Casualty (series 22)

New F2s Toby De Silva and Ruth Winters arrive for their first shift in the Emergency Department. Toby makes several initial mistakes with one being letting a patient that has overdosed on paracetamol and another being that he fails to insert a simple IV line after 6 years of training. He is then sent out with Dixie when a bomb on a bus explodes on a busy main road. He then realises that the shop that was affected was the same shop as he visited on his way to work. He is then forced to assist Maggie in amputating a lads arm to save his mothers life. Toby questions his decision to become a doctor and almost quits, when he saves the life of a young diabetic girl caught up in the explosion.

Selena and Nathan's baby is recovering in the ED,Angel, has been off the ventilator for the past day. Meanwhile a young mother breaks into a house in order to get her baby but the grandmother confronts her on her escape and she suffers a head injury as the mother escapes. The mother is pursued by the father and when she hides, the baby starts screaming she covers his mouth and nose to keep him quiet and hides him in a cement mixer. She then beats the father after he tries to tackle her, he is rendered unconscious. Meanwhile new consultant, Adam Trueman is out for a run when he sees the young mother about to commit suicide off the bridge. He successfully manages to talk her out of it by telling her how she would regret it. Meanwhile the daughter of one of Guppy's patients who died is desperate to speak to him but he gives her the cold shoulder and demands that Alice deals with it, much to Charlie's disgust. Nathan baby's heart keeps stopping so she is put back onto the ventilator, in order to take the strain off of the premature babys heart. The doctors suggest taking her off the machine after all of her organs are failing after getting an e coli infection. Guppy makes a serious mistake after missing treatment steps in a boys dislocated ankle, while Ruth had told him what had to be done previously. The psychotic mother escapes after Guppy confronts the grieving daughter. The witness to the attempted suicide that Adam attended turns out to be a reporter trying to get an inside scoop by using Adam. Guppy hands in his hospital pass saying that he is unfit to practice.

Somebody from the department has been talking to the press about the departments affairs during the bombing that happened in episodes 1 and 2. Harry Harper makes a statement on the news about the news report, defending the department. Meanwhile while driving to the music studio a man spills his coffee over his legs while driving causing him to crash his car. It transpires that his daughter, Susie, was in the boot of the van and was seriously injured in the accident. New receptionist T.C fools Nadia pretending to be a priest when Tess catches him out and gives him a final warning on his first day. Marilyn Fox is dealing with the inquiry and while she interviews Nathan, he blames Charlie for the events and brings up the incident where Charlie prescribed a patient medicine which caused her to have an anaphylactic shock. Alice then confronts Adam about how the press found the information to which he confesses to but Tess covers for him. Guppy confides in Harry about his drug use to which Harry tries to assure Guppy that he can seek help. Susie crashes from an allergic reaction to the medicine, Adam successfully does a surgical airway and then she is transported up to theatre. The trust requests for Nathan Spencer to resign due to the outcome of the inquiry.

While Guppy awaits a train into Holby a young boy gets his arm stuck in a grate on the railway line, with a train approaching his only option is to break the boys arm and pull him free to save his life. Once in the hospital the mother threatens to sue Guppy about how he broke her sons arm. Guppy then fails to manoeuvre the bone into position to allow the blood to flow so Kelsey and Maggie are forced to intervene. Meanwhile an elderly lady from the train is brought in and Toby is assigned to deal with her. After attempting to treat her with Adam's guidance, he once again fails to successfully remove blood from her artery therefore Ruth decides to step in. The mother slaps Nathan after he tells her to take her domestic home with her, Nathan calls the police on her and gets her removed from the department even though her boy is deteriorating in recess for some reason that Guppy can't seem to work out. Guppy then successfully comes to the conclusion that he is a hemophiliac and that the bruises are a symptom and not from his mother or bullies. The boys brain bleed needs a bore hole operation, the surgeons are busy and Maggie attempts her first ever bore hole with Guppy's guidance as Adam is out on a date and not available to come in. Guppy takes over from Maggie after one failed attempt and tells her she can't continue with her shaky hands. Josh's friends from the previous season, Davika and her daughter, are back for plastic surgery, Charlie comes across as implying that they shouldn't be in the country and won't pay Josh back which infuriates Josh. Guppy decides that he will still leave the ED even after having a successful day. Harry returns as the new Consultant manager much to everyone's, especially Nathan's, shock.The train and station scenes were filmed on location at Wirksworth on the Ecclesbourne Valley Railway.^[4]

