A man and a woman are at John Hunter Hospital in a stable condition following a car and truck crash on the Pacific Highway at Hexham.
At about 12.45pm on Thursday, NSW Ambulance responded to reports of the incident, sending six crews to the scene.
Paramedics treated a 63-year-old woman passenger for spinal, abdominal, pelvic and leg injuries, and a 66-year-old man for a fractured ankle and abdominal injuries.
The woman was transported to John Hunter Hospital by road in a serious but stable condition, with an aeromedical team meeting the crew on route to the hospital.
The man was also taken to John Hunter Hospital by road in a stable condition.
NSW Ambulance duty operations manager Inspector Joel De'Zuna said it was "a horrendous accident for everyone involved".
"When responding to any motor vehicle accident, particularly when a car and a truck is involved, you are never really sure how extensive the injuries are going to be," he said.
"Paramedics did a great job responding to the scene and treating the patients efficiently.
"This is a timely reminder for all road users to be vigilant, particularly when driving in wet weather conditions."