Careerdriver you bring up an interesting point about not focusing too much on the 'patient and all the information that should not be part of the go/no-go decision process', by which I presume you mean the patient condition. We just got a flight request for a patient pickup over 100 miles offshore. It's 2:45 AM and nearby weather stations are reporting a zero temperature/dewpoint spread so we've turned this one down but it occurred to me that maybe we should make the patient condition part of the go/no-go process.
Here's what I mean: This patient could have had anything from a broken ankle to a brain aneurysm for all I know. The decision to ask for a helicopter was made by some medical director somewhere who was either looking at the patient's medical chart or (cynical me) at his insurance card but surely wasn't looking at a weather chart or thinking about the risk involved in bringing a patient in from offshore in the dead of night in marginal weather. He made his medical decision and now it's up to me to make my pilot decision and neither one of us is fully informed.
Of course I can't make judgments on medical necessity any more than a doctor can judge the weather but a medically trained flight dispatcher could. Somebody in the chain of operational control could be in a position to weigh the two and see if a helicopter is really called for. Somebody should. Unfortunately though the health care industry in this country is not driven by medical necessity but by profit so the hospital only thinks about filling a bed and the EMS provider only thinks about billing for a transport; nobody does the cost-benefit analysis and up goes another helicopter, launching into the night to pick up a patient with a broken ankle. And therein lies -I think- the root of this problem.
In a strict sense most of these crashes are a result of CFIT at night in marginal weather (or some variation on that theme) but in a larger sense they are a statistical inevitability -the result of the over abundance of EMS helicopters in this country and their gross over utilization. No amount of additional equipment or training is going to remedy that. It's going to take changes in the way aircraft are allocated to different areas, the way they are utilized and how they are dispatched.