For-profit or otherwise; Single or twin: IFR/VFR; autopilot or handflown; until we, in the industry, deal with the real issue, night EMS accident rates will continue out of proportion. Pilot error is problem in all accidents, and a pilot handicapped by a poorly considered transition to a night shift is going to make more errors.
A021, risk matrices, all the rest of the easy answers are not going to make a pilot any smarter. We don't need to reinvent the wheel- sleep deficiency issues, circadian and sleep disruption, a/k/a jet lag, general fatigue, are known issues with some fairly well established resolutions. They may require unsettling, inconvenient and disruptive changes to 'the way we've always done it', but tradition is killing us: For-profit or otherwise; Single or twin: IFR/VFR; Autopilot or handflown.