(1) Reducing the number of available ground ambulance units assessed and deemed necessary to effectively serve a given community or geographic area. The current practice of utilizing the South Kohala ambulance unit as the primary coverage unit and Waikoloa as the secondary coverage unit has a direct impact on ambulance service delivery to residents and visitors of those respective communities. Although this same impact may be experienced with daily emergency medical services operations, it would be minimized through the use of a dedicated aeromedical crew;

(2) Extending the out-of-service time for the respective ground ambulance units involved in the mission through the staffing of the helicopter;

(3) Reducing quality and effective patient care through the use of personnel unfamiliar or less familiar with the equipment and operations of the helicopter unit. This includes, but is not limited to: flight physiology, patient loading and extrication, specialized treatment modalities and practices, space and altitude limitations, and aircraft performance limitations;

(4) Utilizing personnel unfamiliar with or less familiar with the equipment and operations of the helicopter unit. This includes, but is not limited to: radio and communications equipment, aircraft lighting, compartment latch and security mechanisms, emergency evacuation and shut-down procedures, flight following, and scene operations and safety;

(5) Utilizing personnel uncomfortable with or psychologically and physiologically affected by helicopter flight and operations;

(6) Utilizing personnel who may have physical characteristics such as height and weight that limit performance or operations; and

(7) Operating with limited availability of personal protective equipment such as flight suits and helmets.