Jim Doherty on AMBUstat™

AMBUstat was developed in response to the Ebola outbreak.  I was frustrated watching CNN and seeing ambulances wrapped in plastic.  There was even talk about having them incinerated, which was insane to me.  If it indeed had turned out to be a pandemic, we would have run out of ambulances.

I challenged my colleague, Jason, that we needed to start investigating decontamination on a scale suitable for ambulances. We quickly learned that the industry was in serious need of education, as most first responders were unable to explain to us how to properly clean and disinfect an ambulance. At that point, we realized that we would need a program to solve the problem, as no device would be capable of solving it alone.

The problem is serious and people are becoming ill, and even dying, because of it. However, we know that there is no excuse for this and we spend our waking hours (and even in our dreams) considering ways to continue simplifying the program to ensure that it is successful, as, again, there is really no excuse for not having a decontaminated space. As for dangers to first responders, just as these pathogens are harmful to our patients and clients, careers and lives have come to an end for many first responders, simply due to a lack of awareness and/or a lack of attention to the issue.

Now that the Ebola scare has seemed to slow down, there is still a critical need for AMBUstat.  After doing extensive research in infectious disease transmission we quickly realized that even though Ebola is a scary dangerous pathogen, our ambulances were grossly contaminated with such organisms as MRSA, e-coli, norovirus, influenza and, probably most importantly, c-diff.  As a long time EMS provider myself, we were never really trained to understand the transmission of these pathogens, let alone how to properly clean and decontaminate our rigs and equipment.  Again, we appreciate the attention devoted to Ebola, but, to be quite honest, it is the least of our worries, as the pathogens that pose a realistic risk to us are around us every single day and they are not going away.

The AMBUstat starter kit includes our fogging system, test strips, a spray nozzle and a case of Actril cold sterilant.  The sterilant solution is comprised of 1% hydrogen peroxide and .08% peracetic acid, which oxidizes the outer cell membranes of microorganisms.  The oxidation mechanism consists of electron transfer and, when a stronger oxidant, like peracetic acid, is used, the electrons are transferred to the microorganism much faster, causing the microorganism to be deactivated rapidly.

Peracetic acid can be applied for the deactivation of a large variety of pathogenic microorganisms, as well as viruses and spores. Peracetic Acid has greater reactivity and lipid-penetrating properties than just hydrogen peroxide alone, thus penetrating into organic matter easier and faster.  Peracetic acid exhibits a higher oxidation potential than chlorine or chlorine dioxide, and faster degrading residuals with fewer by-products than most biocides – all of which make peracetic acid increasingly useful in today’s environmental climate.

Prior to deploying the atomized cold sterilant, the test strips are placed around the space to be treated and we use them to confirm adequate distribution of the cold sterilant.  As for measuring the surfaces for pathogens, we rely on adenosine triphosphate, or ATP, to tell a story about surface conditions. ATP is known as the energy currency and it resides wherever living things are, including pathogenic microorganisms.

We use technology that detects the presence of ATP and translates that detection into a score that we use to determine the effectiveness of our cleaning and disinfection procedures.  Essentially, the score is 1,000 prior to cleaning and disinfecting, and it is reduced to zero, after cleaning and disinfecting, so we can assume that there has been a significant reduction in pathogens on the tested surfaces.  Unfortunately, considering budget constraints, it is difficult to get this technology into the hands of our customers, so we must train them to assume that the worst conditions exist and manage the situation accordingly – thoroughly cleaning and disinfecting all surfaces above, around and below us.

Before using AMBUstat, we would suggest getting back to simple soap and water to remove any gross contamination.  After the cleaning has been accomplished we would place our cold, dry fogger in the patient compartment, close the vehicles doors, activate the fogger by remote control and treat the space for approximately ten minutes.  The particle size of the fog is so minute, less than seven and one-half microns, it will penetrate even a closed cabinet.

The solution itself is 1% hydrogen peroxide and .08% peracetic acid.  It is so effective we can achieve up to a six log reduction.  What that means to the EMS provider is that we kill 99.999% of all organisms that may do harm to us or our patients. As for how the solution effects surface and electronics, as long as it is used in accordance with our instructions, it poses no known threats outside of what should be expected from normal contact with normal oxidizing elements.

There are so many products competing for attention in the market, ranging from sprays and bombs to ultraviolet lights and other fogging solutions. In a nutshell, we believe that AMBUstat is the best option, as it is consistent, affordable, scalable, safe and eco-conscious.  Most importantly, an investment in AMBUstat provides you with access to knowledge and experience that will be there to ensure your success. 

As long as the AMBUstat program is employed as instructed, it poses no known harm and the program was designed with eco-consciousness.  Peracetic acid breaks down very quickly, disintegrating to hydrogen peroxide and acetic acid, which will fall apart to water, oxygen and carbon dioxide.

We’ve been asked by many first responders about starting a side business with AMBUstat, and yes, one could certainly utilize the AMBUstat program to generate additional income.  One way would be to use the program as a foundation to provide a service to public health and public safety agencies.  There are many agencies who would consider outsourcing the cleaning and disinfection responsibilities to a vendor.  However, we do have concerns about this, as we worry that the agencies will become dependent upon the vendor for this service and neglect the cleaning and disinfection needs that must be addressed between the vendor’s visits, unless the agency and vendor can reach an agreement that has the vendor responding to the agency after every patient/client encounter.

We are very skeptical that an agreement like that could ever be reached, as it would be burdensome, taxing manpower and financial resources. The ideal arrangement would be a hybrid that has the staff cleaning and disinfecting after every patient/client encounter and the vendor providing a deep cleaning and disinfection either once a day or once a week, depending on the frequency of patient/client encounters, demographics and the current state of infectious disease within the community (i.e., flu season, epidemic/pandemic threat). Either way, unless the staff is groomed to independent and accountable, they will not take ownership and the problem will not be resolved.

We are advocating strongly for the adoption of turnaround technicians (TATs) who are dedicated to the issue. In most agencies, the TATs will be drivers since a very large majority of the agencies will not be able to have a member/employee solely dedicated to that task.  An opportunity like I outlined could lead to great win-win scenarios for everyone involved.

Our website will offer an opportunity for you to Contact Us directly for more information to that regard or you can contact Jason at 330-552-2560.


-Jim Doherty

About the Author

Jim has a long-standing history, of 30 years, designing, developing and manufacturing emergency medical equipment. As a co-founder of Emergency Products & Research, Jim decided to find a solution for hospital-acquired infections (HAIs) plaguing our healthcare system.


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