My understanding is it was an IFR EC135 enroute home at 2230 local (2-3 hours after sunset) from a refueling stop at the KLSE for the leg to Madison WI, after transporting a patient to La Crosse.
The topos of the area show hills rising approx 500-600 feet above the airport of last departure, approx 4-5 miles from the airport, roughly N-S, course roughly SE. Very little cultural lighting indicated on the charts in the area of the hills, 5-10 miles across and wooded hills probably obscuring what little might have been there. City of La Crosse West of hills, small towns/lightly populated farmland East, going from light into dark, with little to see across the hills.
A direct line from KLSE to Madison goes across the area of the crash, with a local roadway in the valley bottom, elevation rises 300' or so either side. The "talking heads" report impact near the top of one, wreckage down the slope.
I'm suspicious of the METAR, as some of the automated obs I see bear little resemblance to the cockpit view. I understand that there's software that averages the trend and reports a calculated number for vis. Viewing public sector loops for clouds shows bands E-W moving North into the area about this time.
Before y'all get all bent around IFR, equipment, proficiency and requirements, and given I've never flown in the upper Midwest:
It's VFR/MVFR 95% of the time where I am. When it's IMC, it would take longer to file and fly than transport by ground, so there'd be little obvious revenue gain/business justification.
IFR capability increase the safety of the leg home, if I stayed current and proficient. I wouldn't be able to stay current in normal ops, I'd have to do training legs w/safety pilot, prohibitive as we have staffing issues now. Requiring IFR would eliminate most programs here for very little real gain. Besdies which, I can recover to base a lot cheaper by ground than training costs alone (one time in the last year, for example).
As to the reported crisis in US EMS, I don't have the numbers, but my guess is that we're safer than air taxi as a whole. Air ambulance accidents make good press, and, largely, are fairly well equipped and staffed. Nights and recovery legs do feature far too heavily in the accidents reported for me to be casual about that. It's interesting that the last two fatals in the company were IFR Twins, late day/early night, attempting the return to base VFR, and perhaps encountering weather. Were they both at the end of a long day shift? I don't know.
I've never been pressured in any way to complete a leg in 7 years with the company, period. Management, at every level, will come down like the proverbial ton of bricks on anybody disputing an abort/decline.
I detest the "talking box" fix. Give me a well equipped airframe; good, timely data; Night vision goggles; and night scheduling with scientific, physiologic considerations.