In the thirteenth hour of the Pitt Fest mass casualty response, Pittsburgh Trauma Medical Hospital operates without functioning laryngoscopes, depleted blood supplies, or a neurosurgeon on-site. Robby and Abbot improvise a surgical airway with a personal tactical kit, Mohan drains a delayed intracranial hemorrhage using a bone-marrow drill, and Santos performs an unsupervised REBOA to stop a patient's pelvic hemorrhage. When Jake arrives outside triage with his girlfriend Leah, who has a bullet through her heart, Robby abandons triage logic to save her and fails. A SWAT team detains David Saunders at the hospital entrance under ambiguous circumstances, leaving his connection to the shooting unresolved.

Leah's death closes Robby's thirteen-hour shift with a personal loss layered over the cumulative weight of every patient who died during the event. His breakdown — reciting the dead to Jake, then catching himself in a moment of cruelty — reframes the season's central question about what prolonged trauma does to the people delivering care. Santos's unsupervised REBOA, contrasted against her near-fatal mistake in episode five, completes her arc and raises the show's ongoing tension between institutional hierarchy and clinical necessity.