In this, they differ markedly from operations in say, Europe or Australia, where most HEMS programs are sponsored by the local administrations or survive just thanks to donations.
Also in Europe the HEMS accident rate is really shocking. It's difficult to compare direct, but it seems to me that we have nearly the same rate.
And forget your "donations" or "local sponsoring". It's a business. Also the great EMS operators like the automotive clubs or rega operating under great financial pressure. And a lot of helicopters are operated by small helicopter companies in Austria, Switzerland and Germany. Look at the last accident in germany (25.02.05) CFIT now confirmed.