The facts are fairly simple. The US EMS industry does retain the old tried and true methods of killing themselves. The Stats show Night alone is the biggest factor in fatal accidents....especially when combined with Marginal Weather....simply because the Human Eye cannot see much in the dark.
The Industry tries to compensate for that by going to NVG's....which as anyone with experience with new generation NVG's...is the only way to fly in the Dark. Thus...there is an improvement underway.
Marginal weather compounded by two factors...one fixable by techology....that being the lack of adequate weather reporting for the routes/areas most EMS helicopters must fly...and pre-flight decision making which cannot be fixed by techology have yet to be adequately dealt with.
There is improvement in the weather reporting arena...but there is a long way to go yet.
Pilot decision making is always going to be the Achilles Heel of EMS flying as not one of us are clairvoyant. Add in the fact that even the very best made decision is limited by the accruacy of the information that it was based upon. Which takes us back to the weather reporting and trying to guess what the weather actually is and shall be when we go flying especially at night.
Then...we have the raw fatal fact that way too many of us are not making the right decisions for any number of reasons. Some of these NTSB described "Unprofessional Decisions" border on suicide as when reviewed by others on clear blue and twenty two days....defy logical explanation.
Did I mention the FAA in any of the above or how a new Regulation alone will improve the situation? We have plenty of rules and regulations, industry standards, certification requirements, and all that....but all it takes is bad judgement or a bad decision and the result is the same.
I flew EMS in an un-Sas'd VFR Only BO-105 (the next thing to a Jet Ranger) right up to a fully decked out Bell 412 SPIFR machine. My experience and that of others....remained the same....bad weather compounded by bad decisions and believing legal IFR currency confused as being IFR Proficiency is a dead certain killer of EMS crews.
Until that situation is cured....there may be new ways found to kill ourselves...but they will be few and far between and the old fashioned ways will still continue to thin the herd.
The best of all worlds is to stay out bad weather while flying twin engined...two piloted...fully kitted out SPIFR helicopters while using NVG's.
The problem is paying for it.....as someone must either in Dollars or if you do not....in blood.