Caution: Paralyzing Agent
Way more programs than there used to be even 20 years ago. If HEMS is elite now (and it still mostly is) it was uber elite then.To play Devil's advocate many of our older pilots talk about the glory days when our bases flew 100+ flights a month, frequently hot swapped pilots, and flew in weather minimums 1/3 of what they are today, without NVGs and did not have near the frequency of incidents that occur today. Although the profession has evolved and safety has improved I think the issues are much bigger than those practices being inherently dangerous.
I hate to say it but I think the quality and experience of pilots has drastically declined over the years. You can argue the same with medical crew.