It absolutely is not all calorie in calorie out. Or rather, how calories are stored and burned depend on your metabolic health. There’s a massive amount of literature on this.
Here’s a starting point: https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(25)00201-3/fulltext









Nephew got bit by a tick while on an island in Stockholm’s archipelago. Developed a ring around the bite. Rather than have them wait for 3 hours to take the boat, or even get a taxi boat, a helicopter had him at the hospital and under care within an hour. For that and two nights in the hospital, they got charged nothing.
When he was released, he was on his way back to the helipad to get a ride back to the island and we had to explain to him that we were gonna need to get the bus/boat.