In 1984, the Naval Emergency Medicine Residency Program was established in San Diego at the Naval Medical Center San Diego (NMCSD).  NMCSD, completed in 1988 and costing $500 million (1/2 the cost of a nuclear submarine), is the largest (and best) military medical facility in the world.  The 17-Core Bed Emergency Department (ED) has an annual census of approximately 60,000 patients, admitting 9-10% of the patients who present to our doors.  There are 15-20 staff physicians and 7-9 residents at each of three year levels (PGY 2-4).  The ED is equipped with its own radiology suite (X-ray and CT), expandable 4-8 bed urgent care ward (fast track), and 5-Bed Rapid Triage Area (RTA).