The truth is that the FAA is in the pockets of the aeromedical operators. All attempts to improve the safety of HEMS operations are useless for as long as the profit factor is not accounted. The American EMS model is flawed because it includes the paying customer in the safety decision- making loop.
The presence of such a customer is rendered evident by the clear cost cutting measure of utilizing VFR airframes with NO artificial stabilization, flown by pilots whose IFR flying skills are almost always limited to a checkride every six months in the best case.
Ironically enough, the programs that traditionally utilized complex IFR helicopters were those where the medical structure (hospital or medical organization), contracted out to a Pt135 operator. Those programs were set under siege by the so called Community Based type of operation, where an operator set its own network of cheap single engine VFR helicopters (often flown by pilots with commensurate experience) in locations that were designed to strangle the larger "Cadillac" type of operation. As a result, even the hospital based EMS programs were either forced out of business or had to degrade to fly less expensive equipment to be able to "rake" home the business.
The FAA was never involved in limiting this type of negative competition until the loss of life reached levels of stupidity seen only in bad comedy movies, even then, the measures (and mostly the time frame) "imposed" by the feds were only palliatives set in place to placate the general public, showing that the FAA does not really care to step in this minefield or that those various "safety" committees are really just a buch of smoke screens set to allow the Yugo operations to continue in their set ways.