The drama of the BBC hospital had already teased that a character would die, but some fans did not see it coming.
While Sam Nicholls (played by Charlotte Salt) seemed to keep him together while doing his part in the rescue mission, things were not as they seemed.
Only at the station of the ambulance, Sam was suddenly taken by horrible pains and he saw himself tighten his part.
As she lifted her top, the paramedic exposed a horrible wound as it was revealed that she had a splinter in her liver.
Sam got on an 'ambulance because she was not able to move further, but was soon found by Iain Dean (Michael Stevenson).
"Sam, what happened?" He asked her before identifying her wound and the radio for backup: "wounded abdomen penetrated".
He tried to comfort Sam as he said, "Come on, stay calm and quiet, keep breathing, let me take some liquids, yes?"
But poor Iain could not find him on the ambulance, and Sam urged him not to leave his side.
"Iain, please do not leave me, please do not go, I'm afraid," he shouted.
"Do not be afraid," he said as Sam told him that his time had run out.
"Iain, it's too late," Sam declared as he struggled through his immense grief.
"It's not too late, what are you talking about?" He continues to look at me, keep talking, "Iain exclaimed frantically.
Iain tried desperately to revive his colleague, but it seemed like it would be too late.
The audio was attenuated as Iain clung to the lifeless body of his friend and colleague.
The devastated fans chose Twitter to express their sadness for Sam's heartbreaking fate.
"Naaah, Jeff, Cal, and now Sam, you can not make me this #Casualty," tweeted a fan.
Another complained: "Because he had to die #Successful #sam".
"# Casualty3006 No No No they did not just kill Sam in #Casualty …. @ charlottesalt will miss you a lot … best actress and character of always xx", added a third.
The victim continues on Saturday on BBC One.