heedm,
i've meant you have partial right with the fixed line disadvantages.
"The patient is exposed to the environment beneath the helicopter far too long. Hypothermia, shock, fear, treatment delays are just some of the patient concerns. Danger for those on the line and for those in the helicopter is increased (not as likely to pickle a live load). Since the load must be relocated by moving the helicopter, a guide line is not possible thereby increasing danger of swing, spin, instability, etc. "
On a bigger helicopter like a seaking the patient could be initially transported inside the helo. Absolute clear this means some advantages. Your are also on the right side with load swinging.
It's easier to prevent on hoist ops. On fixed line you have to move the whole helo+fixed line+rescuer system. Need's much more skills. That's what i wanted to discuss, no questions, hoist ops if possible is the better way. But for operators using smaller helicopters on a multirole fixed line ops could be an interesting variant. On a car crash site in urban area or a home visit after a heart attack the BK's or BO's or ... are the winners compared to the "bigs".
We use BK 117 B2 and hoping on a PA max. 4000 ft, 3-4 man crew + patient, in case of an engine failure the OEI limits should be great enough to save the inside and outside crew. The BO counts for a single engine helo. Mostly used for training purposes. In europe we have some operators using the fixed line on smaller helos like A 109 K2, EC 135, AS 350/355, BO's and BK's. Especially in Austria, Switzerland and Germany. They all together have made thousands of fixed line rescues.