This in refernce to VFR Only HELI OPS
which applies to 90 % of USA EMS OPS. Not IFR Cert OPS. Just VFR Only 135 Heli with Pilot practicing IIMC procedures. Pilots here flying VFR Only EMS Heli part 135 have a IFR Rating but 99 % are not current and are not required to be current, as they are not flying IFR. As part of the 135 check or recurrency pilots are req to show proficiency flying under simulated conditions, able to recover IIMC etc and shoot best avail approach or vectors etc.
Most managers tell pilots its ok to do a practice approach on the back end of a patient flt (RTB Return to base ) to help them stay proficient , thinking it is ok to use medics as safety observers..
And a lot of pilots do it thinking it is ok to do so..when it is a faa violation.