Orland (Ind.) Community Volunteer Fire Department was dispatched to a semi-versus-bridge incident, where bystanders had reported being unable to find the driver. A loaded semi had struck the bridge at road speed, and the arriving crews found the driver pinned behind a bridge support. Additional extrication tools and manpower were requested from Fremont Fire Department. Crews coordinated the extrication process from both sides of the support. The only visible parts of the patient’s body were his feet, which were sticking out from the front of the semi. He remained conscious and alert during the 45-minute extrication. Because the large stones and steep embankment made moving the patient difficult, a ladder was used on the embankment for more efficient patient transfer via a Stokes basket to the roadway. Steuben County EMS provided patient care and transported the patient to a trauma center via a Parkview Hospital Samaritan helicopter.