Glad to see this discussion going the way it is.
It seems you guys have some serious challenges ahead. Here is how my mob in Australia do it - note there are several different methods in Aus, but I am one of those poor buggers who works several bases in geographically diverse locations, and this is how we manage.
We operate ME(412)SPIFR, 3 ax AP. 24 hour shifts with strict fatique disciplines. Some of the aircraft are new, some old, some carry just one paramedic, some a cast of thousands. This leads to one problem - the ever-present lack of power margin/range on some ops. Next is the problem of night flight. Yes, we are IFR, but that doesnt alleviate problems of icing, arrival and landing to black-hole roadsides, fog, non-surveyed flight routes and landing areas etc. It seems to me that many of these difficulties would be reduced (not elliminated though) by simply being able to see! I have an NVG background and I still cant believe that we get away with what we do unaided relatively without incident. Frankly SAS, it scares me too! NVG in my ops would allow me an increased ability (not failsafe of course) to see and avoid fog and cloud (ice), avoid terrain (mountain flying at night) and perform far more effective search ops. As for the arguement of inadvert. IMC, I do agree, but it is my belief that this is an IFR job, and thus ought to be conducted by IFR multis with proficient crews.
A healthy company culture of "pilot's decision is final" is vital also.
I often lament some of the short-comings of our system (basically the lack of NVG), but I see that you Yanks have it tougher than me in many ways. I hope you can improve things the way you see fit.
It is worth mentioning that all this gear is obviously expensive and the sad truth is that companies and clients most likely see what we do as an "aint broken dont need fixin' " situation.
That said, fly safe guys and remember that your patient is already in a bad way. Its not your fault and the simple maths of his/her life verses the 3, 4 or 5 of your crew just doesnt add up.
Keep up the discussion guys. Any other examples of how others do it out there?
W