Cure 1 Patient
Can't be easier. Create some diagnosis rooms, diagnose a patient and cure him.




Cure 1000 Patients
It's all about playing the game. You should be able to earn it half way through the game. If you are going for 3 stars on all levels, it certainly won't be missed.


Train a World-Class Researcher
Easiest of the 3 of this type of achievement. To earn this, you must train a doctor through all 5 Research courses. Researchers are involved in constant work, so unlocking all training slots shouldn't be a problem. If you are going for 3 stars on all levels, then it can't be missed. Hiring a doctor with already learned research slots will still count towards this achievement.


Train a World-Class Psychiatrist
Now this one a bit harder. Still, Psychiatrists are mostly having large stream of patients going through them, meaning you won't have problem with unlocking all the training slots. The same, to earn this, you must train a doctor through all 5 Psychiatry courses. Hiring a doctor with already learned psychiatry slots will still count towards this achievement.


Train a World-Class Surgeon
Hardest of the 3 of this type of achievement. To earn this, you must train a doctor through all 5 Surgery courses. Now call me lucky, because I was one of very few people who was able to hire a doctor with 3 Surgery courses already learnt, the 4th slot unlocked, and only 600xp to the 5th and with good traits! Surgery patients are the longest to cure, meaning it will take a long time to develop a single doctor with all 5 slots. Your best bet is to hire a doctor with at least 2-3 surgery courses learnt, preferably with fast learner and high energy traits, or at least with one of these. You can try using marketing, however, instead of using surgery campaign, use doctor campaign. I don't know whether it's a bug or intended, but new employees with surgeon campaign won't give you surgeons every time. It probably does have increased chance to get surgeons, but they will most likely have other courses learnt that will ruin this achievement, besides, running doctor's campaign has less time to next candidate, meaning higher chance to get what you need. You can also make that Surgeon work in GP. It will give you hard time, but for the sake of achievement you will make higher flow of patients run through that doctor, thus developing him faster.


Complete 50 Research Projects
It's all about playing the game. You can speed up researching by adding all those precious super expensive items to the Research room and expanding it. Having multiple at least level 3 researchers running that room will speed it up even more!


Run 50 Marketing Campaigns
I once thought that marketing is absolutely useless, but it's not. It's super effective if employed at the beginning of the game, if you lucky enough to have extra 25000 run some doctor or nurse campaign for a year to quickly pick out the best candidates with the proper qualifications and traits. Once you get steady cash flow in a hospital you can quickly start and cancel 50 campaigns for a quick achievement.


Conduct 25 Machine Upgrades
If you are going for 3 stars on all levels cannot be missed. To speed up upgrading you need to have 1-2 janitors who underwent at least 3-4 Mechanics courses. Upgrades are unlocked through researching.


Capture 100 Ghosts
Going through the deaths of patients will be your regular routine which you will have to get used to, because even the highest end hospital can't guarantee you 100% cure chance. Throughout the whole game I had like 4 patients, who died with 99% cure chance. Dying patients have 50% chance to turn into ghosts, regardless of the illness. They will litter by leaving ectoplasm trails and scare patients and staff alike. But don't you worry, all you will need is a janitor trained in Ghost Capture. Capturing a ghost sometimes nets research points. Often though, you will have to drag the janitor yourself to the location. This will most likely unlock before you finish the game.


Earn 15 Gold Stars
To earn stars, you will have to complete objectives under X star hospital marker. To get this achievement it's enough to just have 1 star in each hospital, without DLC included.


Earn 30 Gold Stars
More stars needed. At least 2 in each hospital or get 3 on the first ones and 1 in later ones.



Earn 45 Gold Stars
Even more stars needed. Earning all stars on all hospitals without DLCs will unlock this achievement. Will probably require at least 50+ hours poured into the game.


Reach $50,000,000 Organisation Value
If you are going for 3 stars on all levels, you probably won't miss it. Organisation value is a total value of all your hospitals. You can increase value of each individual hospital by expanding it; hiring more staff and building more rooms. But most importantly, it depends on your total money and your monthly income in a hospital. Each month, the hospital value changes, depending on it's performance, if you actively playing it. The more earnings and the lesser expenses it gets, the higher the value. Organisation value can be seen in the bottom right corner of map menu.


Earn 10,000 Kudosh
If you are going for 3 stars on all levels, you won't miss it. The best way to earn Kudosh is through completing career objectives. Earning stars, pleasing VIPs, completing staff requests and many more can also earn you some Kudosh.


