When I flew the police R44 in SXM (a few years ago, before TIMTS' time) I noticed an inclination to believe that "the helicopter would always be there". As unsuitable for medevac as the R44 is I tried to educate whomever I came in contact with about its shortfalls in this respect. One day while talking with one of the Saba officials I was told this was understood and that they had an arrangement in place with Island Helicopters in Tortola BVI to use their B222 in EMS fit if required. This seemed eminently sensible to me, using a SPIFR twin with room and staff for proper in-flight patient care. I wonder what happened to this arrangement? I heard on the grapevine that Island had some trouble with the FAA wrt. their 135 certificate but their website is updated as of this year so I assume that was sorted out.
I can think of at least two reasons why the police R44 wasn’t used. First, as TIMTS has also said, there is the “little boy who cried wolf” factor. You can be told only so many times “XYZ is going to die if you don’t…” only to find out it was something minor before you automatically raise the BS flag on that statement and your standard response becomes “OK, we’ll get him at first light”. Your colleagues going through the same experience and warning you about it just speeds up this change of attitude.
Secondly, the police version of the R44 as I flew it is even less suitable for patient transport than the standard version: there is no right rear seat, this space is taken up by electronics, so nobody can sit with the patient to administer even the absolute minimum of care (e.g. preventing the patient from inadvertently opening the door, talking with the patient to keep him conscious, etc.).
In any case, with the only blind flying instrumentation being a single artificial horizon (that doesn’t take well to either the constant vibration in a light helicopter or the salt-laden air in the islands) the only way I would have contemplated a night flight to Saba even in the direst of emergencies would have been with completely clear skies and a scorcher of a moon – and that was when I was young and stupid.