'The pilot can be replaced by the ambulance driver, so get over yourself' That is completely wrong. I have more than a million accident free miles as a driver. I can drive in conditions that I wouldn't walk out to the helicopter in and I have done so. The ground truck, the ambulance can do that, too, but he doesn't have to carefully predict avoiding those conditions and a reasonable response if does encounter them is entirely different than that of an HEMS pilot. The HEMS pilot who responds in a responsible, professional manner and aborts for weather is putting the job on the line with that decision. If his decision can be documented as sound, if management doesn't have a prior grudge and if the med crew feels good about the pilot, things will go well. Otherwise....
HEMS flying isn't terribly challenging until it is, then it's a significant challenge. In the 35 years of professional flying before I started HEMS, I was never so exposed and on my own as I was in HEMS when things went sideways on a transport leg. Abort, divert in the GoM? One was encouraged to 'take a look' with the full knowledge that it might not work out. Aborts happened everyday, get to a platform or airport and the company or the contract would recover you and/or the helicopter. A responsible HEMS pilot never gets to 'take a look', he is expected to complete every leg.
My employer at the Part 91 would give me cash and a credit card when I had remote work to do. I could call the office and expect reasonable support if I had protected my pax and aircraft.
Not so in HEMS- one ad hocs every abort, the company might help arrange a groiund truck for the patient, but the pilot and the aircraft were on their own. If your relief pilot was close enough to drive out and take over, things might go well. I've spent solo nights in the aircraft and I've driven out to relieve and been relieved by the duty pilot, pilot to pilot.
Why all the openings? The money sucks. You are working in professional isolation with people who judge your proficiency by your ability to not scare them too often. And if you do, no matter what, heaven help you.
The Vietnam pilots are retiring. A fair few of the Vietnam pilots who came to HEMS had thousands of hours instructing, they could narrate ham sandwich milkshake to the med crew and make them feel safe. Old guys who want a flying job that allows them to be home every night are in short supply.
A 1500, 2000 hour pilot is an idiot to continue in HEMS. They won't fly enough to build real expertise or experience, yu barely maintain the stick skills you came with. A 20 year 1500 hour HEMS hire will only have 4000-4500 hours at the end of the career, almost but not quite a respectable professional total. And don't get me started on company training, it's a joke and an obvious conflict of interest- they want you back on the line as fast as possible.
Was I in a position to go to an airline as it is now, I would have done so in a skinny minute. That was my plan, but helicopter time was only briefly acceptable to airlines and I was never interested enough in fixed wing to get a commercial.
HEMS is a job for an old, experienced pilot who has had enough adventure, thank you very much. There ain't many now nor will there be in the future- when the Silver State bump starts aging out in about ten years...