Update, 6:18pm: NSW Police report a man driving a ute involved in Friday's fatal two-car crash at Piora is in critical condition.
Early accounts by police at the scene indicated the 28-year-old received only minor injuries in the head-on collision, but as of 1.20am Saturday he was at Lismore Base Hospital in critical care.
A man police believe to be aged in his 50s, driving a Holden sedan, died at the scene.
His front passenger, a 39-year-old woman, was in a serious, but stable, condition on Saturday morning, while a three-year-old girl in the back seat was stable.
The front passenger in the Ford ute, a 21-year-old man, received only minor injuries and was treated at Lismore Base Hospital.
Meanwhile, officers from the North Coast Crash investigation Unit are continuing their investigations into the collision west of Casino and are appealing for assistance.
They ask anyone who witnessed the incident, or events leading up to it, to call CrimeStoppers on 1800 333 000.
Initial report: A MAN died and a child and woman were seriously injured following a high-speed head-on crash on the Bruxner Hwy at Piora, west of Casino, yesterday afternoon.
Richmond police Inspector Mick Dempsey said the crash occurred about 2.45pm when a white Ford Ranger ute travelling east collided with a Holden wagon travelling west.
The man driving the Holden died at the scene, while the woman in the passenger seat and child in the backseat, whose injuries are not life-threatening, were taken to Gold Coast Hospital by a Careflight helicopter.
A large contingent of emergency services workers and vehicles were at the scene, including the NSW Volunteer Rescue Association, who initially had to free the trapped woman from the wreck.
The two men travelling in the Ford ute received only minor injuries and were to undergo mandatory blood and urine testing.
Insp Dempsey said police received reports the Ford Ranger had overtaken a number of vehicles on the predominately single lane road leading up to the crash.
He was unable to confirm whether excessive speed was a factor, but the cars involved were twisted tightly together and largely unrecognisable after the fact, indicating considerable force behind the collision.
At 5.30pm the highway east to Casino was open, but slowed, while westbound traffic was still sitting at a standstill.
The death of the man brings the Northern Rivers' road toll to 25 since the start of the year.