"Black Alert" is the 980th episode of Casualty and the 19th episode of the 30th series. It was preceded by "Lie to Me" and followed by "Shame". It was directed by David Beauchamp and written by Matthew Barry, and will be the first episode since the two-part series premiere to feature all of the main cast members. In addition, Henrik Hanssen, portrayed by Guy Henry made another guest appearance in this episode.
This episode primarily focused on Lofty's interview and leadership as well as the chaos of the black alert in the ED, hence the episode's name. Ethan's emotions are also clearly shown to be in a mess, and it's clear that he has become dissatisfied with himself in the workplace.
Before the start of his shift, Ethan is standing outside the ED reflecting on the recent events in his life. Lily approaches him and says he can't blame himself for missing the signs of Olivia's abuse beforehand, and tells him that "mistakes happen", referencing her harshness to Alicia which she is now seen to regret. Elsewhere, Lofty prepares for his interview for a band 6 nursing position. Rita calls him into the boardroom, and inquires as to whether he received her email, but when he says no, she tells him it doesn't matter anyway. Upon entering the meeting room, it becomes apparent that the email was regarding the fact that the hospital's CEO Henrik Hanssen would be observing the interview process.
Meanwhile, Connie receives a phonecall informing her that St James's has been put on black alert, and she fears that they'll close their doors and divert to Holby General Hospital's ED. She then asks Ethan what he wanted to tell her after Lily told him to take the day off earlier, but he has second thoughts and tells her it's nothing. At the paramedics office, Dixie finds some flowers on the table from Jess, thanking her for her efforts to save her and Olivia the week before. However, Dixie tells Iain that it still doesn't change the fact that she had made the complaint, as they're still going ahead with the investigation.
At reception, Jack inquires as to why there's been a black alert at St James's as it's clear that there's been no major incident. They are interrupted by Big Mac who tells him and Noel that he has passed his motorcycle test. As Ethan is walking through reception, Lily catches his attention and asks why he is still in work, but he tells her to leave it, most likely due to the fact he wants to dive into work in order to take his mind off things. Just after this, Cal greets Ethan only to get a blunt reply. Overhearing this, Charlie assumes that Cal has told Ethan about their birth mother, so he just plays along. Meanwhile, Lofty finishes up in his interview only for Connie interrupt to inform Henrik Hanssen that the hospital has been put on red alert and that she needs all clinical staff back on the floor.
Elsewhere in the ED, Zoe has returned back to work after her temporary departure in November, and Max asks her how her trip was to the United States. He asks who she was with, and she tells him she went to see Nick Jordan, a former colleague. However, Max is unaware of the romantic history between the two. The stress levels within the department start to rise as the patient count is increasing, however Ethan is approached by a desperate man named Chris who is struggling to cope with the loss of his wife and son the year before. Before he is able to give him proper attention, Connie interrupts and tells Ethan he is needed in the ED due to the patient volume.
A young couple, Sarah and Lee, have departed for a trip around the world. They plan to visit different places and meet up at the end of their individual journeys. Back at the ED, Ethan starts to treat an elderly woman named Flossy who has been brought in by her friend Mo, and has been suffering with abdominal pain. He later discovers that she has had a heart transplant years before, and it was Mo's son who donated the heart to her when he died. Outside, Charlie, Dixie and Iain have a small argument as the paramedics are trying to get rid of patients to the ED, but Charlie is annoyed due to the overcrowding. Elsewhere in Holby, a clearly suicidal Chris is parked up with a bottle of liqueur and some tablets, presumably prepared to overdose. However, he appears to have second thoughts and opens his car door, but this occurs just as Sarah and Lee ar driving past which causes them to crash into the back of a nearby parked truck.
At the Emergency Department, Dylan inquires about how Lofty's interview went, and Rita tells him that he gave a good interview. Back at the scene of the car crash, Chris calls the ambulance but then runs off possibly out of fear. Ethan continues to treat Flossy at the ED, but discovers that her gut is being starved of oxygen and will require an operation to correct. However, Flossy insists that she doesn't want an operation, as she's too old. Ethan becomes angry after he is unable to find any available space for Flossy to feel comfy in her final hours. Henrik Hanssen then informs the team that St James's are closing their doors to all admissions and diverting to them, much to their frustration.
