Ryan Collins, 19, crashed on Highway 57 after 10 p.m. Sunday, but no one found him until 7:30 a.m. Monday.
"Temperatures weren't freezing last night, but it was in the 30s, the upper 30s probably, and I'm sure it was pretty uncomfortable night for him," Caldwell Fire Chief Andy Gates said.
A driver saw a tire in the creek and called 911. Gates' crew rushed to the scene, found the wreckage and found Collins.
"He was a little bit fuzzy, but like I said, it was just a miracle that the driver saw him and we were able to get him out," Gates said.
It is the fourth time Gates has seen someone drive off of Highway 57. He said he has asked the state for a guardrail to be installed after each wreck.
"Sometimes, it's hard to get something done like that. I'm sure there is a lot of places that need that type of work done, like I said, I hope maybe this will bring it to somebody else's attention," Gates said.
Collins is at Duke University Medical Center with non-life-threatening injuries. The highway patrol said he may have fallen asleep at the wheel, but charges are pending.
With 78,000 miles of highway, North Carolina has the second-largest, state-maintained highway system in the nation. According to the state Department of Transportation, each year the state spends $3 million repairing guardrails.
Last year, the state spent $7 million, installing rumble strips to help alert drowsy drivers to stay on the road.
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