An outsider to HEMS and cognizant of the excellent though disturbing video link, but if I were the FAA I think I would mandate within a short period of time, in line with the SMS requirements now demanded from operators, that every member of management, aircrew and operational groundstaff attend a CRM course together with customer management, medical teams discussing past major accidents and their causes with a view to an eventual overhaul of the operator's Safety Case with revision of SOP's as necessary plus encouragement of an individual mission risk assessment performed by operational staff taking into account aircraft limitations, crew training, weather and facilities. Mitigations as the risk increases including saying no should be clearly laid out. Bull**** I hear some cry ..... but nothing else seems to have had sufficient effect - this should be seen as the perfect opportunity to encourage frank discussions and understanding / acceptance, by management from both operator and customer, of the limitations of machine and human which in the end might reduce pressure to get on and complete missions regardless. Even better do this with several operators together if practical, and repeat as necessary. Surely this is a duty of care for the patient?