This paper discusses the use of information and communication technologies (ICTs) to support improvisation in hospital emergency response. Important characteristics of emergencies and improvisation are identified. Real-time decision support, communication and coordination, and training for improvisation have been identified as three key areas where ICTs can support the use of improvisation. This paper suggests that the documented plans, procedures, and policies to handle emergency situations in hospitals can complement the process of improvisation rather than forbidding or impeding it. Implications for research and practice are discussed.