US HEMS = Profit, profit, profit
This same story has been going for decades. While ever the US HEMS industry continues, (for the most part), to be run by private for-profit operators, a for-profit health care system and companies seeking a way to make a quick buck with less capable helicopters not suited to specific missions and tasking, you will continue the horrific safety record in the US with little or no change. Take out any profit and commercial incentive and your system will become what it can be.