Complete a Multiplayer Challenge
This one can be missed, but it's very easy. During the game, in the right upper corner click that achievement icon. There, you can see multiple challenges available. Select either one and play through it's duration. You don't have to win.

Have a Level 10 Hospital
This one can't be missed. You can increase your hospital level by expanding it. Hire more staff, and build more rooms. Hiring more qualified staff and training them increases level as well.


Have a Level 20 Hospital
Now this one is a bit of nuisance. By playing seriously I was able to have level 18 hospital with 24 doctors, 17 nurses, 5 assistants, 12 janitors, all buildings built with copies of certain ones for obvious reasons and it wasn't enough. Instead of having level 20 hospital, get yourself a level 20 toilet! Buy the largest plot and then fill it up with the smallest toilets. If it isn't enough buy more plots and repeat.

Win every award in a single hospital.
Missable. Now this one is a bit tough. The hardest award for you to get in either hospital will be "no death award", but even this can be exploited through quick saving. Awards are given each new year on January 1. Your job is to get all 8 in one year. First 5 hospitals are preferable if you want this achievement, since there are ridiculously easy awards like, "doctor of the year", "nurse of the year" etc which you can't miss. However you will struggle for "no death" and "patience choice". No death is pretty self explainatory. Patients choice requires high reputation, high cure rate and overall high happiness of patients leaving the hospital. It took me 2 in-game years to start getting it on yearly basis. Have efficient staff by training everyone, arrange the diagnosts to work only in diagnosis rooms and the ones specialized in treatment to work only in treatment rooms. If you plan to get this in latter hospitals you may want to close off Surgery and DNA lab. These having the highest mortality rate regardless of qualification of your staff and the level of machines, especially DNA lab. DNA patients have 100% chance to die if the treatment fails, so avoid those.

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Shoot 1 Monobeast
Monobeasts are little, worm-like creatures that are lurking in your hospital. Some people speculate that they can only appear in your hospital when Patients with Monobrow illness come. I did saw them dropping off of them. But in latter levels there can be no Monobrow patients and they still appear, so this was never confirmed. One thing for sure though, they like to make homes preferably under your wending machines and bins, especially dirty bins. If you pick either of these up you will disturb their presence and they will start to scatter. They are harmless, except after you kill one, people may slip and fall on them. Hover your cursor over scattering monobeasts and it will turn into sight, press LMB to shoot monobeasts. it will unlock this achievement. You can't shoot them if pause or slow down the game.

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Shoot 10 Monobeasts in a row without missing
Extended version of the Low Brow achievement, which will require some patience, but not that hard actually. If you shoot multiple monobeasts in rapid succession, you will see streak X appearing above killed monobeasts. The trick is to kill 10 monobeasts without missing. That's where space button will come in very handy. Find a place in your hospital with the most bins and wending machines stacked up together for a while, or set it up. You may need to find a hospital you don't mind messing up, or better yet - disable auto save feature, because when I was going for this achievement I auto saved and sold all the rooms to reveal every single monobeast in the building, I got the achievement but the data has been saved, messing up my hospital. Luckily it had 3 stars already, so no big deal. If you have trouble with this, watch this video:










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Injure someone with an exploding machine
You will probably get it without even trying especially in Sweaty Palms hospital. Every machine has 10 uses before it explodes (except Heart Racer which has 14). Machine will catch on fire after 9 uses, make sure there are no extinguishers nearby or disable janitors from extinguishing fires. After machine catches on fire, the patient and doctor will stupidly wave around with their hands up and won't leave the room until machine is extinguished. Burning machine will be slowly losing it's remaining health until it reaches zero at which point it will explode, injuring everyone in the room. The patient will probably rage quit, but it will unlock this achievement.

Earn 1 Star at each hospital in the Pointy Mountains
Earn 1 Star in every hospital of Bigfoot DLC. Underlook Hotel, Swelbard, and Roquefort Castle namely.



Earn 54 Gold Stars
You will need to earn all stars in the main game and in some DLC. It will take at least 80+ hours poured into the game.



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Complete the "Cheesier Gubbins" Research Project in Swelbard
Swelbard is all about researching. You will be given a single researcher from the beginning. Getting more won't be a problem, since all staff for hiring will be unqualified. Cheesier Gubbins will be the third project to research. If you are going for 3 stars on all hospitals you won't miss it. Use tips from previous achievements if you want to speed up researching.



