Complexity is relative to task saturation, which is relative to a whole load of preceding variables. Any flying machine can be considered complex when it gets ahead of the pilot/operator.
The answers to all that's been brought up here starts at the top of each operator, the industry and respective governments involved.
Without reasonable leadership closely tied to making decisions relative to real field operational requirements progress in HEMS is going to be slow indeed. Needless to say from my point of view we have a leadership problem in the HEMS industry.