As this source states:
...since an operator doesn’t get paid unless the helicopter carries a patient, there’s an incentive to fly the mission regardless of how adverse the conditions. And because operators are paid the same rate no matter what equipment they use, operators tend to use older helicopters, and to run them as inexpensively and as ill-equipped as possible.
The EMS Helicopter Industry's Business Model Leads to Unnecessary Crashes : Aviation Law Monitor
More on "Golden Hour" and Other Myths from the EMS Helicopter Industry explains:
The industry has oversold the need for EMS helicopters. The benefits simply do not outweigh the risks.
"Golden Hour" and Other Myths from the EMS Helicopter Industry : Aviation Law Monitor