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Have a Level 5 De-lux Clinic at the Underlook Hotel
De-lux Clinic isn't very popular in Underlook Hotel. To increase room's level you need to fill it up with various furniture that increases room prestige. The easiest way to do this achievement is to have all walls in the room covered with golden award.




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Knock the socks off of Bartholomew F. Yeti
I got this achievement randomly. Bartholomew F. Yeti is one of VIPs. He will visit your hospital at some point of you playing Swelbard hospital. Your task is to impress him, the same way you do with other VIPs. Expand your hospital, aim at increasing it's attractiveness, and prevent deaths during his visit.

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Get a Curing Spree on Topless Mountain
On Topless Mountain, you will be given a single set of patients at a time, called a Wave. Your task is to cure 10 patients without failing a cure. If you do this, all further income from cured patients will be mutiplied by 1.50x for as long as you can maintain the streak. You should be able to earn it, on wave 10+, after you train your staff, and upgrade your machines.



Earn 1 star at each hospital on Pebberley Island
Earn 1 Star in every hospital of Pebberley Island DLC. Pebberley Reef, Overgrowth, and Topless Mountain namely.



Earn 63 gold stars
You will need to earn all stars in the main game and in 2 DLCs. It will take at least 100+ hours poured into the game.



Unlock every plot in Overgrowth
In Overgrowth, unlike other hospitals, you get plots for free by completing selected objectives. Certain plots will require unlocking of other plots. There are a total of 32 plots to unlock. There will be a lot of patients which will require 10+ GP offices, 6 receptions, and 2 of every other diagnosis rooms.



Complete Wave 42 on Topless Mountain
This one took me a very long time. On Topless Mountain, you will be given a single set of patients at a time, called Wave, which you will have to cure before you get the next one. This means you will have to cure patients fast to prevent your expences from overwhelming your income, to win a wave, you need to achieve objective's cure rate. If you fail, you will have to redo the wave. Unlike other hospitals, you get your first bankruptcy warning when your budget reaches -250000$, and hospital will be shut down when budget reaches -500000$ which means game over. It was on Topless Mountain I lost for the first time. You start with 10 patients and cure rate objective of 55%. Each new wave adds +5 patients and cure rate objective increases by 5% every 10 waves. On later waves, this hospital also requires active queue and staff management. Focus on gradually expanding your hospital, but don't overspend your budget, you won't even notice how fast you can go bankrupt. Keep your expences as low as possible, you can't afford high salaries here. As you hire more staff, promote and train them, their salaries increase, so do your expences. Try to keep your staff mostly underpaid. It will obviously ruin staff happiness and morale, but you have no choice. Keep an eye on the threats to resign. You will be getting a lot of them, especially from janitors and assistants. Build a nice large staff room for them with all appliances they may need including luxury machines to return their happiness to appropriate level. If space allows, built small toilet room nearby, exclusive for staff members only. If they get pay rage, give them a raise to underpaid level. Getting pay rage reduces staff member mood by -50%, which will almost always result in a threat to resign from anything else.
By wave 20+ you will need at least 4 receptions and 8 GPs Add more diagnosis rooms as required, hire more staff and most importantly train them.

Complete Superbug Project "Hair Removal"
In Superbug Initiative, you can collab with your friends or other members of community, there can be up to 5 members collaborating in a single project. Click on the Superbug Initiative icon in the upper right corner and select the project. Your first and the easiest project will be "Hair Removal". It doesn't require additional people, and therefore can be completed by you alone. You will be tasked with random objectives like "capture 3 ghosts", "cure 10 patients" etc. These are called nodes and you need to complete them to progress. Hair Removal project won't require high-end hospital to complete.



Complete Superbug Project "Learning Machine Learning"
Now this one is tougher. Learning Machine Learning is the 5th and the last project for now. Time to call in your friends, as you should know by now if you reached this project, certain nodes require more than one person to complete. You will need at least 3 additional people to complete this project. This project will also have harder objectives like "make 400000$ in 90 days" or "cure 10 patients in a row". This project does require high-end hospital. You and your collaborators will need to reach at least Smogley hospital to be able to complete this project.



Complete 50 Research Nodes
As mentioned earlier, Research Nodes are the objectives you are required to complete to proceed with the project. You can complete Hair Removal project alone as many times as you want to farm this achievement.

