dnheli,
Overall the list is good. However, there is more involved. First there have been accidents where there were 2 pilots. However, 2 pilot crews do reduce workload. Many of the accidents have been on the 135 legs. Many of the operators already do this as the medical personnel do not work for them. So legally they are passengers. As for IFR ships and crews, many operators already do this and add flight time into the contract to keep their crews IFR current. However, it is the hospital administrators that go with the lowest bidder that may not do this.
As for IFR infrastructure, while some of the ships used are IFR equipped, they are not certified for IFR. Also while there may be sufficient IFR infrastructure on the east coast, other parts of the country is a different matter. Especially in the mountains. The whole purpose of using a helicopter is to get the victim to the hospital within the golden hour. Now, hospital to hospital transfers should be operated at a higher standard due to the fact the patient must be stable and the speed is not as critical.
NVG's are a special issue. All the operators I have talked to want them. However, the FAA and the DOD are the hold up's there. The FAA doesn't seem to be able to get training programs approved. And the DOD makes it real difficult to get approval to purchase the proper units and make all sorts of ridiculous rules the operator has to follow.
EVS is now starting to become mature enough to be a standard. It has some excellent qualities that would enhance EMS safety. One of the primary points would be the ability to see wires, due to their heat difference.
EGPWS could actually be a negative here. Depending on what system is used. Under current FAA regulations, the size of all EMS helicopters used would only require a system using a warning horn and lights. In a helicopter that would be more of a distraction than a help. The better system would be a system using some sort of moving map where the pilot could not only see the high terrain, but also any escape routes.
One system not discussed would be the addition of TCAS. At least one accident was a mid air. Plus, you add in ENG and Police/fire helicopters, you could have a real circus out there.
As for the AWOS on cell phone towers, who is going to pay for them? The operator, who's contract is year to year? The hospital(s)? The government?
One thing that would help would be better training of those who select and operate the landing sites. I have seen EMS helicopters directed into fields that had so many wires, it looked like a telephone pole convention. Or they put their headlights on high beam into the pilot's face, thinking they are helping him.