With Harry's first day back in the ED under his new duties, he is quick to work with helping Toby out with his cases. Harry is ordered to fire Nathan by his superiors, much to Harry's outrage due to his recent losses. Meanwhile during an Army training exercise with live ammo, a medic is hit from behind with a bullet. Nathan slips on spilled coffee banging his head. While Harry is treating Nathan he tells him that he no longer has a job with which Nathan takes in his stride. The soldier collapses after his superior officer tampers with the machines. Ruth forgets to take a simple pregnancy test on a patient and when it looks like this will have repercussions on her when it turns out that she is pregnant, Ruth blames the mistake on Nadia. The soldier later dies after Adam and Maggie try to operate on him. It transpires that the superior is responsible for the shooting, after he was caught stealing and selling army equipment.

As Adam is telling the family that they could not save their son Toby bursts out laughing and is reprimanded by Adam and sent out on an observation with the paramedics. Davika is leaving for India much to Josh's disappointment as he really loves her. Meanwhile a family are walking through the woods when a car careers off the road through a field, runs down the mother and crushes the granddad into a tractor all the while with the young daughter staring on. It turns out that the driver was a drug mule and a package leaked into his stomach causing him to crash and subsequently die. The grandfather is in a very bad way and Toby tells him that he will probably die as the pressure of the tractor is keeping him alive, he later passes away and Toby faces his demons and tells the family while trying to keep his nerve. Ruth humiliates Adam as when he is trying to tell a woman her brother has died she wears a red nose trying to embarrass him, Adam asks why and she replies that if he doesn't take the blog down she will start acting like her nickname. Harry tries really hard to avoid Charlie or Tess being made redundant but is left with no choice but to let one of them go by Christmas. Josh decides that he will try and pursue this love life with Devika and jumps on the next plane to India.

With Ruth struggling to treat her patient she asks Adam to step in and with a little prompt she reaches the correct course of action. The patient is then stabbed by his brother in resus and dies from his new injuries. The police turn up and begin to interview all of the staff. Charlie turns up late for work after dropping Louis off at school. Harry tells him that he is not in a position to ask for favours after he asks for their meeting to be rescheduled. After smoking in the school store room, Louis and his friends accidentally set fire to the school. With resus closed because the police are examining the crime scene from earlier, Harry decides to upgrade HTC into the temporary resus. With the help of Big Mac, Toby manages to successfully unmask the true culprit behind toxicshark.com, T.C. Toby is forgiven of the false accusations and allowed to do proper doctoring duties instead of cleaning and laundry. After a gas canister explodes in the storeroom the teachers begin to evacuate. As they are trying to escape they are greeted by a fire door with a chain around it, forcing them to turn back to look for a different route out. Greg is first on the scene and despite Dixie's orders he enters the burning building, saving a whole classroom full of pupils. After hearing more screaming from inside the building, Greg ventures back in to find a girl impaled by a plank of wood. While treating her he begins to succumb to the smoke and he is then saved by the fire brigade. Charlie starts to think that the worst has happened to Louis after there has been no sighting of him leaving the building. Charlie finds out that Louis is safe as he skipped school after starting the fire, leaving every other pupil in the path of the impending fire. Adam calls Alice 'squeak' one too many times and she finally tells him her true feelings, about how he is being insensitive to both staff and patients. T.C. and Kelsey are put on punishment duties after Kelsey helps T.C. set up a prank to apologise for his recent blogging which causes Harry to have to lay down the law.

