Harborview Medical Center: Harborview (HMC) is the primary site for both the Trauma-Surgical Critical Care and Burn-Surgical Critical Care fellowships. The 413-bed hospital is the only Level 1 adult and pediatric trauma center and verified burn center serving the entire state of Washington and WAMI region (Wyoming, Alaska, Montana and Idaho). This catchment area comprising 25% of the landmass of the United States. During 2018, HMC admitted over 6900 patients to its 89 critical care beds spread over six intensive care units. The Trauma-Surgery ICU is the primary ICU for the Surgical Critical Care fellowship and admits approximately 2500 patients per year. Annually, the trauma service at HMC evaluates approximately 5500 patients per year and the burn surgery service evaluates over 1,000 injured patients. The large and disparate catchment area, high volumes, and extreme acuity of Harborview’s patient population provides a unique and intensive educational opportunity for those seeking to further their knowledge of surgical disease. While at HMC, fellows will be active in the management of patients with active resuscitation needs to include those with multi-organ failure and the need for extracorporeal membrane oxygenation (ECMO).