergency help

3. Firmly secure dressing with a bandage

4. Treat for shock

5. Support the injured part

Poisoning

A poison is any substance that is harmful to your body. You might swallow it, inhale it, inject it,
or absorb it through your skin. Any substance can be poisonous if too much is taken.

Types of poisoning

Alcohol poisoning – Can happen when someone has drunk an excessive amount

Drug poisoning – Caused by an overdose of prescription or illegal drugs

Food poisoning – Caused by eating contaminated food

Carbon Monoxide poisoning - Caused by inhalation of this deadly gas.

Swallowed poisons – When someone ingests poisonous substances, such as: chemicals, drugs,
plants, fungi or berries.

Alcohol poisoning

If you think someone may have alcohol poisoning, these are the key things to look for:

 • a strong smell of alcohol and you may see empty bottles or cans
 • confusion and slurred speech
 • vomiting
 • reddened and moist face
 • deep, noisy breathing
 • a strong, pounding pulse
 • unresponsiveness

• Reassure them and cover them with a coat or blanket to keep them warm.

• Check them over for any injuries, especially head injuries, or any other medical conditions.

• If they are breathing normally but are not fully responsive, place them into the recovery
position.

• Keep checking their breathing, level of response and pulse.

If you’re unsure about how serious their condition is then call for medical help.

Drug poisoning

Poisons are substances that can cause temporary or permanent damage if too much is absorbed
by the body. Poisons can be swallowed, inhaled, injected or absorbed through the skin.

Someone can get drug poisoning from taking an overdose of prescribed drugs, over the counter
drugs, or illegal drugs.

But the effects will be different depending on the type of drug and how the person has taken it,
such as by swallowing, inhaling or injecting.

If you think someone may have drug poisoning, these are 10 common things to look for:

1. 1. Stomach pain, nausea and vomiting

2. 2. Sleepiness leading to unresponsiveness
3. 3. Confusion and deliriousness
4. 4. Excitable hyperactive behaviour
5. 5. Sweating
6. 6. Shaking hands
7. 7. Hallucinations ‒ they may claim to 'hear voices' or 'see things'
8. 8. Unusually slow or fast pulse
9. 9. Unusually small or large pupils
10. 10. Needle marks which may be infected

Call for medical help.

• If they’re responsive, help them into a comfortable position and ask them what they’ve taken.

• Gather as much information as you can. While you wait for help to arrive, look for any
packaging or containers that will help identify the drugs.

• Keep checking their breathing, pulse and level of response.

• If they lose responsiveness at any point, open their airway, check their breathing and prepare to
treat someone who’s become unresponsive.

Food poisoning

Food poisoning is caused by eating contaminated food. In most cases the food hasn’t been
cooked properly and is contaminated by bacteria such as salmonella or Escherichia coli (E. coli),
which are found mainly in meat.
If you think someone may have food poisoning, these are the five key things to look for:

1. Feeling sick
2. Vomiting, sometimes bloodstained
3. Stomach cramps
4. Diarrhoea
5. Headache or fever

Tell the person to lie down and rest.

• Give them plenty of water and a bowl to use in case they are sick.

• Encourage them to drink as much water as they can, even if they can only manage regular small
sips. If they have diarrhoea, it’s even more important that they drink water to replace lost fluids.

• Giving them an oral rehydration solution is good to way to replace fluids lost through diarrhoea
and vomiting. This solution can replace salt and other minerals which they have lost. You can
buy it in a pharmacy as a sachet which you dissolve in water.

• If the person gets worse, then advise them to call their doctor

Swallowed poisons

Poisons are substances that can cause temporary or permanent damage if too much is absorbed
by the body. Poisons can be swallowed, inhaled, injected or absorbed through the skin.

Swallowed poisons include chemicals, drugs, plants, fungi and berries. Dangerous chemicals
include household products like bleach, which can poison or burn the body if swallowed.

Poisonous plants include foxgloves, wild arum and certain types of mushroom

If you think someone may have swallowed poison, these are the five key things to look for:

1. Nausea and vomiting (sometimes blood-stained)

2. Cramping stomach pains
3. A burning sensation
4. Partial loss of responsiveness
5. Seizures

If the person is conscious, ask them what they have swallowed, how much and when. Look for
clues, like plants, berries or empty packaging and containers.

