Like most Silent Hill games, Silent Hill: Homecoming opens up in dramatic fashion with little description of just what's happening on screen. The game begins to the sound of combat and a nearby explosion that quickly fades to the first-person view of the protagonist Alex Shepherd. Lying down on a gurney, Alex realizes he is strapped down and starts to struggle while asking the strange figure in bloody medical scrubs wheeling him down a dark hallway what is going on.
Referring to his squad, Alex asks if the other members made it through the explosion. Without getting an answer, Alex continues to look around, noticing some disturbing scenes in several other areas of the hospital as he is brought to an operating room.