Episode 4 is the 1096th episode of Casualty and the fourth episode of the 33rd series. It was preceded by Episode 3 and followed by Episode 5. The episode was directed by Thomas Hescott and written by Jeff Povey.
At Sam's funeral, Dylan interrupts Iain's speech and blames him for her death. As Dylan throws himself into work, Iain ponders whether or not he has a point. However, his self-loathing soon turns to anger and he confronts him outside the ED. When Dylan tells him that Sam deserved much better than him, he punches him and knocks him to the ground. After Jan pulls him away, Iain declares that he is not going to his tribunal.
At the ambulance station, Iain finds a young boy, who has run away from the children's ED, hiding under a table. He coaxes him out, but he suddenly has a seizure. Iain carries him to resus, where he receives praise for his quick thinking, and decides to attend his tribunal. He acknowledges that he will be haunted by his mistake for the rest of his life, but he also highlights the dire issues the service faces, such as a lack of backup and long waiting times, and asserts that he is needed on the team. At The Hope & Anchor, he reveals that he is allowed to keep his job. Ruby congratulates him and tells him that she is pleased that they're a team again, but Iain rebukes her and asserts that they're not a team.
Back at the ED, Alicia and Ethan treat a young boy named Leo who has been admitted with stomach pains. After they find bruises on his back, Ethan believes that he is being physically abused by his father. However, Alicia is sceptical and thinks that there is more to it. It later transpires that Leo has been starving himself.