Earn 72 Gold Stars
You will need to earn all stars in the main game and at least 3 DLCs. It will take at least 150+ hours poured into the game.



Expose 50 Alien Infiltrators
In Goldpan and Chasm 24, you will encounter aliens disguised as patients, their cloaking devices will sometime falter with a distinct electric sound and will give them away. These nasties will essentially waste your time by using up your diagnosis rooms, refusing to pay and they will continue to do so until you stop them! Inspect every single patient if you hear electric sound, they can create a real mess if you let slip too many of them. If you identified one, send them home. If you did not mix them up with normal patients, it will put a huge ALIEN stamp on their hud and they will taunt before leaving the hospital. Find and send home 50 of them to unlock this.



Activate every Robo-Janitor prototype in Chasm 24
Semi-buggy. In Chasm 24, you will be introduced with a new very useful type of staff - the robo janitor. Unlike regular staff, they don't need to drink, eat or toilet, and are absolutely free, but require recharging. Their main duty is to maintain stabilizers, and only robo-janitors can do that. And even though they are programmed to do certain duties more efficiently, they cannot be trained. You can have up to 5 of these in a single hospital, and that's exactly what you're gonna do. There are 5 types of these janitors: Mend-friend who repairs things 150% faster. Build & Repair who upgrades things 120% faster. BinBoi who is 70% better at cleaning up litter and empting bins. In & Out who is 100% better at restocking vending machines and servicing toilets. And Life and Death who waters plants 50% faster and can also capture ghosts. You gain these robo-janitors for free by buying plots, but here is the trick: you can't choose what type of robo-janitor you will receive. If you complete Chasm 24 with 3 stars, you will get ability to buy them, and activate whatever type of robo-janitor you need. I had to quit the game before I got this achievement.



Cure a patient with a Frogborne
Easy. Your first Frogborne patients will appear in Camouflage Falls. Just remember to research Toad Hall first.



Earn 1 Star at each hospital in Close Encounters
Earn 1 Star in every hospital of Close Encounters DLC. Goldpan, Camouflage Falls, and Chasm 24 namely.

Complete R.E.M.I. X versions of Hogsport, Lower Bullocks & Flottering
In R.E.M.I.X. update you are offered to complete the first 3 hospitals with altered objectives. To get the achievement you need to get so called "digital star" on all levels. I had to quit the game before achievement popped up.

Earn 1 Star at each hospital in Off the Grid
Earn 1 Star in every hospital of Off the Grid DLC. Wanderoff, Old Newpoint, and Windsock namely.



Earn 81 Gold Stars
You will need to earn all stars in the main game and from at least 4 DLCs. R.E.M.I.X digital stars are NOT required. It will take at least 200+ hours poured into the game.



Maximise your Green Energy capacity in Windsock
In Windsock, you need to buy out solar panels, hydro dams and wind turbines around the map, in order to run your hospital which provide you with electricity. Each energy source provides you with certain amount of energy. Every room requires 1 energy. Surplus energy can be used to accelerate your patients flow, or new staff for hire, which means you won't really need Marketing on this hospital. To get the achievement you need to buy out every single energy source on the map which will increase your hospital energy capacity to 119. As soon as you start Windsock, take all available loans and buy out every single energy source available, and the achievement should pop up, and then restart the level to play properly. I tried to get it naturally, as I expand the hospital, but it didn't work.



Receive the highest possible Eco Rating
In Off the Grid hospitals, there will be VIP from the department of Green Things, who will conduct an Eco Rating. You will mostly receive "Alright", which basically means no reward. To get the achievement, you need to get "Greentastic" rating for your hospital when she comes. To do this. You need to make sure that your hospital is very attractive. Place a lot of flowers around your hospital and most importantly maintain them, using your janitors. The achievement should pop up as soon as the visit is successful.




Cure a patient in the Herb Garden
Very easy. In Old Newpoint, you will get your first Herb Garden patients. The Herb Garden doesn't need to be researched, and you even get one for free at the beginning of the level.

Train Roderick Cushion to Level 5 at Plywood Studios
Plywood Studios objectives mostly revolve around this guy - Roderick Cushion, and you need to unlock all 5 training slots for him. You start out with him at your disposal. He has single training slot, random traits, you can't fire him, and he has ridiculously huge salary which will increase even further as you develop him up to 150000! You're basically stuck with him for the whole duration of this hospital. So it is up to you to decide where he will work. My advice is to restart a couple of times until you get some good traits like high energy, fast learner or healer if you get very lucky. I made him GP, and got him 5 GP slots. Be warn though, that 2 star objective will require him to cure some patients. The achievement should unlock soon as you unlock the 5th slot.




