Geoff/Crab: While interesting, I'm not sure that is relevant to the average low spec US HEMS helicopter with minimal flight simulation available either.
Not all helicopter operations in the US are 'low spec', at least in the case of larger operators. AMC operates 100+ 135/145's alone, in addition to other twins. That is certainly more than some countries entire EMS fleet combined. Simulator training is in place on the EC135, and recognizing the benefit of simulator training they had introduced a full motion simulator for singles (unfortunately the OEM was poor). AMC has also purchased 4 full motion Level 'D' simulators for singles and twins to be introduced shortly, with annual training in the sim for all pilots. 3 static 160º view procedural training devices have been in place for a long while further supplementing training on a biannual basis.
It's not all 'low spec' or devoid of training.