Seasons Greeting Geoff
Having spent the last few years, since the introduction of JAR-OPS, trying to convince old and bold HEMS pilots that the redundant concept of primary, secondary and tertiary missions as per the initial days of UK air ambulance is now redundant, it is painful to find the terms being quoted on here.
I am aware of your background and suspect you are fully aware of the changes but, since it was not that long ago that crews were refusing to take patients in the helicopter because road ambulances had been used to move patients to un-surveyed landing sites (and therefore it had become a 'secondary mission'), I would just like to reiterate that it is the condition of the patient, as judged by the medical system, that defines the HEMS criteria and not the location, i.e. the same exemptions can be utilised (with some limitations) whether the patient is being transferred from hospital to hospital or HEMS site to hospital.
Happy New Year
TeeS