Volunteer paramedics and firefighters with Orchard Farm (Mo.) Fire Protection District along with Rivers Point (Mo.) Fire Protection District work to extricate a woman who became trapped in her vehicle after it collided with a tree at high speed. The patient, who was semi-conscious during the extrication, suffered internal injuries and fractures, including an obvious femur fracture. St. Charles County (Mo.) Ambulance District Paramedic Supervisor Craig Boschert maintained C-spine immobilization from within the car and placed the patient on O via a non-rebreather. After she was extricated, the patient was trauma packaged and firefighter/paramedic Jeremy Hollrah secured a Sager splint on her leg. She was flown from the scene by ARCH Air Medical Service to a Level I trauma center in St. Louis.