That is not the issue, actually there are far more patient fatalities in ground ambulances than in HEMS (if only for the sheer number difference).
The issue is that HEMS is by its nature a much higher exposure activity than say flying offshore or flying tourists in the Grand Canyon, yet it is regulated by the same set of rules and same basic weather restrictions.
In itself flying HEMS it's not (should not be) any different that those two previous activities, there are however human factors to be considered that contribute to make it what it is.
Day/night flying. Night inadvertent IMC (made even more insidious by the use of NVGs) in a VFR only helicopter. Attachment to the job and the (perceived) publicity that it may provide ("heroe" in the small village). The position of the (mostly) single pilot with two passengers who have been given a "crew" title and can hence influence the pilot decisions (if if were only to say no, it would just make things actually easier. And the list goes on and on.
I agree, there is no cure for stupid but there are ways to minimize the stupid moment. This horse has been beaten into a pulp ever since there has been a helicopter flying HEMS in the USA, the solution has not changed, nor has the refusal of the industry to fully implement those fixes, simply because of cost.
Last edited by tottigol; 10th Jun 2013 at 10:28.