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Derek becomes the witness of serious a car accident on his way to the airport. The accident involved a sports car and a SUV. The occupants of the SUV (Sarah and Winnie) injuries did not appear life threatening. However those of Alana and Charlie who were the occupants of the sports car were serious. Derek helped to tend to their injuries until the ambulance arrived.
After the ambulance leaves Derek enters his car to leave and then gets hit by a trailer Truck. At the Dillard Medical Center ER where he was taken, he is found by Winnie who told doctor Edie his name and other information because Derek could not speak. Edie and Paul had a disagreement between getting a CT and going to the OR to stop internal bleeding. This ended turned out to be a deciding factor in Derek’s death.
After Hours of Surgery Derek Succumbs to his injuries. Sometime after arriving at the hospital and learning of what had taken place his wife Meredith makes the decision to take him off life support.