Perioperative emergencies, such as malignant hyperthermia (MH), sudden hemodynamic compromise (Code Blue), local anesthetic systemic toxicity (LAST), and operating room fires fall directly within the purview of the anesthesiologist and require timely, effective, and coordinated responses. Equipped with their expertise in airway management, human physiology and resuscitation pharmacology, anesthesiologists are well placed in not only responding to these situations, but also instituting protocols and systems and educating other operating room providers on these topics. This chapter examines their role and responsibilities across a systems perspective while exploring optimization of the efficiency and cost-effectiveness of these protocols.