I find it interesting that the EMS industry in the U.S. fully supports safety, the efforts of the IHST, etc. Unless it impacts the bottom line. The number of single pilot, unaugmented (SASless and/or lacking autopilot), VFR certified rotorcraft point to that.
Sure, pilots are paid to use their judgement. But what pilot wants to say "No" to a mission in which he could save a life ... even if the weather is marginal, at night, and near the end of his duty day? I'm curious as to how much "judgement" an EMS Op Specs allows a pilot to use, without fear of losing his job?
And how many accidents have occurred when the injuries were not life threatening, and a ground ambulance would have been more appropriate.
Clearly Part 135 doesn't work, as written.
Surely there's at least one lesson to be learned from the Canadians (who, by the way, modeled their system from a public use operation in the Lower 48).