I think everyone here has identified a bit of the solution. The difficult part is implementing it in an environment that's governed almost solely by profit. On the one hand we want to make transport by HEMS safer, while on the other, we are reluctant to regulate someone out of business.
There are business models that work well in terms of profit, and there are those that work well in terms of safety. Occasionally, they are found in the same operation. But by the same token, the absence of accidents does not necessarily imply the presence of safety.
For years we've attempted to solve the problem with incremental measures, focusing on the proximate cause of the latest accident. It's time to look at broader solutions from a "systems" perspective.
Starting from the top:
1. How do we determine that a program is necessary in the first place? Will the community really be better served or is this just a business opportunity? Perhaps the "certificate of need" process needs to be more realistic.
2. How do we fund the service? Does the call volume directly affect the program's survivability? Is there pressure (real or perceived) to keep the "numbers" up?
3. Are the aircraft and crews equipped and trained to be able to surmount the challenges of the operating environment right up to the point of clearly defined mission abort criteria? Once a mission reaches an abort criterion is there a safe alternative?
4. Is the program staffed sufficiently and scheduled properly so as to prevent fatigue-related deficiencies in performance and judgement?
For years we've left it to the operators to make these decisions. Isn't it funny how they can always find a way to justify their operation, in spite of common sense. I think increased government regulation in these areas is the only measure that will ultimately produce an improvement in the the safety record of the HEMS industry.
-Stan-