The Australian who fell from a Phuket tuk-tuk has been transferred by air ambulance to Bumrungrad International Hospital in Bangkok for treatment for head injuries.
Zachary Wade Noble, 30, was seriously injured when he chose to hang from the rear of the local form of public transport while riding back to a resort.
He and his wife are thought to have caught the tuk-tuk after an evening in Patong's Soi Bangla walking street.
Kusoldharm Foundation paramedics treated the Australian after he was flung from the tuk-tuk about 9pm near the Otop shopping centre in Rat-U-Tit 200 Pi Road, not far from the Jungceylon shopping mall.
It is believed his wife was travelling with him. He fell as the tuk-tuk turned into a resort entranceway, Patong police said.
Mr Noble was first treated at Patong Hospital then transferred to the better-equipped Bangkok Hospital Phuket in Phuket City, on the other side of the island.
He was reported to be in a coma and undergoing treatment in the intensive care unit.
Large numbers of Australians visit Phuket at this time of the year, the low tourism season on Phuket but winter back home for many.