Our Emergency Department at Landspitali University Hospital is located in the capital, Reykjavik, in south-western Iceland and serves >90.000 patients/year, including patients brought to us from the rural inner highlands and surrounding sea stretching far into the Atlantic. We are by far the largest emergency department in Iceland. Serving such a vast region requires joint efforts with the Icelandic coast guard and prehospital services, mainly through HEMS. We are about 20 emergency medicine consultants and we currently have a full residency program in emergency medicine. Since 2016 our trainees have been using the RCEM online training portfolio and the University Hospital has from 2017 established a 3 year acute care common stem pathway for trainees planning on a career in Emergency Medicine, acute medicine or critical care.