Excluding the Police.HEMS, UK HEMs is public transport carried out to JAR-OPS standards, just like air ambulance. The HEMS element is catered for with special sections with those rules. As you say, Wylie, inter-hospital transfers are possible to pre-surveyed lit sites at night. I believe the only UK operation that does this at all frequently is the Scottish setup. From what I have been told, they have an on-call pilot at night who can respond with some delay. Their situation is rather different from the rest of the UK. However, there was a suggestion that the UK was going to move to a system with fewer specialist trauma centres, rather than district A&Es. If that happened, there might be more demand for primary HEMS or inter-hosiptal transfer where the cost of the helicopter was justified by the greater distance to be travelled.