Charlie is still struggling to cope with Louis and while trying to ensure he doesn't skip school again he ends up missing yet another HR meeting. The board decides that the blog T.C. made was out of order and to terminate his contract within the department. Charlie gives him a second chance but revokes this after T.C. is caught selling goods on hospital premises. Meanwhile a GP is brought into the hospital after collapsing, Toby calls her partner without consent and the doctor is forced to tell him she is hiv +ve. As her partner goes to leave her son blocks him and punches him in the face, sharing blood, possibly infecting him. Toby's mum, Professor Windsor, visits the hospital for a lecture and to check up on Toby but witnesses him having a very bad day after a patient refuses to let him treat them. Louis gets expelled from school and Charlie goes to pick him up but he is not there, when he checks there house he finds a large bundle of money hidden in a shoebox. Tension rises between Dixie and Greg after Greg has to deal with a solo call to treat a security guard and no ambulance comes for over an hour. The patient later dies causing Greg to begin to lose faith in his job.

It's Tess' last day before she will be made redundant, While Charlie and Tess drop Louis off at a friends house they witness a woman being dragged under a car. Meanwhile an overweight woman comes in to the hospital with stomach pains when it turns out that she has lost her baby. Toby realises that she may be cheating on her husband, Charlie tells him to tread carefully. After the woman phone's Charlie she tells him where she hid the baby, Charlie gets a lift from Dixie and Jeff and they find the baby, freezing cold. Jeff places the baby inside his top as Charlie says it's the best way to warm it up. As they make their way back Charlie gets out the ambulance after seeing Louis, who didn't turn up at his friends house, walking down the street. As he follows Louis he comes across the car from earlier that ran down the woman. The man then hits Charlie after the police give chase. The team give Tess a send off and they arrange a trip for her to go see her son, Sam. After Toby's patient, the woman with the baby, crashes he preforms a solo cardiac shock. After Maggie congratulates him, he snogs Maggie under the mistletoe. Charlie suspects that something more may be going on between the two doctors. After Charlie tells the man who dragged the woman under the car that she died, Charlie punches the patient after he makes remarks about her, the patient retaliates injuring Charlie. Harry asks for Charlie's resignation, to which Charlie accepts in order to let Tess keep her job and to spend more time with Louis.

With the year drawing to an end Kelsey, Abs and Harry's daughter go to the Paradise club to end the year in style. Meanwhile a boy, Dean, with mental issues brandishes a gun in his mother while wearing his dads old army clothes. Meanwhile new doctor, Zoe Hannah's car runs out of petrol and she goes to a nearby farm house looking for fuel when she comes across the mother that has been shot. Meanwhile a girl that has been brought in after a car accident is clear of spinal injuries by Ruth, the girl later tries to stand up to go tot the toilet but collapses and can not feel her legs. Meanwhile at the Paradise club Dean has managed to gain entry, looking for his target. As the nurses and Big Mac pop open a bottle of champagne at midnight, Tess storms in sending them all back to work. Kelsey and Abs, first on scene, give a young girl a tracheotomy with a straw much to Dixie and Jeff's praise. Abs follows Dean upstairs to try and treat him when he aims the gun at Abs. Back in the hospital, Ruth lies to Tess about what happened to the patient and blames what happened on Nadia and that she never said to discharge the patient or remove the collar.

After Abs suffers a gun shot wound after trying to calm down Dean, Tess begins to prepare the department for the impending rush of patients from the shooting. Marilyn is forced to scrub up and is given all of the gruesome task from Tess. Dean is shot by the police and is rushed into resus, where he crashes yet still dies even after she preforms a tracheotomy. Tess treats Abs and tells him that the trust can not be held responsible and will not let Abs help out. He disregards Tess' orders and gets Dean's mum to open up and to tell the police that it was Dean who shot her. Adam's patients waters break just as he is about to leave for a party. Adam and Alice then begin to take her up to the ward when the elevator breaks. After receiving a call from his girlfriend asking where he is, the sound of the woman in labour makes her think that Adam is cheating on her and she breaks up with him. The pair are forced to deliver the baby in the lift. Adam's claustrophobia begins to worsen forcing Alice to take the lead in helping to birth the baby. Tess warns Ruth and Nadia that one of them is lying and that she wants the truth by the end of the day or there will be a formal investigation of how the patient was injured in the hospital. With Harry's daughter still missing after the shooting, he snaps at Marilyn after she complains about missing pudding even with all of the injured patients who are also not here by choice. When Harry's daughter turns up, it transpires that Dean has hid his younger daughter in the car after he could not bring himself to kill her. Nadia decides to take full responsibility and hands in her resignation to Tess.

