Interesting last three posts.
I'd say the biggest problem in HEMS in the US is not knowing WHAT problem/s exists - sounds a bit esoteric but the culture, aka mindset, of the overall utilizatiion of HEMS in the US, perhaps world, involving all those in the mix from ground providers to dispatchers, etc. is rush, rush, rush, time is life, and money! From my perspective this may currently be considered fact and requirement but these points are the antithesis of safe flight operations and from my POV constitute THE primary cause of our accidents.
CEOs? I have no beef, except to say they need to shoulder ALL the responsibility reference everything that happens in their companies! Responsibility cannot be delegated or shared, and total responsibility for accidents does rest with the CEO - that's where the buck starts and stops. CEOs do have the power to start a paradigm shift in this industry such that the adrenalin and rush, rush rush, and etc. is replaced with professional flight operations IAW proven established criteria. The starting point of that shift would be to get rid of all reference to the word Emergency and replace it with normal flight operations definitions and/or acronyms!
We can talk ourselves blue about all the nuts and bolts of this industry, i.e. weather, equipment, takeoff times, etc., but until we decide that identifying what has to be changed on the macro level is what will lead to a lot of very worthwhile micro level changes this is going nowhere and our accident rate/s will persist - this sort of thing always has been the case, always will be!
I'd say we need to discuss macro-level ideas as the starting point to reducing the HEMS accident rate.