Spinoff is NASA's annual publication featuring successfully commercialized NASA technology. This commercialization has contributed to the development of products and services in the fields of health and medicine, consumer goods, transportation, public safety, computer technology, and environmental resources.

EP+R consulted with NASA to determine the best way to deliver atomic oxygen in a device to sterilize ambulance interiors. This small, inexpensive device creates a mist that can kill close to 99 percent of microorganisms in less than an hour.

When paramedics come to a home, the last thing anyone worries about is where the ambulance was earlier that day. But traces of earlier calls could be lingering on the equipment, bags, or even the uniforms the EMTs are wearing, and they could be spreading disease. A product designed with NASA's help aims to sterilize the rig and gear to make it safer for the patients and the paramedics.

The product uses atomic oxygen and oxidation — two things NASA is familiar with, explained Sharon Miller. “I work in space environment testing at Glenn Research Center, and primarily what I do is look at how materials on spacecraft react when they're in the environment of upper atmospheres of planetary bodies and in space.”

In stable form, oxygen is made up of two oxygen atoms bonded together as a pair. In contrast, atomic oxygen is a single O atom, which means it is not stable and wants to react with anything that it comes in contact with to make a stable chemical compound. The destructive properties of atomic oxygen can be harnessed for a very positive outcome: sterilization. “Atomic oxygen removes any hydrocarbon from a surface,” Miller explained.

Jason Thompson started working as a paramedic more than 20 years ago, but he didn't start thinking about disinfecting ambulances until 2014. Like every EMT, he knew and followed precautions that include washing his hands and wearing gloves. But there was no protocol for cleaning the ambulance or medical equipment after a call. In 2014, the Ebola epidemic was at its height, and medical personnel were among the most vulnerable to infection, bringing the question of infectious disease exposure to the forefront.

Thompson, who by then was working for Emergency Products + Research (EP+R, Kent, OH), said he and his colleagues realized that Ebola was only the tip of the iceberg, and they concluded that there needed to be a fast and inexpensive way to sterilize an ambulance and everything in it. EP+R wanted something that was inexpensive, fast, and left no residue since wiping takes extra time and, if an unsterile cloth is used, could risk recontaminating the entire surface. By 2015, EP+R had decided on a machine that sprayed out the sterilizing chemical in a mist or fog, but the team had many questions. What was the best chemical agent to use? Would the fog interfere with the electronics on the ambulance?

The same oxidation process that kills microbes also causes metal to rust. NASA helped EP+R ensure the sterilizing mist wouldn't rust or otherwise harm the ambulance engine or any of the delicate electronics onboard.

Through NASA's Regional Economic Development Program, field centers offer consultation with a NASA subject matter expert. EP+R was paired with Glenn Research Center, and their advice made all the difference. Miller said the team wasn't as far from a solution as they thought. She helped them set up a testing protocol to see what impact, if any, the sterilizing process had on the sensitive electrical equipment on the ambulance and helped them find scientific literature that would answer their questions. Among other things, Miller helped EP+R see that the electrostatic fogger they were considering was potentially a risk for the electronics on the ambulance. She provided advice that helped them to move in another direction.

Just a few months later, EP+R was delivering its first units. The product, called AMBUstat, uses a small fogger to create a mist with a solution that consists of water, peracetic acid, and hydrogen peroxide. Peracetic acid and hydrogen peroxide are both excellent disinfectants and mixed together in a solution, tend to be more stable and work at lower concentrations. The chemical reactions take just minutes, but to get a full clean, EMTs open the drawers, doors, oxygen bags, and supply bags and hang them from the horizontal rail, enabling the fog to hit everything. And if the engine and air conditioning are running, it will also clean the vents and ducts. It takes less than an hour from start to finish to destroy almost 99 percent of the organisms in that space.

Everything fits into a single backpack and costs just $2,195 for a starter set, which includes a first case of the disinfectant fluid. Refills cost around $250 per case and provide enough for 24 to 30 treatments, depending on the size of the ambulance.

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