The problems of the US EMS industry have been discussed here very often.The solution maybe in everybody (the pilots. middle managers,company and the FAA) making a concerted effor towards ensuring/enhancing the three 'T's : Training ,Technology and Temperament.
Most issues are already in the procedures:for instance, in my company, the comm.spec.( dispatcher) does not indicate the nature of the flight until the pilot has made the go/no go decision. That should alleviate most of the emotional decisions. But,since good news does not travel by helicopter, the pilots are already hardwired to make an emotional decision(if I don't go somebody is going to die---maybe I can go up and take a look).And this is further compunded when the patient is already on board. I don't know if it even possible to train or regulate that pressure out of the guy. It is easy to say it is no different from hauling cargo.But we are human and that is what makes it hard to put it into practice.
In the case of the most recent crash there was no economic pressure either. It was a State funded unit. Maybe , the fact that they had all got a lot of bad press in the recent past had a bearing on the thought process of the managers and the pilot---we will never know. But, in this case, it certainly debunks the theory that twin engines, SPIFR capable helicopter and pilot will fix all the problems.All the bells and whistles did not prevent this from happening. So where do we go from here?
Meanwhile, there is an agency working towards eliminating sleep for the night duty pilot to prevent "sleep inertia". The tragedy is they are powerful enough to succeed.
Maybe it is time for me to pull out and dust the old resume-----.
Alt3.