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.

Arch tests to become a fellow of the College of Emergency Medicine but winds up running out of his evaluation with his test patient when the man arrests in the middle of the examination. Finding her grandmother collapsed on the kitchen floor, a six-year-old girl directs the staff to her grandmother's house over the telephone. When the elderly woman dies, Macy takes the young girl home until her vacationing parents can be contacted.

Julia finds herself taking a personal interest in a severely depressed patient after he talks about killing himself and his family. Julia attempts to have the man committed to protect his wife and child, but an improperly filled out form allows him to be released back to his family. Arch, Bree, and Wayne are called out to rescue an injured sky diver but discover that they must also locate the man's detached arm. A man believed to be a Jehovah's Witness dies when the doctors cannot not give him a required blood transfusion

Red's wife phones from Jakarta to tell him that she is pregnant—but that he's not the father. Wayne and Julia are forced to operate in the field when an approaching cyclone grounds their helicopter on a remote island. Before leaving for Jakarta, Red goes to Harry with his desire to have Wayne and his bad bedside manner removed from the ER. With three doctors away from the department, Harry is called upon to take over a delicate procedure from Oopy when the ambitious young intern gets in over his head. Wayne seizes upon Red's absence to endear himself to Harry.

During an unusually quiet graveyard shift, Gosia personally welcomes new intern Sean Michaels to the hospital. In dramatic fashion, Oopy announces he is quitting to become a successful cosmetic surgeon in Hollywood. A light in an abandoned building across the street draws Wayne's attention, when he goes to investigate, he gets stuck in a malfunctioning elevator and then stumbles onto a computer being used in an illegal fund transfer of $80 billion from Swiss banks. Two twins treated after suffering nearly simultaneous heart attacks leave the hospital a sizable donation