Dr. Harry Edwards is forced by the hospital's board of directors to appoint new arrival Dr. Red Buchanan as his successor for the Head of Bethlehem West's emergency department—despite Harry having promised the job to his Deputy Director, Dr. Julia McAlpine. Wayne makes a failed pass at Julia, describing to her the dreams he has had about the two of them together. Wayne and Bree are sent into the Glasshouse Mountains on a medivac to rescue an injured hiker. Tensions resurface between former colleagues Arch and Red now that the two are once again working together. Offended at being passed over for the Directorship, Julia hands in her resignation.

An accident at a theme park marks Red's first day as Bethlehem West's new Director of Emergency Services. Julia's decision to remove and injured girl from an ambulance in favour of a more seriously injured person has tragic consequences when the distraught father of the injured girl attempts to drive his daughter to the hospital himself. Oopy's decision to aggressively treat a cancer-stricken ex-wrestler upsets Gosia. After arguing with Red over the diagnosis of a patient, Wayne approaches Julia to tell her that she has his support. Red talks Julie into staying on with the promise that the department will be hers once he leaves.

A 58-year-old woman acting as a surrogate mother for her daughter-in-law and deceased son is admitted to the ER with complications. After apparently recovering, she is taken home by her insistent daughter-in-law only to be brought back in the next day, at which time she dies following an otherwise successful emergency cesarean delivery. While being transported to the hospital on a medivac flight, a patient jumps from the helicopter, landing in the river, and Arch follows the man out the door. Finding a patient collapsed in the parking lot, Macy performs an emergency tracheotomy to save the man's life. Oopy objects to Macy's actions and files a grievance to cover up his own misdiagnosis of the patient. Harry smugly announces to Red and Julia that he has become the new Chief Executive Officer of Bethlehem West

A mysterious outbreak causes panic in the emergency department. Oopy's complaint against Macy results in Harry formally charging her with ""breech of official duties"" in connection with her parking lot tracheotomy. Red's famous wife, Jane ""Colonel Doom"" Buchanan, breezes through town between international relief missions. Red approaches Wayne to tell him that his personality may not be best suited to a career in emergency medicine. On a medivac with Dr. McAlpine, Marina helps an accident victim come to terms with his circumstances when it becomes clear that his leg must be amputated in order to save his life

A terminally ill cancer patient, brought in by medivac after crash landing his glider, has his controversial last request granted and is quietly euthanised by one of the nursing staff during the night. Incensed over the ""murder"" of his patient, Wayne wants to call in the police but Harry, not wanting to draw further attention to the incident, prevents the matter from going any further. Macy is found guilty of exceeding her duties and is given a two week suspension for performing the tracheotomy in the hospital's parking lot. Arch loses the lucky drumsticks that were given to him as a child by his violin teacher.