One man was last night critically ill and in hospital on life-support with multiple injuries as a result of a head-on crash on the expressway near Westshore.
Another man was also in a hospital ward after being treated for leg injuries and bruising following the Tuesday night incident.
Hawke's Bay road policing Acting Sergeant Taina Puketapu, of Napier, said the two were the only occupants of the vehicles in the crash which happened on the expressway's Ahuriri Estuary Bridge northern approach soon after 9.15pm.
It involved a northbound Toyota Hiace van and a southbound Mazda car. Police are investigating the possibility the car crossed the centre-line into the path of the van, and whether the car driver had been drinking.
Aged 27 and understood to be from Napier, the car driver was thought to have been travelling from a girlfriend's in Bay View to feed his dog at home, sources said at the scene.
He was cut out of the wreckage by fire service crews, given intensive treatment by St John Ambulance paramedics and rushed to Hawke's Bay Hospital in Hastings for emergency surgery.
Fire Service Napier senior station officer Mark McGill said the roof of the car had to be peeled back and a pedal cut out to enable the man to be extricated as ambulance staff worked to save his life.
"They were working pretty hard on him, and they certainly wanted him out of there fairly urgently," he said.
He was surprised the van driver, aged 33 and also from Napier, wasn't more seriously injured.
The man was out of the vehicle by the time emergency services arrived but collapsed at the scene and was taken to hospital with leg injuries, bruising and other injuries.
The crash ended with the van balanced on the railing of the bridge approach. Its rear was suspended above the estuary in a position similar to that in which a van stopped after a crash on the expressway's Tutaekuri River bridge near Taradale three years ago, when two young men died after being thrown on to the riverbed below.