Achieve a high VIBE rating at Fitzpocket Academy
Filtzpocket Academy is very similar to Wanderoff from Off the Grid DLC, except a little harder. You start with empty VIBE system index similar to Wellness index from Wanderoff, and you will need to work hard to increase it. In the VIBE system index there are two indicators that are different from that of Wellness index. Room prestige instead of Reputation, and Patient Happiness instead of Staff happiness. Maintaining and gradually increasing this index is essential, because it will cover your expenses if you hit at least 100%, which is not that hard.The hardest thing to hit naturally at least for me is room prestige, I mostly do not upgrade rooms higher than level 3, but was forced to make about half of all the rooms in hospital to level 5. Keep patients happy, provide luxury machines and avoid long queues, there will be quite many patients later in the game. You will also encounter Paparazzi here. These nasties are the same as Aliens from Close Encounters DLC, but a little harder to spot. Find and send them home, before they mess up your hospital. Upgrade your machines and train staff to increase Cure Rate indicator. Place flowers and other item around the hospital to increase the Hospital's Attractiveness. You shouldn't have issues with other indicators. You need to hit a VIBE rating of 110% to unlock the achievement.




Complete Wave 18 at Mudbury Festival
This one basically require you to achieve 3 stars in Mudbury Festival, and oh boy, this one is harder than Life, Universe, and Everything achievement of Topless Mountain from Pebberley Island DLC, which required you to complete 42 waves, but luckily doesn't take as long. Compared to Topless Mountain objectives, here you don't have to simply achieve cure rate. There will be some random objectives which you may not be prepared for. If you cure all patients before completing all the objectives, you'll have to redo the wave. Here, you'll encounter this new nasty disease called Soiled Self, which is cured with Wash Pit. The problem is that the patients sick with this will move around very slow. There are at least 4 waves you need to look out for:
There is one wave with sausage guys, which are cured by Pharmacy, you will have about 100 of them at once, and you need to cure 40+ of them. Prepare at least 4-5 Pharmarcies to complete this quickly and have at least five level 3 nurses, you're going to need them on wave 18, preferably maxed out by then.
Next is a mix of Soiled Self and Stunt Trouble guys. The whole wave will contain only them, and there will be about 100 of them too, but luckily you'll have to cure only 25 of ST and 20 of SS. Two of each room should be enough complete this.
Next is wave 11. Nothing wrong with it. Except you gain like 10x money for both diagnosis and treatment! This is perfect time to setup for the ♥♥♥♥ that is awaiting you on wave 18.
The final wave to get 3 stars is a total mess. There are 140 patients and about 75% of them are Soiled Self. The trouble with this is that I had only only 4 GPs by then which is totally fine for all the waves I've completed before to save money. As I mentioned before, Soiled Self patients move extremely slow. Some percentage of them will inevitably rage quit no matter what you do, but it is totally in your powers to reduce this percentage to as low as possible. You will need at least 6 receptions to quickly process them, 8 GPs to diagnose them and 4-5 Wash Pits to cure them. Reducing diagnosis threshold for treatment to at least 70% and enabling Fast Track Decision on this wave is crucial. Reduce all the prices as well by at least -30% to sustain their happiness for some time. Have enough toilets, Snack and Drink machines and provide entertainment. Check Life, Universe, and Everything achievement tips in case you need more.




Earn 90 Gold Stars
You will need to earn all stars in the main game and at least 5 DLCs. R.E.M.I.X digital stars are NOT required. It will take at least 200+ hours poured into the game.




Earn 1 Star at each hospital in Culture Shock
Earn 1 Star in every hospital of Culture Shock DLC. Plywood Studios, Mudbury Festival, and Filtzpocket Academy namely.

Earn 99 Gold Stars
You will need to earn all stars in the main game and in at least 6 DLCs. R.E.M.I.X digital stars are NOT required. It will take at least 200+ hours poured into the game.




Earn 1 Star at each hospital in a Stitch in Time
Earn 1 Star in every hospital of Stitch in Time DLC. Clockwise, Clockwise-before-Thyme, and Clockwise-above-Thyme namely.




