Tecpilot,
The Authority is empowered to decide which operation is a HEMS operation in the sense of this Appendix.
I've no wish to hijack this thread but I think that the intent of the quoted remark needs to be clarified.
The first published version of JAR-OPS 3 had definitions of HEMS and SAR inside the Appendix; as SAR is not regulated under JAR-OPS 3 and as the clause was being used to subvert the intent of the Appendix, it was removed and replaced with the referenced text.
However, in view of an apparent misunderstanding of the scope of HEMS in some States (including Germany) a comprehensive ACJ was written and put into Section 2 of the JAR; this ACJ explained in fine detail the distinction between air ambulance operations, HEMS operations and SAR - principally that air ambulance
could be conducted to the main body of JAR-OPS 3 (without the requirement for a HEMS approval), HEMS was to be conducted to the main body as varied by the Appendix and that SAR was under control of the State (whatever their rules may be - somewhat similar to public aircraft in the US). Inter-hospital flights can in no way be regarded as SAR and therefore fall within the scope of JAR-OPS 3 and, depending on the urgency, might take advantage of the alleviation of HEMS (for performance or in-flight conditions).
Contrary to the common (mis)understanding, HEMS operations can be conducted by helicopters operating in Performance Class 3 (single engine operations) - as specified in Appendix 1 to JAR-OPS 3.005(d) paragraph (c)(1); providing they are conducted over a non-hostile environment. However, CAT/HEMS flight at night is prohibited for helicopters operating in PC3 in accordance with JAR-OPS 3.540(a)(6). States manoeuvre their way round this by permitting PC3 at night when there is no carriage of passengers (for example when repositioning) - providing it is permitted in accordance with non-CAT regulations.
Because we do not know the circumstances of the flight, we should not presume that it was conducted outside the regulation (although it does appear that the Lände have discretion to exempt from regulations). I suppose that we can assume that these HEMS operations in PC3 are conducted in the former Eastern part of Germany.
Jim