Agree with Horror Box, SM does make valid points that seem to be the root cause of most EMS accidents in the US.
The reason I started the thread is I recently read Randy Mains' book "The Golden Hour" which was written in the early 80's and outlines the same problems that EMS pilots still face today. It dumbfounds me that in 30 years the industry has learned nothing, while the Canadians and Europeans manage to do it safely.
Unfortunately, I don't think anything will change until profit margins are taken out of the equation and all programs are government contracts or charity based........some how I don't see that happening in the good old USA