Would the ability to say "No." be the hardest thing in aviation?
I'm not an EMS pilot, but whether it is charter ops or EMS or airwork, saying "No, I'm not doing that." is the hardest thing, but it should happen.
I think it gets even harder when you fly all the way there and have a look and then make the decision, no it's not safe, time to go home.
We as pilots need to know that the boss/bean counters will support us when we are in the air and change our minds based on what we see, or can't see as the case may be.
It doesn't matter what the task is, we should be confident that the boss will respect our decisions.
The last time I felt safe saying "no" was when someone else booked a photo job for our R22. I turn up at the end of a 40 min ferry flight to find the photographer is 130 kilos!
I said "No" and they had to find another photographer PDQ. They were told about weight issues and would still have had to pay for that ferry, but how often are we afraid to say "No."?
And push on to get the job done.
All the best gear in the world will not overcome the fact we need to train management (and the client) that some times, some jobs are not going to happen.
And that's okay.