Simple, in my province.
Twin engines, two pilots, single (single payer insurance) dispatcher (including fixed wing) source which filters the requests and pays the bill - no shopping
aspinwing, just how its done in my neck of the woods in Auz, except single pilot Bell 412. Crews tell dispatch after consulting weather what they are capable of doing so there is then no fecking about getting the correct resources to the task eg ground ambulance if flying is out. No going to have a look see, finding you can't do the job and then having to resort to alternatives, not doing justice to the patient by delaying aid, or killing them in the process as seems to be the US want in its competitive drive to turn a buck.