Many of us are flying non-stabilized aircraft at night out here. 407's, 206's and a few others, are never equipped with an autopilot or SAS. So, I would put equipment at the top of the list (to include NVG's), and more IFR and IIMC training a close second.
The problem with EMS in the USA is that probably more than 90% of it is conducted by corporate operators who do not receive any subsidies at all from the government- so everything is profit driven... the bean counters pretty much run the industry. This also creates pressure to fly.
Weather reporting and forecasting in many areas is still either absent or grossly mis-forecast; most pilots have to rely on whatever personal insights they have about the weather patterns in their local area, because the NOAA and NWS still appear geared towards our higher-flying fixed-wing brothers. It would seem that weather close to the ground is something that they don't fully appreciate, unless it is tied to an instrument approach.
Since operators end up having to comply with insurance company requirements, maybe the quick route to change with insurers upping the equipment and training requirements before they will write insurance to HEMS operators. If the accidents keeps happening, this will eventually happen (someday), I think.
I am fortunate that I work for a company that utilizes NVG's and that never frowns or inquires about why I turned a particular flight down. But I still don't have the aircraft that I believe we should all be flying: SPIFR, NVG's, and plenty of recurrent IIMC and IFR training to keep the skills fresh.