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This episode follows the team in control and crews out on the road in Wigan and Bolton. Filmed in 2023 in the north west of England, one of the areas hardest hit by the cost-of-living crisis, the ambulance service increasingly acts as a vital safety net for those struggling to cope. It does this while also working hard to deliver emergency care to over seven million people living in the region amid some of the most challenging times in the NHS’s 75-year history.

It’s a busy start to the shift for the North West Ambulance Service, with a new call being answered every 15 seconds. The service is experiencing worrying delays, with a category 2 response taking an estimated 30 minutes to arrive, 12 minutes longer than the target.
Advanced paramedic John attends the most life-threatening of emergencies and is dispatched to an unconscious patient who isn’t breathing after a fire in a high-rise flat. On arrival, John discovers the patient is now conscious and breathing, but he is badly burnt.

Meanwhile, in control, another call is received for a man who has been burnt in an industrial accident at a food factory. It is reported that he has been drenched from head to toe in 140° oil. Janine and Kirsty are the nearest available ambulance and are immediately dispatched along with the only Helicopter Emergency Medical Service (HEMS) crew available across the region.

The patient has been extricated from the building with approximately 20 per cent burns. The crew decide the best hospital to take him to is one with a specialist burns units, but with two patients potentially needing specialist treatment at the same time, they fear it may not be able to cope with both of them. The team in control update Janine and Kirsty to let them know they may need to take their patient elsewhere. On arrival at the scene, they work quickly to cool the affected areas. It takes 20 minutes after cooling treatment is applied before they can assess the full extent of blistering and determine whether it is safe for him to begin the journey to hospital.

On scene at the flat fire, advanced paramedic John has already decided the only hope for his patient is to send him to the specialist burns unit at Wythenshawe Hospital.

Fortunately, once Janine and Kirsty get their patient in the back of the ambulance, they find that the injury caused by the hot oil isn’t quite as severe as was first thought. They decide it is safe to go to a hospital without a specialist burns unit.

In dispatch, the team are managing twenty ongoing Category 1 incidents – the highest priority. Across the service, some patients are facing delays of two hours for an ambulance to arrive.

Kay and Mark are dispatched to an 89-year-old male who has fallen after having a suspected stroke. On arrival, the crew assess the patient and chat with his worried wife, who reveals they’ve been married for 68 years. The crew make the decision to urgently take him to a stroke unit where he’ll be treated by specialists.

Eight hours into the shift, and 29 patients are currently waiting for an ambulance across Wigan and Bolton alone, and there are only four ambulances available. Suddenly, control starts receiving multiple calls for a road traffic collision between a van and taxi. Janine and Kirsty are immediately dispatched, along with a number of specialist resources, including advanced paramedic Scott. The paramedics find two badly damaged vehicles. Scott decides to assist the HEMS team in treating the driver of the van, while Janine and Kirsty assess the severity of the taxi driver’s injuries.

Once Scott transfers his patient into the ambulance, he decides to blue light him immediately to the major trauma centre at Salford Royal. The taxi driver is severely injured, but nevertheless he is deeply concerned about the fate of the other driver. It is clear he too needs to be taken to the same specialist trauma centre. His worried wife accompanies him in the ambulance. After both patients are handed over at hospital, Scott reveals the shocking news to Janine and Kirsty that his patient - the van driver - has admitted to driving intoxicated after taking heroin.

As the service struggles with the demand, another incident requiring multiple resources is phoned in, this time for an 11-year-old girl hanging off a cliff in a quarry after rock climbing. Her father is also reported as stuck as he tries to rescue her. Fortunately, they are rescued without suffering injury. After a relentless shift managing growing wait times, a shortage of crews and specialist resources, the relief in control is palpable.