It is −50°C with a wind chill of −100°C as a Biomedical Technologist drives up an ice road built on the Arctic Ocean on their way to service the medical equipment at the Tuktoyaktuk Health Centre. In another high arctic town, a Biomedical Engineer is watching nervously for polar bears, which the local Inuvialuit have reported seeing in town as they walk to the local store from the health center. This is extreme Biomedical Engineering and offers a unique set of challenges and opportunities. The Northwest Territories Biomedical Engineering team runs into situations like this regularly as it works in both the Northwest Territories and parts of Nunavut territory to provide full engineering based medical technology management services. In the past 5 years, the program has expanded from a maintenance service for a limited number of health authorities to a recognized territory-wide (ie, state/province wide) and interterritorial "in-house" full engineering-based medical technology management program.