It looks to be a clear need for a cost vs benefit analysis. If we compare having a helicopter that flies with lower DOCs and can fly 70% of the missions to a helicopter that can fly 90% of the missions but has a cost that drives the operation out of business, the helicopter with the lower DOCs will win out every time. If sufficient funds are available in a country to pay to send out an Agusta 139 for every medevac mission then I say great, buy Agusta 139s. If the market can only support Astars or 407s then go with the Astars or 407s and send ground ambulances on missions they can't support. Having cheaper medevac helicopters available on a lower percentage of missions is far better than having no helicopters available due to their cost of operation.