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This study represents a comparison of Helicopter Emergency Medical Services (HEMS) operations, between US Federal Aviation Regulations (FARs), and European Joint Aviation Regulations Operations Specifications. Presently, US regulations allow HEMS operators to conduct work under FAR Part 135, Commercial Aviation Operations, or under FAR Part 91, General Aviation Operations. This allows HEMS operators to accept a greater level of risk by substituting lower minimum procedural standards under FAR Part 91 than under FAR Part 135, and may be partly culpable for a higher rate of fatal crashes in HEMS operations conducted under FAR Part 91. In stark contrast, explicit criteria and minimum operating considerations are stated in the European regulations. The Federal Aviation Administration (FAA) has been slow to take a similar clear and firm regulatory stance as that of its European counterpart regarding the human factors involved in the risk assessment of HEMS operations. Providing clearly defined steps to analyze and mitigate unnecessary threats, developing optimum performance guidelines, as well as minimum acceptable operational standards would benefit not only the US HEMS industry but also the patients and public it serves by reducing exposure to preventable dangers.