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This episode centres on the London Ambulance Service's tactical operations centre, a team working around the clock to accelerate response times to the largest and most complex incidents in the capital. During the shift, we see Pete manage the team as they co-ordinate a response to reports of multiple casualties injured in a shooting in Clapham. Meanwhile, we join crewmates Omar and Kez as they care for a number of elderly patients whose stoicism means they’re reluctant to accept the help offered.

The programme begins with just one hour remaining of a busy day shift. Central London crew Omar and Kez are dispatched to a motorbike crash outside Kilburn station as calls from bystanders continue to come in. With reports that the patient may have suffered a leg fracture, Pete and the team in the tactical operations centre deploy an advanced paramedic with the skills to deliver stronger pain relief. As busy London commuters rush by, the team work together at the roadside to realign the patient’s broken leg. To do so, they must remove his clothes. Then suddenly, a family member arrives at the scene, much to the patient’s surprise.

While the team in control hand over to the night shift, the motorbike crash takes Kez and Omar an hour beyond their finish time. Overnight, the service receives more than 2,000 emergency calls and attends over 1,000 patients.

As a new day dawns, there is a backlog of calls – London’s resident population is boosted each day by tourists and commuters travelling into the capital to the tune of more than two million. Back looking after a team of specialist responders is Pete. He will help provide support to crews across London, including crewmates Omar and Kez – who are also back for another 12 hours - and joining them are north west London crew, Bea and Adrian.

In Marylebone, a patient has slipped on dog wee and hit his head, which is now bleeding profusely. Omar and Kez work quickly to stem the bleeding, while the patient expresses frustration at getting older. After dropping the patient safely at hospital, Omar reflects on his role: 'Every time I go to a patient who is elderly, I just think, one day this is going to be me. This job has shown me that life is fleeting. It’s taught me to appreciate everybody and show love whenever you can.'

Meanwhile, crewmates Bea and Adrian attend an 82-year-old male who has fallen at home. They’re greeted by the patient’s wife, who is relieved to see the crew arrive to help her husband. After climbing several flights of stairs, they find the patient on the floor in his bedroom, unable to get up. It’s the first time the patient has fallen, and the incident serves as a difficult reminder to his family that he is getting older.

Omar and Kez are three miles away. They find a 72-year-old female patient, struggling with shortness of breath. The patient is on palliative care and wants to die at home but requires urgent treatment. The crew are understanding of the patient and family’s wishes but express the importance of hospital care. After some encouragement and reassurances from Omar, the patient agrees to go to hospital after all.

In the tactical operations centre, a call is received from Metropolitan Police with reports of a shooting in Clapham. As information comes in, Pete leads the team co-ordinating the response. With the number of patients unknown, he works quickly to send multiple resources to a rendezvous point where they will wait for the arrival of a police armed response vehicle. As he awaits news from the scene, Pete reflects: 'When you physically can’t see or feel the job, you’re forever questioning yourself, thinking, what have I missed?. You’ve got to make some really quick decisions. Seconds really matter. They add to patient care. They add up to saving lives.'

In Westminster, crewmates Kerry and Jim are dispatched to an elderly patient with suspected sepsis at the Park Lane Hotel in Piccadilly. The patient is visiting London from the Midlands and had plans to see a musical, which he’s sadly no longer able to do as the crew transport him quickly to hospital for further treatment.

As crews on scene at the shooting eventually stand down, Omar and Kez are working their magic again as they attend a 67-year-old patient who has fallen and is reluctant to seek further treatment at hospital, despite fears she may have suffered a stroke. After more words of reassurance from Omar, she relents and agrees to travel with them to hospital.

At the nerve centre of the London Ambulance Service, this episode follows the tense moments around decision making in the specialist tactical operations centre as they dispatch specialist resources to the highest category of calls. It also follows paramedic crews as they are sent to fewer critical incidents and instead experience how an ageing society is creating fresh challenges for the ambulance service.

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