The Bell 427 was originally intended to address this market, but the 427's small cabin size would not adequately accommodate a patient litter,[7] and the systems did not support instrument flight rules (IFR) certification.

[16] However, FAA and EASA disagreed with the weight exemption, which had allowed the 429 to operate for the Canadian Coast Guard.

[18] The launch customer was Air Methods Corporation, the largest medevac provider in the United States, which took one helicopter.

On July 7, 2009, this aircraft (s/n 57006) was delivered to Air Methods (owner) and MercyOne (operator) at Bell's facility in Mirabel, Quebec.

A set of rear clamshell doors under the tailboom is optional for easier patient loading in EMS operations.

The 429 has a glass cockpit with a three-axis autopilot (optional fourth axis kit) and flight director as standard.

[7] By July 2018, 325 aircraft had operated 330,000 hours for police forces, air medical teams, and militaries in 42 countries, including Australia, France, Indonesia, Kuwait, Oman, Switzerland, Slovakia, Sweden, Turkey, Thailand, the United States, and the United Kingdom.