Boundaries Don’t Breathe. Communities Do.

When someone in our community dials 911 for a medical emergency, the help that arrives is not the product of one town acting alone. It is the product of a regional team that Mt. Lebanon shares with our neighbors, a network of EMTs, paramedics, vehicles, training, and dispatch that moves to where the need is, not to where a line on a map says it should be. That is regionalism in the practical sense, not as a slogan but as the daily work of making institutions fit the realities of how emergencies happen.

We made that choice years ago, and it has served us. The question now is whether we will keep investing in it with the seriousness it deserves. I believe we should, and I believe the community is ready to take the next step. This is not about indicting anyone or rewriting history. It is about recognizing that strong systems need periodic rebuilding, the civic version of preventive maintenance. We tune the engine before it seizes, we tighten the bolts before the bridge shakes, and we refresh the rules before drift turns into delay.

Regionalism works because it matches scale to mission. Medical calls do not arrive on a schedule that respects municipal borders. They come in clusters, they lull, they spike again. If each town tried to staff for its own peaks, we would pay too much at noon and still fall short at midnight. A shared system spreads risk, shares readiness, and routes help to where patients actually are. It is common sense, but it only stays common sense if we govern it on purpose. That means clear roles, regular information, agreed service levels, and a budget that reflects the thing we actually buy in emergency medicine, which is readiness. We invoice for transports, but what saves lives is the standing capacity to respond. If we fund only the billable portion and neglect the standing capacity, we slowly hollow out the very reliability families expect when they call for help.

Good governance is a life-safety tool. It is not exciting, and it should not be. It is the discipline of deciding who decides what, on what timeline, with what data, and to what end. It is the habit of publishing a dashboard that tells the same truth in quiet months and busy ones. It is the budget that balances ambition with arithmetic, so that promises made at a microphone are matched by dollars that can carry them through the year. None of this is theatrical. It is the daily craft of keeping an institution steady enough that excellence can repeat itself.

Fiscal resilience is the reform that makes the other reforms possible. We often talk as if finance is the constraint and operations are the aspiration. In reality, finance is policy. The services we can pay for are the services we can keep, and the stability of the funding determines the stability of the response. A resilient model spreads the cost widely and predictably, honors the connection between readiness and contribution, and avoids the ritual of seasonal brinkmanship that treats emergencies like a line item to be haggled over. If the community wants faster response, better training, reliable vehicles, and modern equipment, then the community should pay in a way that is fair, legible, and steady. That is how we keep the lights on and the crews ready without lurching from one short-term fix to another.

There is also a virtue in compacts. People do heroic things; institutions make heroic things dependable. A regional EMS compact is a promise that crosses borders and election cycles. It spells out the response goals we share, the reporting we expect, and the way we will make decisions when the world is calm and when it is not. It sets contributions in terms the public can understand, and it turns debate from a contest of anecdotes into a discussion grounded in facts. Compacts do not remove politics. They civilize it. They give us a frame where disagreement can be productive rather than paralyzing.

Modernization fits inside that frame. It is not mythology about silver bullets or magic providers. It is the straightforward work of letting data shape deployment, of aligning staffing plans to demand curves, of training with the seriousness of a craft, and of smoothing the seams between EMS, 911, hospitals, police, fire and other municipal services so that residents experience one system rather than a series of handoffs. Technology can help, but it only sticks when the institution is well led, well measured, and well financed. Modernization is less about chasing the newest thing and more about getting the core things right and repeating them.

All of this points to a politics of outcomes. The public does not need ornate theories from us. They need to know that a call for help will bring help, that budgets will reflect priorities, and that we will say what we are trying to achieve and then show whether we did. The responsible posture in this moment is to decide, to publish the reasons, and to live with the results. That is not an argument for rigidity. It is an argument for a cadence of improvement that runs on time: quarterly reports that mean something, annual plans that actually steer, and multi-year commitments that protect both taxpayers and patients from whiplash.

So what comes next for us is not a reinvention of EMS, but a recommitment to the regional model that already serves us, with a clearer spine. We should renew our shared expectations in writing. We should treat the revenue cycle and the readiness budget with the same seriousness we bring to clinical protocols. We should invest in the basics that make performance durable, which includes people, vehicles, training, and honest information. We should keep our board culture focused on stewardship, so that the institution gets stronger each year, no matter who holds the gavel. And we should talk to the public with plain language about the tradeoffs we are making. When people understand what readiness costs and what it delivers, they tend to support it, because everyone can imagine the moment when the minutes will matter.

Boundaries do not breathe. Communities do. We already act like one when the siren sounds. Let us keep acting like one when we plan, when we budget, when we measure, and when we explain ourselves. If we continue to govern and fund like neighbors who share a fate, then the promise we want to keep is simple. When the call comes, we will be ready.