OK, now we're getting somewhere. You're saying the State/County has a need,  

The use of a CON (certificate of need) is a device the county is using to control who gets to fly into/out of the county, i.e., the route a legitimate carrier air carrier operatates in.   They are doing this to control the number of air ambulances, the particular air ambulances, and to create a m0n0poly on air commerce.   This is an unfair business practice and preditory when they are doing this to protect their own interests in the air ambulance arena.

And, the issue in the link above was directly addressed:

Since [any certificated air ambulance operator] is a Part 298 air carrier, the State of [wherever], or any political subdivisions thereof, including the [a city or county], is preempted from controlling entry into the field of interstate air ambulance service.

CON's issued by States or Counties for air ambulance service are not legal since they are preempted by Federal Law (not FARs).