Hi Gomer,
Your points are valid and you can see them contributing to the culture that currently pervades US HEMS. When you say that "anything not specifically prohibited is permitted" is the crux. The list I put up did not exclude taking regulatory steps that would prohibit non-compliance, but that regulatory requirement should only be initiated when there is a demonstrable safety case to support it. in other words, change the system to mitigate the risk.
This DOES happen in the USA. 1 in 80,000 of Americans will be killed on the road as a pedestrian this year - almost all of them will be "jaywalking". That is why some places have a "jaywalking" regulation. It is not unconstitutional, against the core values of the USA, nor changing or challenging a culture - it is to reduce risk to the general population. The same can be said for the introduction of seat belt rules, helmets on motorbikes and riding around in the back of utes ("trucks" as you might call them).
There is an identified risk in HEMS, even where that risk is perceptually increased beyond the facts due to media and emotional reactions to lost loved ones. Mitigating that risk is not a business restriction if it can be based on a safety case, such as the two crew in the front. Aircraft not capable of such SHOULD be phased out over the next 10 years, and if the business case (ie benefits) are not large enough for the extra cost, then I would suggest the risk V benefits of the existing model is not supportable.
I suggest that the US Medical fraternity is looking for ways to restrict or stop HEMS (yes, there are gathering loud calls for the cessation of night HEMS and the severe restriction of day HEMS). Lets identify the risks ourselves, produce mitigators and then institute them before we find regulatory knee jerks that do kill the business.