**3. Infection risks to paramedic first responders and patients**

Previous research has detected MRSA in road-based ambulances in both metropolitan (47.6% of vehicle tests positive) [5] and rural areas (49% positive) [9]. An assortment of equipment used by emergency services crew has also shown frequent contamination [10–12]. Moreover, examination of nasal swabs demonstrated a disconcertingly raised prevalence of MRSA among paramedic first responders, 6.4%, much higher than the 1.5% MRSA colonization rate of the general public [18]. Of further concern, regarding a parallel issue of work-related stress it was reported that "paramedics ranked outbreaks of new and highly infectious disasters highest for fear and unfamiliarity" [19].

The existence of MRSA and multi-resistant *S. aureus* in emergency medical vehicles could pose a threat to the health of patients and their companions during and after the 4.4 and 32 million emergency ambulance responses each year in, respectively, Australia and the USA [20, 21], as well as to the paramedic first responders who work in these vehicles. This type and level of risk applies equally to emergency service crew in all nations worldwide. It would therefore appear that emergency medical helicopters may act as vectors of transmission of potentially deadly pathogens to the multiple thousands of patients that they transport between sites annually. By amplifying the frequency of response calls per vehicle type the implication is equally clear that road-based ambulances may spread infectious disease-causing microbes among the millions of patients that they transfer to and from hospitals each year. More broadly, inadequate infection control measures across all classes of emergency medical vehicle could exacerbate the major impact on public health of an infectious disease pandemic or bioterrorism event.

*Healthcare Access - Regional Overviews*

**76**

**Figure 3.**

**Figure 2.**

*forming units [7].*

*Number and type of bacterial colonies recovered from different internal areas of the helicopter at emergency service site A for successive microbiological sampling periods. Bacterial counts are presented as Log10 of colony-*

*Number and type of bacterial colonies recovered at each emergency service helicopter site for successive microbiological sampling periods. Bacterial counts are presented as Log10 of colony-forming units [7].*
