In 2018, Rhode Island became the first state in the U.S. to enact a law requiring the use of surgical smoke plume evacuation in settings where energy-based devices are used on patients for surgical procedures. This effort was championed by AORN and nurses from Rhode Island. It has long been known that surgical smoke plume contains many dangerous components and that the potential for long term health problems exists. Despite the known components of surgical smoke plume, many in healthcare refuse to accept any of the data that exists. Most of the time, it is surgeons that are the biggest obstacle to implementation of a smoke evacuation policy followed by healthcare executives and materials managers. With laws already in place in Rhode Island, and several states that are following. What can OR Managers and Hospital executives do to be prepared to comply with the new laws? The industry has many options available to hospitals and outpatient surgery centers that are both cost effective and provide adequate protection for employees.