• Call 999 or 112 for medical help and tell them as much information as possible.
• Keep checking their breathing, pulse and level of response.

• If they become unresponsive, open their airway and check breathing

Pharmacy design
Layout – An arrangement or a plan, especially the schematic arrangement of parts or areas.
 Importance  It plays significant role in the development of the customers’ perception which
have a positive impact on its sale potential.
Objective of layout design
• To attract a large number of customer
• To increase the sale and decrease the selling expenses
• To have space for reserve for stock, office and resting place for the employees
• Proper entrance for goods
• To minimize the movement of customers with within the premises of the drug store
Types of layout design
1. Self-selection
• Consumer may see handle and select items
• Used For nutritional supplements cosmetic, contraceptive, OTC drugs
2. Self service
• Minimum Clerk service
• Maximum exposure of product to customers
3. Clerk Or personal Service
• Exposure of product is less
• Used for Prescribed drugs
• Maximum interaction between consumer and the pharmacy personnel

Style of layout designs

Grid Layout – Products are displayed in straight and parallel lines
Free Flow layout – Fixture are irregularly shaped such as circles arches and triangle
Grid Layout Advantages
 More Product Exposure
 Possibility of self service
 Familiarity with product that can be needed in future
 Simplified,
 Security – Minimum pilferage (petty theft)
 Maximum utilization of available space
Free Flow Layout Advantages
 Allowance for browsing and wandering freely
 Increased impulse purchases
 Visual appeal and Flexibility
Disadvantages
 Loitering encouraged
 Possible confusion
 Waste of floor space and Costly

List of minimum requirements for a pharmacy:

Premises: The word Pharmacy shall be displayed in writing sign board having minimum length
of 5 feet and width of 2.5 feet.  The premises of a pharmacy shall be separated from room for
private use  The premises shall be built dry, well lit and ventilated and shall be of sufficient
dimensions to allow the goods in stock, especially drugs and poisons to be kept in a clearly
visible and appropriate manner.  The area of the section to be used at dispensing department
should not be less than shall not be less than 6 sq meters for each additional person.  The height
of the premises shall at least be 2.5 sq Meters.  The floor of the pharmacy should be smooth
and washable  The walls shall be plastered or tiled or oil painted so as to maintain smooth,
durable and washable surface devoid of holes, cracks and cervices.  The dispensing department
shall be separated by a barrier to prevent the entry of the public.

Assignment: draw a plan of a community pharmacy showing all necessary areas (POM
dispensary, wiating area, washroom, wash basin, shelves and counters for all other
medicines)
ENVIRONMENTAL ISSUES AND PREVENTIVE HEALTH CARE
Pharmaceutical Waste and waste disposal:
Pharmaceutical waste is any waste which contains medicinal drugs that are expired, unused,
contaminated damaged or no long needed.

Different Types of Pharmaceutical Waste

Over-the-counter drug waste

Over-the-counter medications, like those which alleviate headaches, allergies, colds and acid
reflux, can be purchased without a prescription. However, you still need to handle them properly,
as they can contaminate water when dropped down a toilet or sink. When placed in the trash,
they can contaminate landfills and runoff. Even over-the-counter drugs can cause illness or
injury when misused by children and adults.

Non-controlled/non-hazardous prescription drug waste

Non-controlled/non-hazardous prescription medications include those used to treat high blood

pressure, diabetes and bacterial infections. These can be dangerous if taken by those who do not
clinically need them. In some states, it’s against regulations for providers to place these into the
trash. These drugs can be sent for disposal in a medical waste incinerator.

Controlled drug waste

Controlled drug waste is any waste classified by the DEA as something that requires control
because it is highly addictive, regularly abused or toxic when accidentally taken in high doses.
This waste is usually made up of prescription/pharmaceutical drugs. Controlled substances need
to be disposed of properly to meet DEA requirements. They are collected in a satellite container
on site, consolidated, audited, packed, transported and then treated and disposed of by a
regulated substance disposal company, like Universal Waste Management.

