The 41st episode of series 32 is the 1089th episode of Casualty overall. The episode was directed by Paulette Randall and written by Michelle Lipton. This episode marks the first appearance of paramedic Ruby Spark, portrayed by Maddy Hill. The events of this episode are mostly presented as flashbacks as Ruby recounts her day.
On her first day, paramedic Ruby Spark is assaulted by an overdosed drug addict after she revives him. Once she is treated at the ED, she, Iain and Sam attend a hoax call. Afterwards, they arrive at the house of an elderly woman named Daisy with end-stage cardiac failure who is already familiar with Iain and Sam. The calls turns out not to be an emergency and, when her colleagues start helping Daisy with domestic chores, Ruby receives a cold response once she points out that fitting a TV remote with new batteries isn't in their purview.
Shortly after, Sam agrees with Ruby's suggestion of calling the fire brigade to rescue a patient from a garage roof. Her judgement turns out to have been good in hindsight when, in resus, the patient appears to have sustained a spinal injury. They return to Daisy's house where Ruby finds her unresponsive and begins resuscitation, despite Daisy having filled out a DNAR form. Iain and Sam implore her to stop, but Ruby demands to see the actual paperwork. They manage to find the form, but Daisy is soon back in sinus rhythm. She is taken into the ED, and Ruby is heartbroken to learn that she is likely brain-damaged.
Ruby hears that the patient she treated on the garage roof is likely paralysed and is forced to disclose his condition to his wife in order to coax her back inside. However, it transpires that his immobility is only temporarily, prompting Connie to reprimand her for her mistake. However, she is appreciative when Eddie takes responsibility. She decides to sit with Daisy as she passes away.
At the ambulance station, Ruby recounts the events of the day to Jan and, believing that she is not cut out for being a paramedic, she tenders her resignation. Jan tears it up, bluntly tells her the reality of the job and assures her that her colleagues won't hold what happened against her.
Back at the ED, Alicia struggles to keep a lid on her emotions and snaps at Ethan, Bea, Eddie and Ruby. Bea begins to suspect that her instability has something to do with Eddie, and gets her to open up. Alicia tells her about her experience with Eddie in May, and Bea tells her that what he did counts as rape. However, Alicia thinks that she is making mountains out of molehills and leaves.
Meanwhile, Bea is informed by Alex Broadhurst that she has been given the place on the international trauma course. Elsewhere, Jacob finds out that Blake tried to kiss Sam, and Noel Garcia decides to celebrate the NHS' 70th anniversary with stickers.