Send 100 cured patients through the Yesterizer in Clockwise-above-Thyme
The hardest achievement in the DLC, but isn't really hard actually, it just requires some farming. In Clockwise-above-Thyme you will gain access to Yesterizer. You can use it to send any patients that came to you through the portal back where they belong. Though it requires an Assistant trained in Yesterization and there are 5 levels which will improve the speed at which you send the patients back in time. I suggest getting marketing running and improving your reputation ASAP to speed up new candidates for employment. You will eventually need at least 3 Assistants trained in Yesterization, just don't employ and train them too quickly. Only the cured patients send back in time will count towards this achievement. Though feel free to send any patients that came through the portals back, if your GPs can't handle the flow. This will prevent reputation loss from patients being sent home. I've done this with 3 GPs, with additional 3 portals and dilation of 33%.




Cure 100 patients from time portals in a single year
You will most likely get this without having to do anything as you develop your hospital. In Clockwise-before-Thyme, you will be able to research your own version of Time Portals and can use it to speed up patient flow.




Cure a patient with Lightheadedness, Beheadedness, Hotheadedness, and Byteheadedness in Clockwise-above-Thyme
Another easy achievement. All these diseases are cured in the Deluxe-a Luxe clinic. You can also use marketing to attract patients with these diseases, but I am pretty sure it's not necessary.

Earn 1 Star at each hospital in Speedy Recovery
Earn 1 Star in every hospital of Speedy Recovery DLC. Ailing, Betts Shore, and Pointy Pass namely.




Earn 108 Gold Stars
You will need to earn all stars in the main game and all DLCs. R.E.M.I.X digital stars are NOT required. It will take at least 200+ hours poured into the game.




Collect 20 patients in one trip with a Pantomobile.
In Speedy Recovery, you will be introduced with a new Emergency mechanic. You will be sending Ambulance into hot spots yourself, which will deliver you patients. The potential illnesses you will have to deal with can be viewed in the dispatching menu. This achievement requires you to collect 20 patients at once using Pantomobile and this can be done in the first hospital. Moreover I totally recommend doing it on the first location, which is Ailing. Pantomobile has to be researched with all of it's upgrades and then upgrades to be applied on the Pantomobile for it to be able to carry 20 patients. Time to dust off your previous hospital, if you want to do it quicker, as this DLC will require you do a lot of researching. You can still develop research lab in new locations, it's up to you. After you've done this, wait out for a major emergency with 20 patients, and as soon as such location pops up on the tracking map, immediately send Pantomobile there. It travels the slowest out of all cars so it's crucial to send the car immediately, because after location pops up, every minute or so, one patient will be dying, and there can be only 20 patients in one location, so watch closely.




Have at least one of each type of ambulance fully upgraded in the same hospital.
In Speedy Recovery, there are a total of 6 Ambulance vehicles, 3 ground (Compliant Colin, Pantomobile, Big Healer) and 3 airborne (Relicopter, Airloovator, Feather Balloon). You start with Compliant Colin available at the start, a small all-round well balanced vehicle. The upgrades for it and all other vehicles with their respective upgrades have to be researched, before they can be built. This achievement can be earned starting from second hospital of Speedy Recovery DLC which is Betts Shore. Each upgrade costs 5000, which is a total 60000 for all vehicle upgrades, only Gretchen Gearbox can upgrade and maintain hospital vehicles, you can use her knowledge to train more Janitors to upgrade ambulance vehicles, which isn't really necessary, besides those trained Janitors won't be able to repair them.




Reach the top of every league table at once for 3 months.
This one is probably one of the hardest achievements in the game, except it isn't. It's very similar to I'd Like To Thank My Mother. The task is to take 1st place in all graphs considering your performance in Emergency Response for 3 consecutive months. There are 5 graphs: Patients Collected, Cure Rate, Death Rate, Failure Rate, Emergency Reputation. I tried many things: preventing my rivals from collecting any patients at all, making sure I got the most qualified staff etc. - nothing worked, I could only score 1st in all graphs for 2 months and was mostly overthrown on Failure Rate and Emergency Reputation. I got it in the first 3 months after starting Pointy Pass.
Once the level starts, hire as many driving and flying staff as you can and keep sending them each month. Collect as many patients as you can to stay 1st at Patients Collected graph. Prevent deaths and cure failures and don't send home any patients until March. When sending Ambulance, make sure no patient dies in the location you send it to. This will up your Emergency Reputation. If you fail to get this achievement in the first 3 months after starting Pointy Pass, restart the whole level until you do. The rankings are updated each month.