My bad for not differentiating between 109a and 109e! I've only got to demo the E and not work the machine. I still say that the gold standard is medical attendant seated at the head. If you are working a multi-mission helicopter then you have many other things to consider, but for a pure EMS machine I think you will find little argument about seating arrangements. We had a seat in the BO-105 that crew could sit forward on the way to the call and then sit aft at the patients head during transport. I think it was made by Bucher, but it has been a while (note the name Xems!) In the 222 the seat could reverse. It all depends upon what the crew input is. Biggest mistake I have ever seen in EMS was having the aviation side of the house outfit the aircraft without any input from the medical side. Talk about some infighting! Anyway, I say as long as the crew is happy with the configuraiton, you will be just fine.