AIR AMBULANCE PLT DISTR BY NOISE IN BACK OF ACFT; CLBS ABOVE ASSIGNED ALT.

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WE DEPARTED SHEPPARD AIR FORCE BASE RWY 17. IT WAS A NORMAL TKOF; WX WAS GOOD VFR BUT MODERATE TO LIGHT TURB; OUR CLRNC WAS: CLRED TO FWS; BOIDS 2 FWS MAINTAIN 2300; EXPECT 9000 IN 3 MIN. AFTER TKOF FLY HDG 150 DEG. WE WERE GIVEN THE NORMAL DEP FREQ AND A SQUAWK CODE. AFTER BEING ESTABLISHED ON A HDG OF 150 DEG; SOMETHING IN THE CABIN DISTRACTED ME FOR A SPLIT SECOND AS I WAS PASSING 2000 FT; I QUICKLY RESUMED MY SCAN FOR TFC; THEN I REMEMBERED TO LOOK DOWN AT THE ALTIMETER (WHICH HAD BEEN MOVED TO A NEW POS LOWER DOWN ON THE PANEL). I WAS THEN PASSING 2900 FT. DUE TO THE FACT THAT WE HAD A PATIENT ON BOARD I COULD NOT 'DIVE' QUICKLY BACK TO MY ASSIGNED ALT. AT THIS TIME I BEGAN A QUICK BUT SMOOTH DSCNT BACK TO 2300 FT. WE THEN VERIFIED OUR ASSIGNED ALT WITH ATC; AS THIS ALT EXCURSION CAUSED SURPRISE AND CONFUSION BTWN THE 2 PLTS. NO OTHER ACFT WERE INVOLVED OR AFFECTED BY THIS OCCURRENCE. NO EVASIVE ACTION WAS REQUIRED BY ANY ACFT. WE TOLD SPS DEP THAT WE WERE SORRY FOR THE CONFUSION. WE ASKED THEM IF WE CAUSED THEM ANY PROBLEMS AND THEY SAID NO. CONTRIBUTING FACTORS: DISTR OF PF DUE TO CRITICAL CONDITION OF PATIENT. FAILURE OF COPLT TO TELL PLT WHEN HE REACHED ASSIGNED ALT. MOVEMENT OF ALTIMETER TO NEW NON-STANDARD LOCATION BY MAINT STAFF IN SPITE OF PLT COMPLAINTS. DIFFICULT TO UNDERSTAND SPD APCH/DEP CTL DUE TO THEIR RADIO EQUIP AND CTLR TRAINING. UNUSUAL ASSIGNED ALT 2300 FT COMPARED TO 3000-4000 FT DUE TO HIGH DENSITY MIL TRAINING. CALLBACK CONVERSATION WITH RPTR REVEALED THE FOLLOWING INFO. RPTR STATES THE MAJOR PROBLEM WAS POOR CREW COORD AND THE FACT THAT ALTIMETER WAS MOVED TO POS OUTSIDE NORMAL SCAN. THIS WAS BACK UP ACFT AND NOT THE NORMAL ACFT IN USE. FO WAS FAIRLY NEW. LOUD NOISE WHICH CAUSED DISTR MAY HAVE BEEN FOLDING STAIRS. OCCASIONALLY THE SPRING THAT FOLDS THE STAIRS GETS CAUGHT AND THEN RELEASES WITH A BANG. RPTR ALSO CONCERNED ABOUT THE LARGE OXYGEN BOTTLE BREAKING LOOSE AND ROLLING. RPTR HAS GREAT CONCERN REF INTERP OF REGS ALLOWING OUTBOUND PORTION OF FLT (NO PATIENT ON BOARD) TO BE CONSIDERED PART 91. THIS ALLOWS IFR APCHS TO ARPTS WITH NO WX OBSERVER AND CONSIDERS MEDICAL TEAM AS FLC. WITHOUT THIS INTERP THEY WOULD NOT BE ABLE TO PICK UP PATIENTS 'OUT IN THE BOONIES.' THEY WOULD NOT BE ABLE TO SERVE THE PUBLIC VERY WELL. APPARENTLY THERE IS CONTROVERSY OVER THIS INTERP.