Actually, yes you can place the blame on them. They can refuse to fly. Many programs do it, some will even get on scene and tell a ground crew or hospital to send them by ground as they do not meet the appropriate criteria.
State protocols are **** and they need to go. Most are antinquinated documents older than Rid and Vent put together (good 'ol early morning pre-coffee jab). They are not up to date on evidence based medicine, they are way too generic, and all too often seen as the bible of EMS with no variance allowed.
As a flight medic, I can attest it will be a cold day in he!! before some pencil pushing politician at a state capital tells me when I will or will not fly a patient. Fortunately, Texas doesn't operate that way and my particular program is dedicated to our hospital system which can and does refuse flights that are not medically necessary.
Reducing individual medic's making an ignorant call to fly (i.e. off of mechanism alone) is great and all, but as long as you have state protocols telling you absolutes in an "individual mileage will vary" world, the problem will continue.
Steve - I think we see eye to eye on most of these issues. However, I do not see the need to sacrifice patient care by eliminating a provider in all areas. Nor do I see eliminating the single side loaders as a feasible solution (with the strong exception of the 206). The 407 and A-star both are sufficiently powered. With the addition of good CRM, NVG's, TCAS, recurrent training, an effective operational control center (OCC), multi-provider communication in the case of flight aborts, and a few other tweaks here and there, I think those programs can be safe and effective. Looking at the recent statistics, few show that the aircraft is the issue. Most are direct failure on the part of the pilot and bad decision making. I have yet to see any accident in recent history caused by a failure of the company's in place prevention plans. Its always weather, hazardous attitudes, or just plain bad decision making.
I do agree it is optimal to have two, but you and I both know it it will not happen in our lifetime with the opposition out there. God, I pray I am proven wrong, but not optimistic. All we can do in the meantime is control the aspects we have direct control over and the biggest one is flying unneccesarily with low acuity patients that need to go by ground. there is a strong shift towards that goal, hopefully it will keep up!