[This story contains major spoilers for the season premiere of CBS' Survivor: David vs. Goliath.]

Everyone enters Survivor understanding their time in the game will likely end before the final 39th day, but nobody could have anticipated the way in which the new season's opening round would send off the first one out: not through a vote at Tribal Council, but through a medical emergency.

The closing moments of the Survivor: David vs. Goliath season premiere pulled back the curtain on how the veteran CBS reality franchise operates, in harrowing fashion. Filmed in the Mamanuca Islands of Fiji, Survivor is shot across several closely clustered islands, necessitating transportation by boat for castaways and crew. Following their loss at the first immunity challenge, the David tribe boarded a boat to take them back to their camp on an island roughly 15 miles across the sea from the site of the challenge. Mere minutes into that trip, the David tribe's boat encountered rough waters, due to the turbulent weather conditions brought on by Tropical Cyclone Josie, a storm that claimed at least four lives in Fiji in early April.

During the ride, the David tribe's boat encountered a particularly bumpy stretch of sea, resulting in an impact that left property manager Pat Cusack with a back injury. His pain was severe enough that the boat turned around and returned to the challenge beach. There, Pat was treated by the Survivor medical team, a group led by Dr. Joe Rowles. Shortly after inspecting Pat, the medical team ruled the possible extent of his injury would require examination at a hospital — a decision that would necessitate his removal from the season. Despite protesting through the pain, Pat was pulled from the game.

Listen to the full story of Pat's evacuation in the final episode of "First One Out," in the player below.