HEMS SPIFR Question  

There is a difference between "hand flying" and with (without) "AP".  Hand Flying would indicate you are manipulating your rate of descent and starting/stopping turns via hand.  Your SAS, AFCS, altitude/heading/airspeed holds are still on and active.  You're just not dialing in your altitudes and headings via the pots.  Without AP would indicate you want to secure all stability augmentation which in turn alleviates your holds as well as dialing in altitudes/headings too.  At some point during the approach, you're going to have "hand fly" it to the deck.