Crab
Most HEMS pilots in the UK are ex-military, and therefore qualified to comment on the differences beyween civil and military aviation. HEMS approaches into genuinely restricted sites, urban areas etc, will always be conducted on the basis of risk versus need - its when the pilot earns his money, and is the reason behind the experience requirements for recruitment in the first place.
The majority of incidents, however, do not need a high risk approach, and, following a site recce, often can be accessed via a conventional approach into a small field or other suitable area close to the incident.
AssumIng this field doesn't stretch to 300 metres or so, this "conventional" approach is llkely to take the form of the "slow and steep" variety referred to. The EC135, for has 3 such "VTOL" profiles, all of which comply with Class 1 performance requirements. The same criteria can then be applied to the subsequent departure.
Yes, HEMS operations can be risky, but why make it riskier than necessary?