The Real Problem
is that HEMS in the US is, to some extent, definitely devolving.
Money is tight, weather becoming more active, class of helicopter going single engine - which means definitely not two pilots, or IFR capability or the possibilty of recovering to some mode of flight that will carry the helicopter to safety in the event of an engine failure, less possibility of pay increase for crews who have to feed families, provide kid's education costs, etc.
Offshore and fire fighting and corporate and other areas of our industry slowly move forward, while HEMS (despite the tout of those in management that TAWS and Rad Alts and all the other useful bits will save the day) slowly gets taken down by the profit motive.
It sure would be nice to see a CEO of a HEMS operator draw a line in the sand and start going after reimbursement for flights so the proper equipment, personnel, training and support structure can exist to do this job with a modicum of ethic and predictability. At present these companies are looking internally to cut costs (a noble gesture) but that goes ONLY so far, beyond that the money has to come from reimbursement.
I very much admired that Alan Bristow went after his clients for proper reimbursement. In that respect he's the example for others to follow.