Coyote- excellent post! You describe exactly how the professional pilot "approaches" such a situation (no pun intended). And you're right, it's all about priorities- don't focus or obsess on one thing to the exclusion (or detriment) of others. And I agree with you totally about the H-V curve. What I disagree with is pilots who convey the attitude that the chart may be disregarded merely because they are landing, or that it does not apply to the landing mode. To me, those are dangerous mindsets.
My experience has shown me that some low-time pilots really don't know how to make a true confined-area approach. Oh, they know the theories, and can do a passable steep approach to an airport. But ask them to go out and actually put the bird into a small site with obstacles around, maybe not great forced-landing areas on the way in *and* a crosswind to boot and...well...sometimes their improvisational skills leave something to be desired. Why? Simple lack of experience. Or maybe they get in a hurry and don't take enough time to think things through. We who do it for a living get ourselves into such situations as a matter of course, and we get proficient at them because we have to.
Like you, I would advise against an "EMS-type" of approach in which the pilot comes to a high hover with a subsequent vertical descent. If the site is *that* tight, I'd think very seriously about whether I need to be going in there (somebody would have to be bleeding). To my thinking, a constant-angle approach (even if the course over the ground varies) is much better and safer...more stable and controllable. Plus, you don't have to mess with the HOGE capabilites of your ship.
Helicopters can make very safe, very steep, very controllable approaches. They do not have to be autorotative if you keep the RoD and airspeed in check. Keep it above ETL in most helicopters and you'll be fine. The beauty of- and the problem with- flying helicopters is that when you operate off-airport there are no hard-and-fast rules. You have to make it up as you go along based on many factors (the aforementioned site size, obstacles, forced-landing areas, noise-sensitive areas, wind, load, OAT, how you're feeling that day...). You use your cumulative amassed knowledge and experience and do the best you can.