Re: Three Dead....Another Night Bad Weather Flight Over Dark Terrain
TC, UK and European EMS operators indeed have an enviable safety record compared to the US, but that's at least partly a function of volume. If you don't fly as much, and as much at night, as we do here then you won't have as many accidents. If you did, you would.
The charitable nature of an EMS operation may help to reduce pressure to fly but doesn't completely eliminate it. Once you load up a badly injured patient there may be pressure to fly regardless, and indeed many accidents happen with a patient on board on the way to the hospital. By the very nature of the job, pilots are going to feel the need to fly. As you pointed out, CRM training is a great tool and can be used to train pilots to manage the inevitable pressures of the job.
At the risk of enraging every ex-military US pilot on this board I would also like to point out that -in the US at least- military experience is not always a benefit. US military pilots almost always share flying duties as part of a two-pilot crew. Many have never flown solo ('solo' during military training is often flown with a 'stick buddy') and are not used to managing a flight single handedly. I don't mean to imply that they don't make fine EMS pilots, only that a military background is not neccessarily a seamless fit with a subsequent career in EMS.
I think it's easy to pinpoint what must be done: to reduce the US accident rate, EMS operators must increase the ability of pilots and aircraft to fly at night and in marginal conditions, through increased training and upgraded equipment. The difficult part is to restructure the healthcare system in such a way that it becomes financially attractive for operators to do so.