New receptionist Noel he is quick at pulling pranks and joking with colleagues. A young hitchhiker, Joe, catches a lift from a lorry driver, after she brandishes a screwdriver on him they swerve off the road into a caravan. Abs calls for a nurse meeting after receiving a letter from the nurses union about Charlie's situation, the union decide not to support them and Abs decides that the nurses will do an unofficial work-to-rule where the nurses will do the bare minimum as stated in their contract. Ruth goes out to the accident scene as the response doctor after a prolonged entrapment. Ruth makes another careless mistake after not checking how much morphine Greg gave Claire before giving her more causing a morphine overdose. Ruth then begins to insinuate to the boyfriend that she knows that he is beating Claire and locking her in the caravan but it turns out that it is her that is neglecting him. Marilyn threatens Kelsey that if this work-to-rule continues then another nurse might lose their job. After the driver of the lorry dies Zoe blames Abs for his death, Abs then makes an inspirational speech about how he is not the issue and how hard nurses work and that they go above and beyond theur job description yet when they do what they're paid to do they are blamed for negligence.

In a chocolate factory a man has fallen into a chocolate vat. Dixie jumps in to rescue him after he starts to drown, she then gets stuck and begins to sink with the patient but is rescued by the fire brigade. Meanwhile a woman's leg is amputated when a train runs over it and is brought into resus. New nurse Lewis is straight into resus but Tess quickly sends him out due to his lack of experience. Kelsey and Alice set up dating sites after Adam suggests it to them. The patient from the chocolate factory stops breathing for no reason while being treated by Lewis and is rushed into resus where Harry praises Lewis for his quick response. It turns out that the woman wanted the train to amputate her leg so Zoe diagnosed her with BIID (Body Integrity Identity Disorder, desire for elective impairment). After Maggie interferes with Zoe's patient, Zoe makes it clear to Maggie that she won't tolerate it. Her patient then begins to spasm while Lewis takes her up to theatre. Tess shares her suspicions about Lewis to Abs. While Tess is taking a patients body to the morgue she is ambushed by Lewis who injects her with the same substance he gave to the other patients. Big Mac finds her and races her into resus. The team begin to treat her and as she begins to regain consciousness she warns the team that it was Lewis and they seal off the hospital. Big Mac successfully manages to apprehend him. Lewis says that he did what he did, so that he could then save their lives in resus and impress other people. After the shift Adam goes out to an engagement party where he meets Jessica Harrison and they have a one night stand together.

Maggie's daughter begins her contractions, Jeff is injured in a pub brawl making Greg consider whether he should resign after Dixie calls him a liability. While vandalisng the underside of a bridge, the man slips and is left dangling down from the bridge. Greg is first on the scene. The rope snaps and he falls onto the road causing a car pile up. As Greg checks out the damage he finds that his patient from last week, Ruby, was involved in the crash. Chloe, the mother, has been impaled through the stomach and is trapped in the car. A chemical from a van begins to spread across the scene causing the fire brigade to tell the paramedics to retreat. Chloe passes away and Greg tells Ruby that her mother is just sleeping. Back in the hospital Ruth is treating the graffiti artist in cubicles while Adam treats Ruby, After Adam requests a blood gas for Ruby, Kelsey tells him that seen as she is on an agency shift she can not do them much to Adams disgust. Kelsey asks Adam to step outside where she tells him that she is not impressed with his attitude. Tess is forced to close the department as they can not cope with all the patients, even though Dixie and Jeff are literally minutes away they are forced to divert to St James, an extra 10 minutes away. It then transpires that the chemical was Carbon tetrachloride, Ruby dies after Adam, Kelsey and Zoe try desperately to resuscitate her for 30 minutes. Tess shouts at Abs blaming the work-to-rule in causing the death of the elderly man ,that Dixie had in the ambulance, and Ruby . The department gather outside to see themselves in graffiti as the graffiti artist from earlier made them a tribute.

