On November 28, 2003, at approximately 2208 central standard time, a Bell 206L1 air ambulance helicopter, N103AE, was substantially damaged following a loss of control during engine start at the Paris Municipal Airport (7M6) near Paris, Arkansas. The helicopter was registered to and operated by Air Evac Leasing Corporation, of West Plains, Missouri. The airline transport pilot and paramedic received minor injuries. Dark night visual meteorological conditions prevailed, and a company visual flight rules (VFR) flight plan was filed for the 14 Code of Federal Regulations Part 91 positioning flight. The air ambulance flight originated from Paris, Arkansas, at 2200. The Director of Operations reported in the Pilot/Operator Aircraft Accident Report (NTSB Form 6120.1/2) that the medical evacuation helicopter was responding to a request for an air ambulance medical transfer that was received at 2200. The aircraft experienced a blade separation from the aircraft during startup. Upon investigation, the 10,650-hour pilot reported that he started the aircraft with the main rotor still tied down. Recognition of this error came too late in the start sequence, and one of the main rotor blades broke and separated from the aircraft.