Background: A Hands-free Communication Device (HCD) system is an information and communication technology (ICT) being implemented to help OR staff respond to emergency situations. Methods: We purposefully sampled 18 OR staff to participate in semi-structured interviews and observations. Interview and observation data were transcribed and analyzed using a constant comparison method. Results: OR staff described benefits and challenges associated with integrating the HCD system with the variety of already available (ICTs). Some subjects described sometimes-burdensome mental processes determining what technology to use given a particular clinical scenario. Discussion: We propose a model that frames the decision-making process by which users determine which communication modality to use, given the perceived urgency of a communication, and the perceived availability of an intended message recipient. Conclusion: Developers and implementers would do well to consider an ICT's impact on how it accounts for the urgency of communication, the availability of intended recipients, and users' abilities to integrate the ICT with already existing modalities.