Hazardous drug waste

Hazardous drug waste is any waste that has potential to cause death or serious illness or a waste
that poses a significant hazard to human health or the environment when improperly treated,
stored, transported or disposed of. These drugs are highly regulated if you’re a provider and must
be disposed of as hazardous waste. Consumers can dispose of these drugs, along with their over-
the-counter, prescription and non-controlled drugs in a DEA-compliant envelope or collection
receptacle.

Disposal methods
Expired pharmaceuticals and other substandard pharmaceutical products present a serious threat
to public health and to the environment. Their elimination from the public and subsequent
disposal is mandate of ensuring that only safe, efficacious and quality drugs are availed to the
entire population

1. Return to donor or manufacturer

Wherever practical the possibility of returning unusable drugs for safe disposal by the
manufacturer should be explored; particularly drugs which present disposal problems, such as
antineoplastics. For unwanted, unrequested donations, especially those that arrive past or
unreasonably near their expiry date it may be possible to return them to the donor for disposal.

2. Landfill
To landfill means to place waste directly into a land disposal site without prior treatment or
preparation. Landfill is the oldest and the most widely practiced method of disposing of solid .

3. Waste immobilization: encapsulation

Encapsulation involves immobilizing the pharmaceuticals in a solid block within a plastic or
steel drum. Drums should be cleaned prior toand should not have contained explosive or
hazardous materials previously. They are filled to 75% capacity with solid and semi-solid
pharmaceuticals, and the remaining space is filled by pouring in a medium such as cement or
cement/lime mixture, plastic foam or bituminous sand.
The sealed drums should be placed at the base of a landfill and covered with fresh municipal
solid waste.

4. Waste immobilization: inertization

Inertization is a variant of encapsulation and involves removing the packaging materials, paper,
cardboard and plastic, from the pharmaceuticals. Pills need to be removed from their blister
packs. The pharmaceuticals are then ground and a mix of water, cement and lime added to form
a homogenous paste. Worker protection in the form of protective clothing and masks is required
as there may be a dust hazard. The paste is then transported in the liquid state by concrete mixer
truck to a landfill and decanted into the normal urban waste.

5. Sewer
Some liquid pharmaceuticals, e.g. syrups and intravenous (IV) fluids, can be diluted with water
and flushed into the sewers in small quantities over a period of time without serious public health
or environmental affect. Fast flowing watercourses may likewise be used to flush small
quantities of well-diluted liquid pharmaceuticals or antiseptics.
 6. Burning in open containers
Pharmaceuticals should not be destroyed by burning at low temperature in open containers, as
toxic pollutants may be released into the air. Paper and cardboard packaging, if they are not to be
recycled, may be burnt. Polyvinyl chloride (PVC) plastic however must not be burnt.
While burning pharmaceutical waste is not advocated as a method of disposal, it is recognized
that it is not infrequently used. It is strongly recommended that only very small quantities of
waste pharmaceuticals be disposed of in this way
7. Medium temperature incineration (less than 850 °C)
Many older municipal solid waste incinerators are medium temperature incinerators and the use
of these facilities is encouraged as an interim measure, rather than less safe options, such as
inadequate discharge to a landfill. In this case, it is recommended that the pharmaceutical waste
is diluted with large quantities of municipal waste (approximately
1:1000).

8. Novel high temperature incineration

These are furnaces that operate at temperatures well in excess of 850°C, have long combustion
retention times and disperse exhaust gases via tall chimneys, often to high altitudes.
Usually, cement kilns are used. Pharmaceuticals should be introduced into the furnace as a
reasonably small proportion of the total fuel feed. It is suggested that as a sensible "rule of
thumb" no more than 5% of the fuel fed into the furnace at any one time is pharmaceutical
material. Cement kilns typically produce 1,500 to 8,000 metric tons of cement per day and
therefore quite large quantities of pharmaceutical material can be disposed of in a short period. It
may be necessary to remove packaging and/or to grind the pharmaceuticals to avoid clogging
and blockage of the fuel feed mechanisms