Approximately 7.5 million patients in the United States suffer from heart failure. Of these, 75,000 to 100,000 have end stage heart failure, are under the age of 75 and would be candidates for heart transplantation. Unfortunately, only about 2100 hearts will be available for transplant. The remainder of these patients as well as patients waiting for a heart transplant should be considered for long-term mechanical circulatory support. Newer devices allow patients to travel, work and lead nearly normal lives. When problems occur, they are likely to present to non-implanting hospitals. In order to care for these patients safely until transfer to an implanting hospital can be arranged, all hospitals should have policies and procedures for the management of patients with left ventricular assist devices (VAD). This talk will review common VAD emergencies as well as suggest ways that non-implanting hospitals can manage risk.