The fact remains that operating a 24 hr capable EMS/Police/search and rescue helicopter, costs millions of dollars per year, not including the cost of purchase which is also millions of dollars. Just where are you going to find that amount of money from the tax revenue in the NA? It is not even a million people. Its not going to happen.
What can happen is having a commercial operator on the island that has a helicopter that is at least capable of putting a stretcher in it. It earns its own doing charters and tours etc., and when the emergency arrives it can be called out and paid for by the local government or patient(family). But even then, to have a IFR capable helicopter, the operator will then incur even more expense just to license, equip, and license the crew for such IFR. In my company's case(the company I work for), that just does not equate as there is not enough business (night flights, IFR type weather) that justifies that expense. So again, it will be a daytime only operation that such an operator would have.
And Sandy Helmut, it is still a "crisis" in Montserrat, and the helicopter is only in Montserrat once a week to work with the scientists only. Before the airport was finished, the 365 was a replacement for airline service due to the loss of the old airport. Once the new airport opened, it was ended and a new contract commissioned to serve the MVO scientists.
Maybe the Dutch government could fund a helicopter for the NA, but they are spread over hundreds of miles so just one helicopter would not suffice. And again the population base would not lead the government to think it was a wise expenditure.
Meanwhile, same for me, get me on a jetplane to at least Guadeloupe or better yet Miami if I have a life threatening condition.