Glenn is having a rough morning: no matter how hard he tries, Nancy ignores him and instead she intently reads a mysterious letter. Meanwhile, during a softball game, things get heated between the pitcher and the players. Suddenly, the batter hits the ball right into the pitcher's face. Nancy and Glenn are called to the scene.
While en route to the trauma scene, Nancy tries to tell Glenn which way to go, but he claims he knows which way is faster. Suddenly and out of nowhere a bus slams into Glenn and Nancy's rig, causing it to flip over and leaving them both in need of medical attention.
Two hours earlier, Glenn wants to celebrate his and Nancy's 50th shift together. Rabbit has tickets to a basketball game and Tyler, Marisa, and Nancy all take one, but Glenn, a "probie," isn't invited.
Tyler and Boone pick up a homeless man, Ben, on their shift. Ben was walking in the middle of the road and trying to conduct an imaginary orchestra. Tyler and Boone take Ben into their rig, where Ben relentlessly throws a pillow in Boone's face. Although Tyler is thoroughly enjoying this, Boone orders him to pull the ambulance over so Boone can switch places with him. However, Tyler is having a blast singing with Ben in the back.
At the hospital Glenn aggressively pursues Nancy. While Glenn grabs sheets, he finds Diana in the back eating her patient's food. Glenn and Diana bond over both being new and not getting the respect they deserve. Being new sucks. Meanwhile, Dr. Joe hands Nancy the letter she was reading right before the accident. He has written a letter of recommendation for her to do a residency.
Back to present time, and Nancy and Glenn are severely injured inside their rig. Nancy is more concerned about Glenn's status than her own, although there is a big gash on her head. Nancy calls in the accident; besides she and Glenn, there are other people injured in the bus and in a taxicab.
Tyler is having a blast with Ben when Boone gets the call about Nancy's accident. When Tyler and Boone find out Nancy's rig was in the accident, they immediately put on their serious faces. Rabbit demands to fly the helicopter before its completely fueled; as long as it can get them to the scene of the accident and back, he doesn't care.
Tyler and Boone are the first to show up and Tyler runs to Nancy, however Boone checks out the other injured people who are in the cab and on the bus. Glenn tells Tyler that Nancy is in pretty bad shape, and she isn't responding to Tyler's questions. Boone orders Tyler to help him with the other crash victims because it's protocol. Tyler can't believe it, but he has to listen to Boone's orders. Nancy tells Tyler to follow Boone's orders, but it's apparent that she is in pain.
Tyler gets on the bus and begins to treat the victims with Boone. The fire department quickly comes and Tyler continues to keep an eye on Nancy's rig. When the rescue team tries to get Nancy and Glenn out of the rig, Boone stops them and tells them that the guy in the cab is in worse condition. Boone must again separate himself from his emotions and follow protocol, but Nancy's life may be in danger.
Meanwhile, at the hospital, Dr. Joe orders Diana to place both Glenn and Nancy in his care, even though there are over 30 injuries coming to them. Nancy's father, Dr. Lyndon Carnahan is at the hospital and can only sit and wait for his daughter to arrive. Dr. Joe does his best to set Lyndon's mind at ease.
Back at the scene, paramedics work on Glenn and Nancy. Glenn says his neck is fine, but Nancy is in pain, and she thinks she broke a few ribs. Ben, the homeless man, leaves Tyler's rig. Glenn is taken out of the rig and Nancy directs the paramedic to the pain in her stomach. Rabbit runs in for the rescue and tells Nancy that she has "hot belly," which means she probably has a ruptured spleen and doesn't have much time.
Rabbit rushes Nancy to the helicopter. En route to the hospital Nancy begins to lose her eyesight and she panics. Rabbit does his best to console her and gives her morphine for the pain, which knocks her out. Dr. Joe and Lyndon are there to bring Nancy to surgery.
Diana checks on Glenn, and he says he's fine, but seems completely shaken up. Diana also says that Glenn's head injury should be okay pending a CT scan. However, Glenn is more concerned about who was at fault for the accident. Meanwhile, Marisa wants to know if Rabbit can continue working after seeing Nancy in critical condition. Rabbit says he can and Marisa takes his word for it.
Diana checks on Lyndon, Nancy's dad. Lyndon finds the letter Dr. Joe wrote for Nancy and begins to read it. Rabbit and Marisa arrive on scene to a call. There is a slightly obese man sitting on the beach, eating a burger. Apparently the man believed he was having a heart attack, but it turned out to be heartburn. Rabbit is irritated and forces the man to undergo procedure. Rabbit scolds the man for his diet and starts to shove food down his throat, topping it off by pouring soda over the man's head. Marisa runs to break it up.
To Lyndon's surprise, Dr. Joe scrubs in during Nancy's surgery. Suddenly, Nancy begins to massively bleed from the spleen. Dr. Joe knows they need to get her more blood. Once the blood loss is stabilized, the surgeons continue to work on Nancy. Dr. Joe is obsessive with every move the surgeon makes and Lyndon watches with a careful eye. The surgery is finally complete and the surgeons sew up Nancy.
Marisa will not work with Rabbit anymore today. What he did to the obese man was unacceptable and against code. Marisa tells Rabbit he's grounded and to go to the hospital to check on Nancy. Meanwhile, Tyler and Boone are having troubles of their own. Tyler tells Boone that they almost lost Nancy because Boone followed protocol. The captain tells Boone he did the right thing, but if Nancy's not okay, Boone's going to feel "a hell of a lot worse."
Glenn finds Rabbit at the local bar, drinking alone. Glenn is being made to take a drug test and is under investigation. He blames himself for the accident even though Rabbit tells him it's not. However, Rabbit is far from calm. He tells Glenn that in the three years he drove with Nancy, he never had to worry about her, until today. When Rabbit gets up in Glenn's face, Glenn collapses. Rabbit, who is drunk, needs to walk a sober paramedic through the procedures to help Glenn.
At the hospital, Diana claims the radiologist reported that everything looked fine with Glenn's head injury, but her attending physician teaches her a lesson about who should have the final say in a patient's care. Glenn tells Diana another thing about being new that sucks is all the mistakes they make.
After Nancy's surgery, Lyndon confronts Dr. Joe about the letter of recommendation. Lyndon believes that Dr. Joe is in love with Nancy. At first Dr. Joe laughs this off, but Lyndon wants to know, since Dr. Joe is not Nancy's father or supervisor or boyfriend, what is he getting at by writing such an emotional, gushing letter? Lyndon tells Dr. Joe that he will take the letter as misplaced paternal pride, because anything else would be unacceptable.
Tyler and Boone are out looking for Ben and Tyler confronts Boone about what happened today. Boone says that no one wants to lose a partner and if anything like that happened to Tyler, Boone would lose it. Just then, they find Ben, composing his very own imaginary orchestra.
Glenn visits Nancy after her surgery. They both are beat up, but in good spirits. Rabbit visits with Nancy as well and apologizes to Glenn. Rabbit makes Nancy promise not to scare him like that again. Tyler, Boone, Marisa and Diana all rush in and bring pizza to the Nancy recovery party. After a trying and emotional day, the response team is able to enjoy themselves for the first time.