Toby calls off work sick and Harry is desperate to see him to check on how he is coping after Ruth's suicide attempt. He does not want the department to fail Toby as well as Ruth. Everyone is directed to Holby after St James deals with a major RTA. Meanwhile a group of 3 kids run through the woods after overdosing on antidepressant pills. After bumping into an estranged old man the boy ends up stabbing the man in the stomach. Marilyn tries to force Harry to sign off on a press report that says that Ruth could not cope and that it was her own fault. While attending the call to the woods, Dixie, Jeff and Snezana manage to get the ambulance stuck in the mud. Meanwhile at the pub Toby is forced to help deliver Maggie's daughters baby while he is under the influence of alcohol. Dixie and Jeff do not notice the girl in the woods and leave to assist Toby, presuming the call is a hoax, only to find the stabbed man in the middle of the road. Johanne's baby's cord is stuck and Toby calls Tess to try to get help as the ambulance has been delayed. When the paramedics arrive Snezana argues with Dixie over whether they should risk delivering the baby in the pub or attempt to transport her to the hospital. Toby is given the final decision and chooses to deliver the baby in the pub. The young girl who was in the woods with the boys collapses and is found by police and brought in. Adam, Harry and Kelsey treat her when she begins to deteriorate. They then discover that her friend was the one who stabbed the elderly man with dementia who is fighting for his life in resus. Harry refuses to let Maggie have a few hours off to see her daughter in maternity. Harry then gives Toby a week off for compassionate leave if he agrees to see a specialist. Marilyn threatens him that if he goes public with Ruth's diary then the board will ensure that he loses his job.

Toby returns after his compassionate leave and tells Harry that he thought that him of all people would have supported Ruth after reading the newspaper article. Curtis and Jeff bring in a patient with a severe leg injury, Sean Anderson comes down to the department to assist Toby and Zoe in treating the patient. Dixie and Snezana bring in a young girl who has been impaled in the neck by a bracket, Harry tells Toby that the two of them will work together on the case. Toby manages to form a connection with the patient and successfully manages to treat her, Harry treats the mother and discovers that she has been burned by an iron on her back, she confides in Harry over how her husband has been beating her. After Toby's patient begins to deteriorate Tess suggest paging Harry, Toby then puts Martha to sleep in order to intubate her, when he can't fit the tube down her throat he is forced to perform a surgical airway, Adam tries to stop him as he has not been trained but Harry decides to let him try and encourages him. After he successfully manages the airway, he is praised by the team. Adam criticises Harry over leaving Toby by himself when Harry tells him that him flirting with Jessica wasn't exactly productive either, Adam then tells him that he had already offered his services earlier to which Harry refused. Noel breaks patient confidentiality after telling the woman's abusive partner that she is in cubicles. It then transpires that the husband is not only abusing the mother but also the daughter. A formal complaint is lodged against Jeff after he makes offensive and racist remarks towards a patient. Harry reaches out to the press and gives them Ruth's diary as he believes it will help hundreds of F2's like her.

With Ruth now off life support, she is beginning to recover but is still not awake, Adam braces the team that they will make one final attempt to take Ruth off of sedation and warns them that they should say their farewells. Harry is brandished by the press as part of the cover up, Marilyn tries to make a scapegoat out of Harry after the public cry for the boards resignation. The team applaud Harry for his actions when he then tells them that this will be his last day as consultant manager of the department. Meanwhile a construction worker falls from his site and is rendered unconscious, during his fall his building materials also land on other workers and on a car. Adam and Harry clash while treating the man who fell and argue over whether to intubate or not, their argument spills out of resus and into the corridors where Adam questions him as to why he waited so long to release the diary. Charlie is working in a Health Centre where he is treating a patient with whiplash. Marilyn makes an official press conference criticising Harry's actions, he then suggests to Adam that he should become the next Clinical lead which Adam declines. After Harry's departure, Toby finally manages to pluck up the courage to visit Ruth when after speaking to her, she begins to move. Harry decides to play one last ace-By inviting Charlie to return to the ED.