I myself do not see a problem with hot-loading or un-loading or patients or survivors if you have sufficient crew guards in place. On some rare occasions (medical considerations), the doctor or paramedic will ask not to shutdown. I have done this for many years using AS350, BO105, BK117 and Bell 412 with no dramas.
The biggest problem is that, for some reason, people seem to think that they have to rush around when the engines are running. No matter how much you ask/tell people to slow down, they still insist on running around.
