The train on which Marian was travelling crashes, trapping her in the wreckage. Although she cannot escape, she's free to move around the carriage to help those injured, assisted by fellow passenger Dr Nick Burnett - who turns out to be the Royal's new locum. Back at the hospital, a shortage of staff puts the casualty department under pressure when the crash victims begin to arrive.

Carnegie disapproves when Nick admits several homeless people from Elsinby to the hospital. Gordon is reluctant to let Jill take on heavy duties. However his plans fall apart when she is called to attend to road along the coast when a female victim of a car accident goes into labor. Meanwhile, Matron is stunned when she sees who is the new student nurse, and patient who enjoys gossip discloses where Ken is.

As the hospital staff come to terms with the loss of Stella and Frankie, everyone’s surprised when an attractive surfer, who crashes into Dr Burnett’s car, turns out to be the new ambulance driver, Bobby.

Alun is getting ready for a gig in town with his new band and deafens everyone while he practices in the porter’s office. Marian reasons that they should all go and watch the gig as Stella loved a good night out and wouldn’t want to see her friends sitting in every night. However, when Dr Burnett explains he can’t go as he’s on call, Marian is soon charmed by Bobby, who agrees to be her date to the gig. Will Marian turn to Bobby for a good time?

Dr Burnett is called out to a run down farm house where 15-year-old Simon, who has speech and learning difficulties, is running a high fever. The farm is in a bad state and the family seem to be struggling to cope. They’re horrified when Burnett reveals he needs to get Simon to hospital ASAP in order to rule out meningitis. Will they get to the bottom of Simon’s illness?

Weatherill treats a schoolgirl whose crush on a teacher has spiralled out of control, while Ormerod and Ellis launch a daring cliff rescue when a family picnic goes awry. Jack and Alun use an old map to hunt for buried treasure underneath the hospital, and an old friend of Matron is taken ill.

Mr Middleditch has come in to St Aidan's hospital, accompanied by his wife, for a routine operation. Noticing that Mrs Middleditch looks unwell, the hospital decides to give her a blood transfusion. Distracted by the attentions of a rich divorced playboy, who has promised to marry her, Susie Dixon administers the wrong blood, which later results in serious consequences for both her and the patient.

The hospital’s future is in doubt following DHA's decision not to sanction a financial package to repair the Casualty department. The hospital is only offered an authorised high interest loan, that doesn’t cover all the costs of the everything that needs to be done. The hospital's budget for the year ahead has also been cut so that the Royal will need to dip into the Middleditch trust fund to keep the hospital open. Jean ends up announcing that the only way forward is to consider a a complete closure of Casualty. Ralph ends up taking some secret action to rectify the situation but also ends up bringing up some difficult issues in his past. Carol and Ralph finally end up getting together.

A can of worms is opened when Gordon attends to a local family's problems, and when violence spills onto the Royal's wards he gets caught up in the crossfire. Meanwhile, baby Aisling's adoption is final. However, Sister Brigid is confused by her feelings.