Is this the question Shy?
So what is your "text book" solution to the issue in question, ie. how would you make "VFR" Night Ops safer?
The most effective way would be to adopt the UK method....ban it! If one does not do it...one cannot have an accident.
My recipe....
Work like heck encouraging Pilots and Crews to take more time considering the weather, route, and reason for the flight before launching. I would require a pre-takeoff briefing of the Med Crew by the Pilot or (P-I-C) on the reasons "Why" the flight is going to be undertaken and not just the reasons why a flight was declined.
If one cannot articulate the reasons and factors that contribute to the decision to go....as well as why not to go....then that should be a warning sign.
Over a period of time....an inconsistent explanation would stand out during the brief and hopefully someone would question that.
That process would also slow down the pace just a bit....which in the middle of the night...with a pilot wakiing from a nap or sound sleep....would not be a bad thing but still allow for a timely departure.
Educating pilots and Med Crews about dangerous weather and reviewing in detail as many fatal accidents as possible citing the chain of events that led to the crash would also be a good thing. Judgement cannot be taught but it can be improved by education.
I also believe in written debriefs or after action reports. Documenting the existing weather prior to takeoff....and later comparing the forecasts and anticipated weather against that encountered would also work as a tool to improve awareness of weaknesses in the weather reporting and evaluation of weather by crews.
Most fatal accidents are a result of bad weather at night...thus that is where the focus needs to be. Prevention is far more effective than any other measure....that comes down to using the best information possible and making a logical, business-like, professional decision.
Some of the changes that have taken effect over the past few years has improved the situation....the accident rate is showing that. NVG's are an improvement, raising the miniumums for Night VFR helped, and requiring Operators to operate centralized dispatch/operations centers has helped.
As long as helicopters fly in the dark, in remote areas, far from weather reporting stations, and humans are involved....the potential for tragedy shall stay with us.
Knowing when to Chicken Out is the key to any pilot's continued longevity! There is not a rule book anywhere that can beat that for effectiveness!
Getting the folks to know when to Chicken Out and encouraging them to do so is the key.