Something like 1/3 the EMS hours flown are in the dark, and 2/3 (+) the accidents occur at night. (Excuse the spelling, I'm post-night shift), because-
Many, if not most programs, split hitches day/night. Example I work the first 4 days, 0800-2000, Mon-Thu., then 2000-0800 Fri-Mon.
NVGs are almost non-existent. I've been IIMC, nights, something like 10 times in 4 years- once in the terminal sector of the leg, at the scene LZ; twice enroute, the least exciting of all; and the rest on departure. Aided vision would have prevented each and every one.
Never, repeat, never IIMC days, on EMS. I have used alternate patient delivery points, days- arranged ground transport from a suitable, safe landing point.
We do the hardest part of our job when we're at our worst, intellectually and physically. This, in an industry that preaches safety, recognises that the pilot's the most dangerous part of the helicopter, and has practically intimate connections to the "science" of medicine.
Lest you think I'm a whiner- I started flying in '68, and did half my Viet Nam tour on missions that required low level or NOE, at night. Aside from combat casualties, the night EMS risk profile seems a spectacular match for the typical accident profile "in country."
We're all guilty of many sins of omission in the industry-
The pilots have got to start refusing runs, a major reeducation issue. The quitter profile just isn't conducive to a career in aviation...
The operators, well, scheduling, equipment- NVGs!- and training, see above first and foremost...
And the government- when exactly was the last timne anybody crashed and burned because they didn't have two days' fuel sample on hand for inspection?
Give me (us) NVGs; some, even a little, science in scheduling; and real line oriented flight training...