An elderly man has been airlifted to Royal North Shore Hospital in a stable but serious condition.
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NSW Ambulance Inspector Norm Rees said a 78-year-old man was trapped after crashing his car into an embankment and travelling over the seawall at Belmore Basin.
He said the man's 75-year-old wife had been extricated from the vehicle and transported to Wollongong Hospital with "minor aches and pains".
Police and ambulance - including a rescue helicopter - were called to the scene after the accident, which happened around 5.30pm.
A rescue operation was required to remove the driver from a car after he crashed it over the seawall.
Insp Rees added it looked like the elderly driver had hit the accelerator rather than the brake.
"They have gone over the pier and gone about three metres in the vehicle."