The reasons why ????????
Methinks a Zotov Error Map would be very revealing. This Flight Safety 'tool' tracks back every related decision by everyone whose slightest touch has influenced the events that lead to an accident.
Although not quite up to date Davis Beaty's "The Naked Pilot" also shines a wicked spotlight on those tempted to utter those not-so-magic-words "PILOT ERROR".
Some dispassionate analysis of the root causes of so many accidents in the US EMS world might reveal the truth but I don't think we would be far wrong to conclude that the old adage "If you want cheap then you'll get cheap - and evertything that goes with it seems to apply here.
Safety costs, quality costs and nothing, believe me nothing puts that reality into sharper focus than when you suffer a fatal accident in your own organisation. Suddenly people come up with the cash that should have been there in the first place. Suddenly everyone, including the bean-counters want to help.
Why oh why do we have to wait - can't these people read! Or are they founder members of the "It'll never happen to us" club!!