At the scene of the crash, Iain and Dixie manage to get Sarah and Lee out of the car, only for it to explode seconds later following a petrol leak. Coincidentally, Jess also arrives at the scene, but her and Dixie try to act professional. At the ED, Louise is lumbered with a difficult patient, Peter, who refuses to be triaged, and demands to see a doctor immediately. Ethan gets involved, and is infuriated when he says he called an ambulance, and says that he's wasting their time. Cal and Charlie manage to calm him, and Louise gets the man back to reception. Soon after, Cal admits to Charlie that he hasn't told Ethan about their birth mother, and tells Charlie to stop getting involved. After Louise manages to get Peter to reception, he begins to take pictures of the ED and the staff to post online and show "what the so called NHS has become". Infuriated, Lofty insists that they'll have to call security if he doesn't comply. However, the argument escalates and results in Lofty being pushed backwards through one of the glass pane dividers in reception. Although not severely injured, he sustains minor injuries to his face.
Whilst the staff are clearing up the glass in the reception area, Connie suggests to Hanssen that they request tents from the ambulance service and set up a triage outside to reduce the stress on the ED. Although he initially has doubts, Lofty offers to take charge of the operation. Meanwhile, Sarah and Lee are being treated in the ED but they notice that she is tachycardic and her pulse is weak, but they can't figure out what the cause is as she was conscious at the scene. Lofty informs Connie about his plans for the outside triage, whilst Jess approaches Dixie. She asks if she got the flowers, and lets her know that she's dropped the complaint. bt Dixie tells her that they're still going ahead with the investigation. Jess asks Dixie if she'd like to go for a drink, but Dixie doesn't think that it's a good idea.
Lee is told that he has broken several ribs, but should recover. After a chat with Jacob, he decides that he doesn't want to leave Sarah for their break, and says he wants to go and see her so Jacob takes him to where she's being treated. Outside in Lofty's tent triage, Peter returns with Louise and she notices that he's burning up so gives him a bed, although he complains about being treated in a tent. Big Mac also sets up the fundraiser stand which was in reception for a new infuser. It's a competition between the women and men to see who can raise the most money. Max approaches him and asks him who Nick Jordan is after Zoe mentioned him earlier. Meanwhile, Lily begins to treat Peter despite all his complaining. Upon checking his symptoms, Lily concludes that he has the common cold and that he has wasted her time.
Back in the ED, Sarah stops breathing and upon further inspection, Connie discovers a small puncture in her chest. Ethan is intent on saving her and tries to perform a procedure in the ED. The puncture has occurred close to her heart and resulted in a clot which is causing her heartbeat to slow down. Ethan performs the procedure with the help of Rita and Robyn and it's successful and they manange to get a faint pulse. In the tent outside, Louise notices that Peter is still there, and gives him a lecture on what effect his time-wasting has on the grand scheme of things in the NHS. Following this, Lily tells him he got owned. Back outside the ED, Dixie apologises to Charlie about their disagreement earlier, and when Lofty asks why they've suddenly made up, he attributes is to the fact that they're passionate people.
In Lofty's triage outside, Rita comes in and is impressed with his organisational and leadership skills. He also asks Big Mac to take down the infuser fundraiser table saying that it's inappropriate. Inside, Cal apologises to Charlie for his rudeness to him earlier and he says it's okay, as it's his life and he can choose what to do. The donation boxes for the infuser are moved back to reception, and Noel and Jack celebrate as the men are winning by a long way in terms of donations. However, their celebration is cut short after Big Mac delivers a letter for Louise. Inside, she finds a note from Peter along with a large wad of cash, telling her to put it towards the donations. Robyn and Louise are left happy having clearly won.
Towards the end of the day, Hanssen arrives at Connie's office to congratulate her for the day, and lets her know she made the right call and congratulates her. Following Sarah's treatment, Ethan goes back to visit Flossy who peacefully dies with Mo at her side. Just after, he receives a text from Cal telling him they need to talk. Back at the paramedics office, Jess visits Dixie and they kiss. However, Dixie asks Jess to leave, saying she can't do it. Elsewhere, Ethan asks Lily if she's seen Cal but she says she hasn't. He inquires about a covered body of a patient who had died, and she tells him that he "had a fight with a bus" and was DOA. After Lily leaves, he notices the hand of the patient sticking out and recognises the wedding ring. He pulls back the cover to realise that it's Chris. He's left feeling distraught knowing that he could have stopped him from leaving the ED if he hadn't had to go to help elsewhere in the department.
Back in the tents outside, Rita informs Lofty that his shift ended two hours ago, and is wondering what he's still doing there. She then tells him that she initially had one reservation which was whether he could step up and lead, but said he proved himself by setting up the triage outside. She offers him the job if he wants it and congratulates him. He goes over and thanks Dylan for his support, and hugs him, saying he owes him a big drink.